Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia.

Kristina Adachi,Karin Nielsen-Saines,Jeffrey D Klausner

doi:10.1155/2016/9315757

Kristina Adachi, Karin Nielsen-Saines + Show 1 more

Open Access

https://doi.org/10.1155/2016/9315757

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Abstract

Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia.

Highlights

Others have recovered C. trachomatis from the amniotic fluid and fetal lung and liver tissue from women suffering pregnancy loss with intact membranes [86, 106, 115]. Another retrospective study found that women with chlamydial infection prior to birth were at higher risk for stillbirth [116]
In one of the HIV Prevention Trials Network (HPTN) 040 substudies of 1373 HIV-infected pregnant women, the rates of HIV Mother-to-Child Transmission (MTCT) among women infected with C. trachomatis (10.7%) were significantly higher compared to those uninfected (8.1%); further analysis suggested a possible association of chlamydial infection and increased HIV MTCT [24] (Table 2)
Untreated sexually transmitted infections (STIs) in pregnancy, Chlamydia trachomatis, continue to negatively impact the health of women and infants worldwide given the lack of a C. trachomatis vaccine and lack of adequate STI screening and treatment policies in most countries

Summary

Introduction

In women aged 15–49 years, C. trachomatis prevalence rates in these WHO regions are cited as follows: 5.1 million (2.6%) in Africa, 5 million (1.1%) in Southeast Asia, and 20.5 million (4.3%) in the Western Pacific [7]. Other individual studies of pregnant women in China, Mongolia, India, Nepal, Bangladesh, Thailand, Papua New Guinea, and Pacific Islands (Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu) reported rates of 4.9–14%, 19.3%, 0.1–35.9%, 1%, 41–44%, 5.7–16.2%, 11–11.1%, and 11.9–26.1%, respectively [30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51] (Figure 1). Similar findings were seen in a study in Thailand that reported higher rates of chlamydial infection in HIV-infected versus HIV-uninfected pregnant women (16.2% versus 9.1%) [50]

Chlamydia trachomatis in Pregnancy

Adverse Pregnancy Outcomes

Findings

Adverse Infant Outcomes

Preventing Chlamydial Adverse Pregnancy and Infant Outcomes

Conclusion