VAGINAL INFECTIONS & ADVERSE BIRTH OUTCOMES: Findings from the 2004-2007 Mississippi PRAMS Kristin Z. Black, MPH UNC Gillings School of Global Public Health.

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Presentation transcript:

VAGINAL INFECTIONS & ADVERSE BIRTH OUTCOMES: Findings from the Mississippi PRAMS Kristin Z. Black, MPH UNC Gillings School of Global Public Health

STI Surveillance in the U.S.  19 million new cases of STIs every year  Chlamydia, Gonorrhea, & Syphilis are the only notifiable STIs reported to the CDC  Chlamydia is the most commonly reported STI  Young people ages 15-24, especially young women of color, are bearing the burden

Are vaginal infections (e.g., yeast, bacterial vaginosis, Chlamydia, Gonorrhea) associated with adverse birth outcomes (e.g., PTB, LBW) among Mississippi women after controlling for maternal factors? RESEARCH QUESTION:

1) Women who reported having vaginal infections during their most recent pregnancy are more likely to have experienced adverse birth outcomes (e.g. PTB, LBW) than women who did not report having vaginal infections. 2) The relationship between vaginal infections and adverse birth outcomes will be partially explained by maternal factors. HYPOTHESES:

Mississippi PRAMS  Ongoing, population- based surveillance system  57 core & 12 state questions  Oversample VLBW infants  Phase V: 2004, 2006, & 2007  n = 3535  years old

Characteristics of Survey Participants CharacteristicUnweighted CountPercent (%) Race/Ethnicity Black/non-Hispanic % White/non-Hispanic % Age (years) ≤ % % % % Education Level Less than high school % High school % Greater than high school %

Characteristics of Survey Participants CharacteristicUnweighted CountPercent (%) Body Mass Index (BMI) < % % % % % Marital Status Not married or other % Married % Hypertensive Disorder Hypertensive % Normotensive %

Characteristics of Survey Participants CharacteristicUnweighted CountPercent (%) Initiation of Prenatal Care 1 st trimester % 2 nd trimester % 3 rd trimester381.10% None631.83% Tobacco Use 10+ cigarettes/day % 1-9 cigarettes/day % 0 cigarettes/day %

Characteristics of Survey Participants

Participants with Vaginal Infections by Outcome Variables

Logistic Regression Models Table 3 – Logistic Regression Modeling for Vaginal Infections and Adverse Birth Outcomes MODEL 1MODEL 2MODEL 3 Gestational Age Vaginal Infections Birthweight Vaginal Infections Gestational Age Vaginal Infections + Race/Ethnicity Vaginal Infections + Age Vaginal Infections + BMI Vaginal Infections + Education Level Vaginal Infections + Marital Status Vaginal Infections + Initiation of PNC Vaginal Infections + Tobacco Use Vaginal Infections + Hypertensive Disorder Birthweight (Same as above) Gestational Age Vaginal Infections + ALL Variables Birthweight Vaginal Infections + ALL Variables

Analyzing Risk

Strengths + Limitations STRENGTHS  Population-based sample  34% of the population had vaginal infections LIMITATIONS  Self-reported data  Low response rate in 2005 & 2007  Write-Ins

Conclusion + PH Implications  Both of my hypotheses were confirmed, yet the ORs were close to 1.00  Vaginal infection treatment during pregnancy hasn’t been shown to improve birth outcomes  Women should be screened and treated for STIs prior to becoming pregnant  Imperative that women receive preconception and preventive care throughout their lifecourse

Acknowledgements

References (1) Centers for Disease Control and Prevention. Sexually Transmitted Diseases in the United States, 2008: national surveillance data for Chlamydia, Gonorrhea, and Syphilis Nov:1-7. (2) Cotch MF, Pastorek JG2, Nugent RP, Hillier SL, Gibbs RS, Martin DH, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. Sex.Transm.Dis Jul;24(6): (3) Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N.Engl.J.Med Dec;333(26): (4) Andrews WW, Goldenberg RL, Mercer B, Iams J, Meis P, Moawad A, et al. The Preterm Prediction Study: association of second- trimester genitourinary chlamydia infection with subsequent spontaneous preterm birth. Obstet.Gynecol. 2000;183(3): (5) Blas MM, Canchihuaman FA, Alva IE, Hawes SE. Pregnancy outcomes in women infected with Chlamydia trachomatis: a population- based cohort study in Washington State. Sex.Transm.Infect Jul;83(4): (6) Johnson HL, Ghanem KG, Zenilman JM, Erbelding EJ. Sexually Transmitted Infections and Adverse Pregnancy Outcomes Among Women Attending Inner City Public Sexually Transmitted Diseases Clinics. Sex.Transm.Dis Sep 16;37(12):1-5. (7) Mann JR, McDermott S, Gill T. Sexually transmitted infection is associated with increased risk of preterm birth in South Carolina women insured by Medicaid. J.Matern.Fetal.Neonatal Med Jun;23(6): (8) Andrews WW, Klebanoff MA, Thorn EA. Midpregnancy genitourinary tract infection with Chlamydia trachomatis: association with subsequent preterm delivery in women with bacterial vaginosis and Trichomonas vaginalis. Obstet.Gynecol. 2006;194(2): (9) Silveira MF, Ghanem KG, Erbelding EJ, Burke AE, Johnson HL, Singh RH, et al. Chlamydia trachomatis infection during pregnancy and the risk of preterm birth: a case-control study. Int.J.STD AIDS 2009 Jul;20(7): (10) Riggs MA, Klebanoff MA. Treatment of vaginal infections to prevent preterm birth: a meta-analysis. Clin.Obstet.Gynecol Dec;47(4): (11) O'Brien RF. Bacterial vaginosis: many questions--any answers? Curr.Opin.Pediatr Aug;17(4): (12) Carey JC, Klebanoff MA. What have we learned about vaginal infections and preterm birth? Semin.Perinatol Jun;27(3):

QUESTIONS???