Ureaplasma and Mycoplasma screening in women at high risk for preterm birth

Abstract

To examine the association of positive Ureaplasma and Mycoplasma (U & M) with preterm birth and the rates of recurrence in a high-risk pregnant population. This was a retrospective study of all pregnant women who had U & M cervical culture at a tertiary care center. At our institution, it is our protocol to perform U & M cervical culture for women with high risk factors of preterm birth (history of preterm birth, recurrent pregnancy loss, multiple gestation, and cerclage) and treat women and partners. Test-of-cure is performed after the treatment. We examined rates of recurrence after the treatment. For the analysis of preterm birth (less than 37 weeks), we limited analyses to women who had cervical culture at less than 16 weeks, singleton gestation, and the indication for culture being a history of preterm birth or recurrent pregnancy loss. Adjusted odds ratios (aOR) with 95% confidence interval (95%CI) were calculated, controlling confounders. Of 510 women, 311 (61%) and 95 (19%) had Ureaplasma and Mycoplasma, respectively. Of 178 who had Ureaplasma treated and had test-of cure, 137 (77%) had recurrence. Of 41 who had Mycoplasma treated and had test-of-cure, 10 (24%) had recurrence. There was no difference in preterm birth between women who had negative Ureaplasma, those who had Ureaplasma and treated, and those who had Ureaplasma but were not treated (38% vs. 33% [aOR 0.81; 95%CI 0.43-1.54]) vs. 54% [aOR 1.91; 95%CI 0.58-6.27], respectively). Similarly, there was no difference in preterm birth between women who had negative Mycoplasma, those who had Mycoplasma and treated, and those who had Mycoplasma but were not treated (38% vs. 27% [aOR 0.64; 95%CI 0.24-1.75] vs. 40% [aOR 1.05; 95%CI 0.28-3.91], respectively). Ureaplasma is prevalent and the recurrence rate after treatment is high. Women who had positive Ureaplasma or Mycoplasma and were treated did not have increased odds of preterm birth compared to those who did not have Ureaplasma or Mycoplasma. Our findings question the clinical utility of screening for U & M in pregnancies at high risk for preterm birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)