Preconception Chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes.

Autor:	Chakraborti Y; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Hinkle SN; 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., Jensen JS; Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark., Haggerty CL; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA., Darville T; Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA., Mumford SL; 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., Schisterman EF; 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., Silver RM; Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT, USA., DePaoli Taylor B; Department of Obstetrics and Gynecology, University of Texas Medical Branch., Galveston, TX,; Advocate Aurora Research Institute, Milwaukee, WI, USA. Electronic address: brandie.taylor@aah.org.
Jazyk:	angličtina
Zdroj:	Fertility and sterility [Fertil Steril] 2024 Dec 17. Date of Electronic Publication: 2024 Dec 17.
DOI:	10.1016/j.fertnstert.2024.12.017
Abstrakt:	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. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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