| Objectives. A primary goal of STI detection and treatment is to prevent adverse pregnancy outcomes (APOs). We sought to test the association of STIs and APOs (preterm birth and low birth weight) among pregnant women who sought STD clinical services.; Methods. We conducted a case-control study of pregnant women ages 13-49 who attended STD clinics in Baltimore, MD during 1996-2002 and were tested for bacterial vaginalis (BV), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), early syphilis (ES), and Trichomonas vaginalis (TV). We linked STD clinic data with state birth records to test the association of STIs and APOs. Cases were women who delivered preterm and/or low birth weight newborns and were compared with controls using multiple logistic regression.; Results. Among 1531 pregnant women, 767 (50%) had singleton births with post-natal data available. There was a 23% prevalence of APOs (6.9% preterm birth; 4.2% low birth weight, and 11.9% preterm birth and low birth weight). 97% of pregnant women were African American (mean age = 22.3); 39% reported prior spontaneous or elective termination of pregnancy, and 60.1% of women reported at least 1 antenatal care visit in the 1st trimester of pregnancy. Prevalence of maternal infection was 54.7% (BV: 30.5%; CT: 14.0%; NG: 7.3%; TV: 14.7%; ES: 0.8%). Adjusting for age and maternal weight gain during pregnancy, CT in the 1st trimester of pregnancy was associated with term delivery of a low birth weight newborn (aOR=3.44, CI 1.09-10.82, p=0.04). NG, diagnosed any time in pregnancy, was associated with preterm delivery of a normal birth weight newborn (aOR=2.50, CI 1.03-6.06, p=0.04), adjusting for age, medical factors in pregnancy, and history of NG infection.; Conclusions. STIs and APOs were prevalent among pregnant STD clinic attendees. Prospective studies designed to further elucidate the relationship of STIs and APOs are needed. The STD clinic visit may represent a critical opportunity to target interventions that will improve perinatal outcomes. Future interventions should include: enhanced counseling messages and case management, including follow-up care, and referral to substance abuse rehabilitation and antenatal care programs. |
