Chorioamnionitis in Teenage Births: A Retrospective Cohort Study

Abstract

Our county is one of three counties in Illinois with the highest rates of teen pregnancies and sexually transmitted diseases (STDs). Prior studies have shown that teenage pregnancy, STD and chorioamnionitis lead to preterm birth. Our objective was to determine the relationship between chorioamnionitis and preterm birth as well as STDs (Gonorrhea, Chlamydia, Trichomonas) in the teenage population. We performed a retrospective cohort study by reviewing electronic medical records of females age 19 or younger with deliveries from 01/01/2012 to 12/31/14 at our tertiary referral center. Patients with multiple gestation were excluded. After descriptive statistics and univariate analysis, a multivariable logistic regression was used to examine the association between preterm deliveries and chorioamnionitis as well as STDs and chorioamnionitis controlling for age, marital status, race, parity and smoking status. 562 charts were reviewed, 517 teens with live singleton births were identified. The rate of STIs was 17.2% (gonorrhea 3.5%, chlamydia 14.7%, trichomonas 3.3%). The rate of preterm deliveries was 18.4% (95/517). The rate of chorioamnionitis based on clinical evaluation was 19/517 (3.7%), chorioamnionitis based on placental pathology report was 15.1% (78/517), clinical diagnosis and pathology findings combined was 16.8% (87/517). However, pathology was only obtained in 314 cases (61%). Patients with preterm labor were more likely to have chorioamnionitis (OR 3.5) (95% CI 2.0-6.1). STDs were not associated with preterm deliveries or chorioamnionitis (p>0.05). Although many patients with STD diagnosed during pregnancy had chorioamnionitis either clinically or on placental pathology, this association was not significant. This may be due to early treatment of STDs and close follow up documenting cure. The few previous studies describing the incidence of chorioamnionitis on placental pathology in teenagers, showed roughly 8-10% of patients to be affected. Our teenage population had a higher incidence of 15.1% of chorioamnionitis on pathology. Also, our patients had a higher than average rate of STDs, almost double the rate expected in sexually active teens. We hypothesize that the same behaviors that cause STDs in our teenage population might lead to infection by other agents known to cause chorioamnionitis.