Burdette Emily R, Young Marisa R, Dude Carolynn M, Wall Kristin M, Haddad Lisa B
From the Department of Gynecology and Obstetrics, Emory University School of Medicine.
Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA.
Sex Transm Dis. 2021 Dec 1;48(12):925-931. doi: 10.1097/OLQ.0000000000001490.
Treating chlamydia and gonorrhea in pregnancy has been shown to decrease the associated risk of preterm birth in some studies. Delayed treatment of these infections among nonpregnant patients carries known consequences. It is unclear whether delayed treatment in pregnancy similarly increases adverse outcomes.
We conducted a retrospective cohort study of women who delivered at a safety-net hospital from July 2016 to June 2018. Women with at least one visit who were tested for chlamydia and gonorrhea were included. Women diagnosed after 36 weeks (preterm analysis) or 31 weeks (early preterm analysis) were excluded. We used multivariable logistic regression to examine the association between no infection, timely treatment (<1 week), and delayed treatment (>1 week, not treated) with preterm (<37 weeks) and early preterm (<32 weeks) birth.
Among 3154 deliveries, 389 (12%) were preterm. Among 3107 deliveries, 74 (2%) were early preterm. In adjusted models, women with timely (adjusted odds ratio [aOR]; 1.7, 95% confidence interval [CI], 1.0-2.7) and delayed (aOR, 1.7; 95% CI, 1.1-2.5) treatments had increased odds of preterm birth. Similarly, women with timely (aOR, 2.5; 95% CI, 1.0-6.2) and delayed (aOR, 2.4; 95% CI, 1.2-4.9) treatments had increased odds of early preterm birth. Among women who tested positive, multiple infections were not associated with an increase in preterm birth (preterm: 17% vs. 20%, P = 0.53; early preterm: 5% vs. 6%, P = 0.74).
Chlamydia and gonorrhea are associated with preterm and early preterm births, regardless of time to treatment. Creative solutions are needed to improve the prevention of these infections in pregnancy.
一些研究表明，孕期治疗衣原体感染和淋病可降低早产的相关风险。非孕期患者延迟治疗这些感染会带来已知的后果。目前尚不清楚孕期延迟治疗是否同样会增加不良结局的发生风险。
我们对2016年7月至2018年6月在一家安全网医院分娩的女性进行了一项回顾性队列研究。纳入至少有一次衣原体和淋病检测的女性。排除在36周后（早产分析）或31周后（早期早产分析）诊断出感染的女性。我们使用多变量逻辑回归分析未感染、及时治疗（<1周）和延迟治疗（>1周，未治疗）与早产（<37周）和早期早产（<32周）之间的关联。
在3154例分娩中，389例（12%）为早产。在3107例分娩中，74例（2%）为早期早产。在调整模型中，及时治疗（调整后的优势比[aOR]；1.7，95%置信区间[CI]，1.0 - 2.7）和延迟治疗（aOR，1.7；95% CI，1.1 - 2.5）的女性早产几率增加。同样，及时治疗（aOR，2.5；95% CI，1.0 - 6.2）和延迟治疗（aOR，2.4；95% CI，1.2 - 4.9）的女性早期早产几率增加。在检测呈阳性的女性中，多重感染与早产增加无关（早产：17%对20%，P = 0.53；早期早产：5%对6%，P = 0.74）。
无论治疗时间如何，衣原体感染和淋病都与早产和早期早产有关。需要创新解决方案来改善孕期这些感染的预防。
