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

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Abstract

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 (I2 = 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.

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Acknowledgements

We would like to acknowledge reference librarian Angela Dixon for her assistance with the development of the search strategy.

Funding

The authors received no funding for the completion of this systematic review.

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Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Strong Memorial Hospital, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY, 14642, USA

    Courtney Olson-Chen

  2. Northeast Ohio Medical University, 4209 OH-44, Rootstown, OH, 44272, USA

    Kripa Balaram

  3. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    David N. Hackney

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  1. Courtney Olson-Chen
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  2. Kripa Balaram
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Contributions

COC and KB conducted the systematic review and extracted the data. DNH conducted the statistical analyses. COC and DNH drafted the article and all authors contributed, read and approved the final manuscript. COC, KB and DNH had full access to all the data in the study and had final responsibility for the decision to submit to publication.

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Correspondence to Courtney Olson-Chen.

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Not applicable as this is a systematic review of prior studies with no direct collection of patient data.

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Olson-Chen, C., Balaram, K. & Hackney, D.N. Chlamydia trachomatis and Adverse Pregnancy Outcomes: Meta-analysis of Patients With and Without Infection. Matern Child Health J 22, 812–821 (2018). https://doi.org/10.1007/s10995-018-2451-z

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