Preconception Chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes.

IF 6.6 1区医学 Q1 OBSTETRICS & GYNECOLOGY Fertility and sterility Pub Date : 2024-12-17 DOI:10.1016/j.fertnstert.2024.12.017

Yajnaseni Chakraborti, Stefanie N Hinkle, Jørgen Skov Jensen, Catherine L Haggerty, Toni Darville, Sunni L Mumford, Enrique F Schisterman, Robert M Silver, Brandie DePaoli Taylor

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Abstract

Objective: 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.

Design: Preconception cohort study conducted using data and specimens from the Effects of Aspirin in Gestation and Reproduction (EAGeR) study - a randomized placebo-controlled trial.

Subjects: 1228 individuals with proven fecundity and a history of 1-2 pregnancy losses.

Exposure: Preconception C. trachomatis seropositivity determined using an ELISA based synthetic peptide assay at baseline.

Main outcome measures: Time-to pregnancy (fecundability) was defined as number of menstrual cycles to β-hCG-detected pregnancy; live birth status was determined from medical record abstraction; pregnancy loss was defined as any loss post positive β-hCG test.

Results: 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 (RR: 0.77, 95% 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 (FOR: 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.

Conclusions: 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, as this may identify treatments to improve outcomes among those with a history of infection.

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研究目的研究孕前沙眼衣原体血清阳性对受孕率、活产率和妊娠失败的影响，并评估低剂量阿司匹林治疗（81 毫克/天）对活产率和妊娠失败的影响：设计：利用阿司匹林对妊娠和生殖的影响（EAGeR）研究--一项随机安慰剂对照试验--的数据和标本进行孕前队列研究：受试者：1228 名已证实有生育能力并有过 1-2 次妊娠失败史的人：受试者：1228名经证实有生育能力且曾有过1-2次妊娠失败史的受试者。暴露：在基线时使用基于ELISA的合成肽检测法确定孕前沙眼衣原体血清阳性：主要结果测量指标：妊娠时间（受孕率）定义为检测到β-hCG妊娠的月经周期数；活产情况根据病历摘要确定；妊娠损失定义为β-hCG检测阳性后的任何损失：调整混杂因素（基线人口统计学和生育史变量）后，沙眼衣原体血清阳性（n=134/1228，11%）与活产可能性降低（RR：0.77，95% CI：0.59，0.99）和妊娠损失风险增加（RR：1.16，95% CI：1.04，1.29）有关，但与受精率无关（FOR：0.92，95% CI：0.71，1.20）。在沙眼衣原体血清反应蛋白水平≥1.95但≤10 mg/L的慢性炎症患者中（n = 50/134，37.3%），小剂量阿司匹林治疗可提高活产率（RR：1.68，95% CI：0.96，2.92）并降低妊娠损失风险（RR：0.83，95% CI：0.65，1.10）。然而，样本量降低了精确度：结论：有过妊娠失败史的妇女之前接触过沙眼衣原体可能会影响妊娠失败的风险。我们的研究结果表明，今后有必要对沙眼衣原体可能影响长期生殖功能的机制进行研究，因为这可能会找出改善有感染史的妇女预后的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Fertility and sterility 医学-妇产科学

CiteScore

11.30

自引率

6.00%

发文量

1446

审稿时长

31 days

期刊介绍： Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.