title: Urogenital schistosomiasis during pregnancy is associated with low birth weight delivery: analysis of a prospective cohort of pregnant women and their offspring in Gabon.
abstract: An estimated 40 million women of childbearing age suffer from schistosomiasis. Animal models indicate a deleterious effect of maternal schistosomiasis on pregnancy outcomes. To date there is a lack of epidemiological evidence evaluating schistosomiasis-related morbidity in pregnancy. This study was designed to describe the impact of urogenital schistosomiasis on pregnancy outcomes in a highly endemic region of central Africa. Pregnant women attending antenatal clinics in Fougamou and Lambaréné, Gabon, were consecutively screened for the presence of Schistosoma haematobium eggs in diurnal urine samples. Maternal and newborn characteristics assessed at delivery were compared between infected and uninfected mothers. The impact of maternal schistosomiasis on low birth weight and preterm delivery was assessed using logistic regression analysis. Urogenital schistosomiasis was diagnosed in 103 (9%) of 1115 pregnant women. Maternal age was inversely associated with the prevalence of urogenital schistosomiasis, with a higher burden amongst nulliparous women. Low birth weight was more common amongst infants of S. haematobium-infected mothers. This association was unaffected by controlling for demographic characteristics, gestational age and Plasmodium infection status (adjusted Odds Ratio 1.93; 95% confidence interval: 1.08-3.42). Other risk factors associated with low birth weight delivery were underweight mothers (adjusted Odds Ratio 2.34; 95% confidence interval: 1.12-4.92), peripheral or placental Plasmodium falciparum infection (adjusted Odds Ratio 2.04; 95% confidence interval: 1.18-3.53) and preterm birth (adjusted Odds Ratio 3.12; 95% confidence interval: 1.97-4.96). Preterm delivery was not associated with S. haematobium infection (adjusted Odds Ratio 1.07 95% confidence interval: 0.57-1.98). In conclusion, this study indicates that pregnant women with urogenital schistosomiasis are at an increased risk for low birth weight deliveries. Further studies evaluating targeted treatment and prevention programmes for urogenital schistosomiasis in pregnant women and their impact on delivery outcomes are warranted.
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany; Département de Parasitologie-Mycologie, Université des Sciences de la Santé, BP 4009 Libreville, Gabon; Leiden University Medical Centre (LUMC), 2333 ZA Leiden, The Netherlands.
authors.forename: Ghyslain
authors.initials: G
authors.lastname: Mombo-Ngoma
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Josiane
authors.initials: J
authors.lastname: Honkpehedji
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Arti
authors.initials: A
authors.lastname: Basra
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Jean Rodolphe
authors.initials: JR
authors.lastname: Mackanga
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Rella Manego
authors.initials: RM
authors.lastname: Zoleko
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Jeannot
authors.initials: J
authors.lastname: Zinsou
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Jean Claude Dejon
authors.initials: JC
authors.lastname: Agobe
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lell
authors.affiliation: Ngounie Medical Research Centre, BP 133 Fougamou, Gabon.
authors.forename: Pierre-Blaise
authors.initials: PB
authors.lastname: Matsiegui
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonzales
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Selidji Todagbe
authors.initials: ST
authors.lastname: Agnandji
authors.affiliation: Leiden University Medical Centre (LUMC), 2333 ZA Leiden, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Yazdanbakhsh
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Menendez
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany; Leiden University Medical Centre (LUMC), 2333 ZA Leiden, The Netherlands.
authors.forename: Ayola Akim
authors.initials: AA
authors.lastname: Adegnika
authors.affiliation: Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, BP 118 Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, 1090 Vienna, Austria. Electronic address: Michael.ramharter@meduniwien.ac.at.
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D019353:Endemic Diseases; D005260:Female; D005681:Gabon / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications; D016778:Malaria, Falciparum / Q000150:complications; D008297:Male; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000469:parasitology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000469:parasitology* / Q000503:physiopathology* / Q000652:urine; D011256:Pregnancy Outcome / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012548:Schistosoma haematobium / Q000302:isolation & purification; D012553:Schistosomiasis haematobia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000652:urine; D055815:Young Adult
keywords: Gabon; Low birth-weight; Pregnancy; Prematurity; Schistosomiasis