title: Epidemiologic factors and urogenital infections associated with preterm birth in a midwestern U.S. population.
abstract: OBJECTIVE
  To correlate epidemiologic factors with urogenital infections associated with preterm birth.
  
  
  METHODS
  Pregnant women were sequentially included from four Wisconsin cohorts: large urban, midsize urban, small city, and rural city. Demographic, clinical, and current pregnancy data were collected. Cervical and urine specimens were analyzed by microscopy, culture, and polymerase chain reaction for potential pathogens.
  
  
  RESULTS
  Six hundred seventy-six women were evaluated. Fifty-four (8.0%) had preterm birth: 12.1% (19/157) large urban, 8.8% (15/170) midsize urban, 9.4% (16/171) small city, and 2.3% (4/178) rural city. Associated host factors and infections varied significantly among sites. Urogenital infection rates, especially Mycoplasma hominis and Ureaplasma parvum, were highest at the large urban site. Large urban site, minority ethnicity, multiple infections, and certain historical factors were associated with preterm birth by univariable analysis. By multivariable analysis, preterm birth was associated with prior preterm birth (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 1.27-6.02) and urinary tract infection (aOR 2.62, 95% CI 1.32-519), and negatively associated with provider-assessed good health (aOR 0.42, 95% CI 0.23-0.76) and group B streptococcal infection treatment (surrogate for health care use) (aOR 0.38, 95% CI 0.15-.99). Risk and protective factors were similar for women with birth at less than 35 weeks, and additionally associated with M hominis (aOR 3.6, 95% CI 1.4-9.7).
  
  
  CONCLUSIONS
  These measured differences among sites are consistent with observations that link epidemiologic factors, both environmental and genetic, with minimally pathogenic vaginal bacteria, inducing preterm birth, especially at less than 35 weeks of gestation.
authors.affiliation: Gundersen Health System and Gundersen Medical Foundation, La Crosse, Aurora Health Care, Inc., Milwaukee, the Marshfield Clinic Research Foundation, Marshfield, the University of Wisconsin, and the Wisconsin Network for Health Research Central Administration, Madison, Wisconsin.
authors.forename: William A
authors.initials: WA
authors.lastname: Agger
authors.forename: Danish
authors.initials: D
authors.lastname: Siddiqui
authors.forename: Steven D
authors.initials: SD
authors.lastname: Lovrich
authors.forename: Steven M
authors.initials: SM
authors.lastname: Callister
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Borgert
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Merkitch
authors.forename: Tina C
authors.initials: TC
authors.lastname: Mason
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Baumgardner
authors.forename: James K
authors.initials: JK
authors.lastname: Burmester
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Shukla
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Welter
authors.forename: Katharina S
authors.initials: KS
authors.lastname: Stewart
authors.forename: M J
authors.initials: MJ
authors.lastname: Washburn
authors.forename: Howard H
authors.initials: HH
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000382:microbiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D015146:Midwestern United States / Q000453:epidemiology; D019535:Mycoplasma hominis / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000382:microbiology; D047928:Premature Birth / Q000453:epidemiology*; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000382:microbiology; D014509:Ureaplasma / Q000302:isolation & purification