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Background <p>We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy outcomes in Cape Town, South Africa.</p> Methods <p>Eligible women <i>≥</i> 15 years, without HIV, attending first antenatal care (ANC) visit before 28 weeks gestation, received diagnostic testing at enrolment and either same-day or follow-up treatment for <i>Chlamydia trachomatis</i> (CT) and <i>Neisseria gonorrhoeae</i> (NG) using either on-site GeneXpert or laboratory-based testing with TaqMan qPCR assays. We assessed prevalence of CT/NG, time to treatment and the frequency of poor pregnancy outcomes, individually and combined including pregnancy loss (miscarriage [&lt; 20weeks] or stillbirth [≥ 20weeks]) and perinatal outcomes (low birthweight [&lt; 2500&#xa0;g], preterm birth [&lt; 37weeks], small for gestational age [&lt; 10th percentile] and neonatal death [&lt; 7days]) among women with or without CT/NG at study enrolment. Logistic regression models evaluated the impact of time to CT/NG treatment on the frequency of individual and combined poor pregnancy outcomes, adjusting for maternal characteristics.</p> Results <p>Among 1237 pregnant women, the prevalence of CT/NG at first ANC visit was 28% (24% CT, 8% NG). Of those diagnosed with CT/NG (<i>n</i> = 345), 54% received immediate treatment(&lt; 7 days), while 34% experienced delayed treatment (median time to treatment 28 days (interquartile range: 15–57)) and 12% were untreated during pregnancy. Among women with CT/NG, the frequency of miscarriage (12%) and stillbirth (9%) were highest among women with untreated CT/NG, lower among delayed treatment (4% and 3%), and lowest among immediate treatment (1% and 2%), respectively. Among women with CT/NG at enrolment, poor pregnancy outcome was 28%, 23%, and 29% for immediate, delayed, and no treatment, respectively; 22% among women with no CT/NG at enrolment (overall χ² test, <i>p</i> = 0.05). Untreated CT/NG were associated with increased odds of pregnancy loss (adjusted odds ratio (aOR); 3.27, 95% CI: 1.09–9.80) compared to CT/NG with immediate treatment and compared to no CT/NG at study enrolment (aOR; 5.05, 95% CI: 2.23–11.43). Multivariable analysis showed no significant difference in poor pregnancy outcome by time to CT/NG treatment.</p> Conclusion <p>Untreated CT/NG during pregnancy increased the odds of experiencing a miscarriage or stillbirth. These findings suggest potential benefits of STI screening using diagnostic tests leading to the timely treatment of curable STIs in pregnancy, and randomized trials are urgently needed to clarify these effects.</p> Clinical trial number <p>Not applicable.</p>

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Impact of antenatal screening for Chlamydia and Gonorrhea on pregnancy outcomes in South African women

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Dorothy Chiwoniso Nyemba,
  • Alex de Voux,
  • Rufaro Mvududu,
  • Remco P. H. Peters,
  • Sinead Delany-Moretlwe,
  • Leigh F. Johnson,
  • Thomas J. Coates,
  • Landon Myer,
  • Dvora Leah Joseph Davey

摘要

Background

We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy outcomes in Cape Town, South Africa.

Methods

Eligible women ≥ 15 years, without HIV, attending first antenatal care (ANC) visit before 28 weeks gestation, received diagnostic testing at enrolment and either same-day or follow-up treatment for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using either on-site GeneXpert or laboratory-based testing with TaqMan qPCR assays. We assessed prevalence of CT/NG, time to treatment and the frequency of poor pregnancy outcomes, individually and combined including pregnancy loss (miscarriage [< 20weeks] or stillbirth [≥ 20weeks]) and perinatal outcomes (low birthweight [< 2500 g], preterm birth [< 37weeks], small for gestational age [< 10th percentile] and neonatal death [< 7days]) among women with or without CT/NG at study enrolment. Logistic regression models evaluated the impact of time to CT/NG treatment on the frequency of individual and combined poor pregnancy outcomes, adjusting for maternal characteristics.

Results

Among 1237 pregnant women, the prevalence of CT/NG at first ANC visit was 28% (24% CT, 8% NG). Of those diagnosed with CT/NG (n = 345), 54% received immediate treatment(< 7 days), while 34% experienced delayed treatment (median time to treatment 28 days (interquartile range: 15–57)) and 12% were untreated during pregnancy. Among women with CT/NG, the frequency of miscarriage (12%) and stillbirth (9%) were highest among women with untreated CT/NG, lower among delayed treatment (4% and 3%), and lowest among immediate treatment (1% and 2%), respectively. Among women with CT/NG at enrolment, poor pregnancy outcome was 28%, 23%, and 29% for immediate, delayed, and no treatment, respectively; 22% among women with no CT/NG at enrolment (overall χ² test, p = 0.05). Untreated CT/NG were associated with increased odds of pregnancy loss (adjusted odds ratio (aOR); 3.27, 95% CI: 1.09–9.80) compared to CT/NG with immediate treatment and compared to no CT/NG at study enrolment (aOR; 5.05, 95% CI: 2.23–11.43). Multivariable analysis showed no significant difference in poor pregnancy outcome by time to CT/NG treatment.

Conclusion

Untreated CT/NG during pregnancy increased the odds of experiencing a miscarriage or stillbirth. These findings suggest potential benefits of STI screening using diagnostic tests leading to the timely treatment of curable STIs in pregnancy, and randomized trials are urgently needed to clarify these effects.

Clinical trial number

Not applicable.