title: Maternal Chlamydia Infection During Pregnancy and Risk of Cyanotic Congenital Heart Defects in the Offspring.
abstract: OBJECTIVE
  Genital Chlamydia is a common bacterial sexually-transmitted infection among reproductive aged women, particularly younger populations. Cyanotic congenital heart defects (CCHDs) constitute about one quarter of all cardiac malformations at birth, and are associated with high rate of morbidity and mortality. Epidemiological research on the association between maternal Chlamydia during pregnancy and CCHDs in the offspring is lacking.
  
  
  METHODS
  Using data from the 2012 United States birth certificates, we examined the association between CCHDs and prenatal exposure to Chlamydia among live singleton births with CCHDs (n = 2487) and unaffected singleton births (n = 3,334,424). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using unconditional logistic regression analysis for all CCHDs combined, and isolated CCHDs (without other major congenital malformations).
  
  
  RESULTS
  Overall 1.7% of case and 1.7% of control women reported having Chlamydia during their pregnancies. After controlling for potential confounders, we found a weak positive association between maternal Chlamydia during pregnancy and all CCHDs combined (aOR = 1.39; 95% CI 1.02-1.90). The positive association persisted for isolated CCHD cases, but with marginal significance (aOR = 1.34; 95% CI 0.96-1.74). Subgroup analyses for younger women showed an increased risk for CCHDs; however, the associations were not statistically significant.
  
  
  CONCLUSIONS
  Maternal exposure to Chlamydia during pregnancy was weakly associated with a higher risk of CCHDs in the offspring. The finding should be interpreted with caution due to limitations of birth certificate data. Future studies using more robust data sources are warranted to further study the association between maternal Chlamydia during pregnancy and CCHDs in the offspring.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, USA.|Department of Veterans Affairs, Center for Medication Safety, Hines, IL, USA.
authors.forename: Diane Y
authors.initials: DY
authors.lastname: Dong
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: José N
authors.initials: JN
authors.lastname: Binongo
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, USA. vkanche@emory.edu.
authors.forename: Vijaya
authors.identifier: http://orcid.org/0000-0002-2803-8030
authors.initials: V
authors.lastname: Kancherla
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000150:complications* / Q000473:pathology; D003490:Cyanosis / Q000209:etiology; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects; D011247:Pregnancy; D012306:Risk; D014481:United States
keywords: Birth defects; Chlamydia; Congenital heart defects; Cyanosis; Risk factors