Chlamydia trachomatis and Adverse Pregnancy Outcomes: Meta-analysis of Patients With and Without Infection

• Published in: Maternal and child health journal Vol. 22; no. 6; pp. 812 - 821
• Main Authors: Olson-Chen, Courtney, Balaram, Kripa, Hackney, David N.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2018; Springer; Springer Nature B.V
• Subjects: Adult; Chlamydia; Chlamydia infections; Chlamydia Infections - diagnosis; Chlamydia Infections - epidemiology; Chlamydia Infections - microbiology; Chlamydia trachomatis; Complications and side effects; Development and progression; Female; Fetal Membranes, Premature Rupture - epidemiology; Gynecology; Health risk assessment; Heterogeneity; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Small for Gestational Age; Infections; Maternal and Child Health; Medicine; Medicine & Public Health; Meta-analysis; Neonatal diseases; Nucleic acids; Obstetric Labor, Premature - epidemiology; Pediatrics; Physiological aspects; Population Economics; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - microbiology; Pregnancy Outcome - epidemiology; Premature Birth; Public Health; Risk factors; Sexually transmitted diseases; Sociology; STD; Studies; United States; Pregnancy outcomes; Perinatal infection; Preterm birth; Chlamydia trachomatis
• ISSN: 1092-7875; 1573-6628; 1573-6628
• DOI: 10.1007/s10995-018-2451-z

Objectives We conducted a meta-analysis to determine the association between Chlamydia trachomatis and adverse perinatal outcomes. Methods Electronic databases were searched between 1970 and 2013. Included studies reported perinatal outcomes in women with and without chlamydia. Summary odds ratios were calculated using fixed- and random-effects models. Study bias was assessed using a Funnel Plot and Begg’s test. Results Of 129 articles identified, 56 studies met the inclusion criteria encompassing 614,892 subjects. Chlamydia infection in pregnancy was associated with preterm birth (OR = 1.27, 95% CI 1.05, 1.54) with a large quantity of heterogeneity ( I 2  = 61%). This association lost significance when limiting the analysis to high-quality studies based on the Newcastle–Ottawa Scale. Chlamydia infection in pregnancy was also associated with preterm premature rupture of membranes (OR = 1.81, 95% CI 1.0, 3.29), endometritis (OR 1.69, 95% CI 1.20, 2.38), low birthweight (OR 1.34, 95% CI 1.21, 1.48), small for gestational age (OR 1.14, 95% CI 1.05, 1.25) and intrauterine fetal demise (OR 1.44, 95% CI 1.06, 1.94). Conclusions This review provides evidence that chlamydia in pregnancy is associated with a small increase in the odds of multiple adverse pregnancy outcomes. The literature is complicated by heterogeneity and the fact that the association may not hold in higher quality and prospective studies or those that use more contemporary nucleic acid testing.