Preconception chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes

Authors

Yajnaseni Chakraborti, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Stefanie N. Hinkle, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jørgen Skov Jensen, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
Catherine L. Haggerty, Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Toni Darville, Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
Sunni L. Mumford, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Enrique F. Schisterman, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Robert M. Silver, Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT, USA.
Brandie DePaoli Taylor, Advocate Health - MidwestFollow

Recommended Citation

Chakraborti Y, Hinkle SN, Jensen JS, et al. Preconception Chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes. Fertil Steril. Published online December 17, 2024. doi:10.1016/j.fertnstert.2024.12.017

Abstract

Objective:To study the impact of preconception Chlamydia trachomatis seropositivity on fecundability, live birth, and pregnancy loss and to assess the effect of low-dose aspirin therapy (81 mg/day) on live birth and pregnancy loss.

Design:Preconception cohort study conducted using data and specimens from the Effects of Aspirin in Gestation and Reproduction (EAGeR) study - a randomized placebo-controlled trial.

Subjects:1228 individuals with proven fecundity and a history of 1-2 pregnancy losses.

Exposure:Preconception C. trachomatis seropositivity determined using an ELISA based synthetic peptide assay at baseline.

Main outcome measures:Time-to pregnancy (fecundability) was defined as number of menstrual cycles to β-hCG-detected pregnancy; live birth status was determined from medical record abstraction; pregnancy loss was defined as any loss post positive β-hCG test.

Results:After adjusting for confounders (baseline demographic and reproductive history variables), C. trachomatis seropositivity (n=134/1228, 11%) was associated with a reduced live birth likelihood (RR: 0.77, 95% CI: 0.59, 0.99) and an increased risk of pregnancy loss (RR: 1.16, 95% CI: 1.04, 1.29), but was not associated with fecundability (FOR: 0.92, 95% CI: 0.71, 1.20). Among a subset of C. trachomatis seropositive individuals with chronic inflammation indicated by increased C-reactive protein levels ≥ 1.95 but ≤ 10 mg/L (n = 50/134, 37.3%), low-dose aspirin therapy improved live birth rates (RR: 1.68, 95% CI: 0.96, 2.92) and reduced the risk of pregnancy loss (RR: 0.83, 95% CI: 0.65, 1.10). However, the sample size reduced precision.

Conclusions:Prior exposure to C. trachomatis among women with a history of pregnancy loss may impact risk of pregnancy loss. Our results indicate the need for future studies exploring mechanisms by which C. trachomatis may influence long-term reproductive function, as this may identify treatments to improve outcomes among those with a history of infection.

Document Type

Article

PubMed ID

39701359