Chakraborti Yajnaseni, Hinkle Stefanie N, Jensen Jørgen Skov, Haggerty Catherine L, Darville Toni, Mumford Sunni L, Schisterman Enrique F, Silver Robert M, Taylor Brandie DePaoli
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Fertil Steril. 2025 Jun;123(6):1072-1081. doi: 10.1016/j.fertnstert.2024.12.017. Epub 2024 Dec 18.
To study the impact of preconception Chlamydia trachomatis seropositivity on fecundability, live birth, and pregnancy loss and to assess the effect of low-dose aspirin therapy (81 mg/day) on live birth and pregnancy loss.
Preconception cohort study conducted using data and specimens from the Effects of Aspirin in Gestation and Reproduction study-a randomized placebo-controlled trial.
A total of 1,228 individuals with proven fecundity and a history of 1-2 pregnancy losses.
Preconception C. trachomatis seropositivity determined using an enzyme-linked immunoabsorbent assay-based synthetic peptide assay at baseline.
Time-to pregnancy (fecundability) was defined as number of menstrual cycles to beta human chorionic gonadrotropin-detected pregnancy; live birth status was determined from medical record abstraction; pregnancy loss was defined as any loss post positive beta human chorionic gonadrotropin test.
After adjusting for confounders (baseline demographic and reproductive history variables), C. trachomatis seropositivity (n = 134/1228, 11%) was associated with a reduced live birth likelihood (relative risk [RR]: 0.77, 95% confidence interval [CI]: 0.59, 0.99) and an increased risk of pregnancy loss (RR: 1.16, 95% CI: 1.04, 1.29), but was not associated with fecundability (fecundability odds ratio: 0.92, 95% CI: 0.71, 1.20). Among a subset of C. trachomatis seropositive individuals with chronic inflammation indicated by increased C-reactive protein levels ≥1.95 but ≤10 mg/L (n = 50/134, 37.3%), low-dose aspirin therapy improved live birth rates (RR: 1.68, 95% CI: 0.96, 2.92) and reduced the risk of pregnancy loss (RR: 0.83, 95% CI: 0.65, 1.10). However, the sample size reduced precision.
Prior exposure to C. trachomatis among women with a history of pregnancy loss may impact risk of pregnancy loss. Our results indicate the need for future studies exploring mechanisms by which C. trachomatis may influence long-term reproductive function, because this may identify treatments to improve outcomes among those with a history of infection.
研究孕前沙眼衣原体血清学阳性对受孕能力、活产及妊娠丢失的影响，并评估低剂量阿司匹林治疗（81毫克/天）对活产及妊娠丢失的作用。
采用来自“阿司匹林在妊娠和生殖中的作用”研究的数据和标本进行的孕前队列研究——一项随机安慰剂对照试验。
总共1228名已证实具有生育能力且有1 - 2次妊娠丢失史的个体。
在基线时使用基于酶联免疫吸附测定的合成肽测定法确定孕前沙眼衣原体血清学阳性。
受孕时间（受孕能力）定义为月经周期数至检测到β人绒毛膜促性腺激素阳性的妊娠；活产状态通过病历摘要确定；妊娠丢失定义为β人绒毛膜促性腺激素检测阳性后的任何丢失。
在对混杂因素（基线人口统计学和生殖史变量）进行调整后，沙眼衣原体血清学阳性（n = 134/1228，11%）与活产可能性降低（相对风险[RR]：0.77，95%置信区间[CI]：0.59，0.99）和妊娠丢失风险增加（RR：1.16，95% CI：1.04，1.29）相关，但与受孕能力无关（受孕能力优势比：0.92，95% CI：0.71，1.20）。在沙眼衣原体血清学阳性且C反应蛋白水平升高表明存在慢性炎症的亚组中（C反应蛋白水平≥1.95但≤10毫克/升，n = 50/134，37.3%），低剂量阿司匹林治疗提高了活产率（RR：1.68，95% CI：0.96，2.92）并降低了妊娠丢失风险（RR：0.83，95% CI：0.65，1.10）。然而，样本量降低了精确性。
有妊娠丢失史的女性既往暴露于沙眼衣原体可能会影响妊娠丢失风险。我们的结果表明未来需要开展研究探索沙眼衣原体可能影响长期生殖功能的机制，因为这可能有助于确定改善有感染史者结局的治疗方法。
