title: Sexually transmitted infections and adverse pregnancy outcomes among women attending inner city public sexually transmitted diseases clinics.
abstract: BACKGROUND
  Studies in antenatal care clinics suggest that lower genital tract infections (LGTI) may be associated with adverse pregnancy outcomes (APO). We sought to characterize antenatal care patterns and determine whether LGTI are independently associated with preterm birth and/or low-birth weight among a high-risk public sexually transmitted diseases (STD) clinic population.
  
  
  METHODS
  Electronic STD clinic medical records and state birth records were matched for 730 pregnant women age 13 to 49 tested for 5 treatable LGTI (bacterial vaginosis, chlamydia, gonorrhea, early syphilis, and trichomoniasis) in a case-control analysis. Cases were women with preterm and/or low-birth weight newborns; controls were women without APO. The association between LGTI and APO was assessed using logistic regression.
  
  
  RESULTS
  Although pregnant women attending STD clinics reported high risk behaviors and were found to have high rates of LGTI (55%), most of these women were engaged in antenatal care (85%). Of the pregnant women, 22% experienced an APO (7% preterm birth, 4% low birth weight, and 12% preterm birth and low birth weight). In multivariate analyses, chlamydia was associated with low-birth weight (adjusted odds ratio [aOR]: 2.07, 95% confidence interval [CI]: 1.01-4.24), and gonorrhea was associated with preterm birth (aOR: 2.01, 95% CI: 1.02-3.97), particularly when diagnosed during the first trimester (aOR: 2.95, 95% CI: 1.30-6.70).
  
  
  CONCLUSIONS
  Our findings confirm the association of some LGTI with APO and suggest that timing of LGTI screening may affect outcomes. STD clinic visits represent a critical opportunity to target interventions aimed at improving pregnancy outcomes.
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA. hjohnson@jhsph.edu
authors.forename: Hope L
authors.initials: HL
authors.lastname: Johnson
authors.forename: Khalil G
authors.initials: KG
authors.lastname: Ghanem
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Zenilman
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Erbelding
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000150:complications / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D015231:Sexually Transmitted Diseases, Bacterial / Q000150:complications* / Q000453:epidemiology; D013587:Syphilis / Q000150:complications / Q000453:epidemiology; D014247:Trichomonas Vaginitis / Q000150:complications / Q000453:epidemiology; D016585:Vaginosis, Bacterial / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult