Chlamydia trachomatis Screening and Treatment in Pregnancy to Reduce Adverse Pregnancy and Neonatal Outcomes: A Review.

Kristina N Adachi,Jeffrey D Klausner,Karin Nielsen-Saines

doi:10.3389/fpubh.2021.531073

Kristina N Adachi, Jeffrey D Klausner + Show 1 more

Open Access

https://doi.org/10.3389/fpubh.2021.531073

Copy DOI

Abstract

Chlamydial trachomatis infection has been associated with adverse pregnancy and neonatal outcomes such as premature rupture of membranes, preterm birth, low birth weight, conjunctivitis, and pneumonia in infants. This review evaluates existing literature to determine potential benefits of antenatal screening and treatment of C. trachomatis in preventing adverse outcomes. A literature search revealed 1824 studies with 156 full-text articles reviewed. Fifteen studies were selected after fulfilling inclusion criteria. Eight studies focused on chlamydial screening and treatment to prevent adverse pregnancy outcomes such as premature rupture of membranes, preterm birth, low birth weight, growth restriction leading to small for gestational age infants, and neonatal death. Seven studies focused on the effects of chlamydial screening and treatment on adverse infant outcomes such as chlamydial infection including positive mucosal cultures, pneumonia, and conjunctivitis. Given the heterogeneity of those studies, this focused review was exclusively qualitative in nature. When viewed collectively, 13 of 15 studies provided some degree of support that antenatal chlamydial screening and treatment interventions may lead to decreased adverse pregnancy and infant outcomes. However, notable limitations of these individual studies also highlight the need for further, updated research in this area, particularly from low and middle-income settings.

Highlights

Chlamydia trachomatis accounts for nearly 130 million new cases worldwide, it remains a perpetually overlooked global health issue, in low and middle-income countries with limited resources (1–5)
While there is a large body of literature investigating the treatment of chlamydial infections in pregnancy, few of these studies provide meaningful data relevant to this review
Of the 15 studies that have been included in this review, eight of the studies provided at least some information on the chlamydial screening and treatment effect on adverse pregnancy outcomes such as low birth weight, preterm delivery, preterm labor, or premature rupture of membranes; the other seven studies provided at least some information on the chlamydial screening and treatment effect on neonatal chlamydial infections[1]

Summary

Introduction

Chlamydia trachomatis accounts for nearly 130 million new cases worldwide, it remains a perpetually overlooked global health issue, in low and middle-income countries with limited resources (1–5). Chlamydial infection in pregnancy has been associated with complications including fetal loss, premature rupture of membranes, preterm labor and delivery, and low birth weight among others (1, 3, 7–18). Many studies, including a 12-study meta-analysis by Silva et al (19), have found an association between chlamydial infection in pregnancy and increased risk for preterm. Some have suggested that untreated chlamydial infection in pregnancy may lead to as much as a two- to four-fold increased risk for preterm labor and delivery (12, 15, 20). The increased risk for preterm delivery with C. trachomatis infection is of particular concern given the high neonatal morbidity and mortality associated with premature birth (21). It has been estimated that 30–50% of infants whose mothers have active, untreated C. trachomatis infection will develop conjunctivitis, and 10–20% of infants will develop pneumonia (11–13, 22)

Methods

Results

Discussion

Conclusion