(P90) Neisseria gonorrhoeae and hypertensive disorders of pregnancy: Is there effect modification by maternal characteristics?

Background: Prenatal chlamydia has been linked to preeclampsia (PE), a morbid and deadly hypertensive disorder of pregnancy. However, this association is primarily with term PE a milder phenotype of the syndrome. Less is known about the impact of Neisseria gonorrhoeae on PE phenotypes. We determined if gonorrhea was associated with term or preterm PE and if effect modification by maternal characteristics was evident.

Methods: This retrospective analysis included 43,727 singleton and first recorded deliveries from an administrative database. Individuals were enrolled between 2011-2021 at one of three hospitals in Houston, TX. Data on maternal characteristics, sexually transmitted infections, medical history, and preeclampsia defined by gestational age of delivery were obtained. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals adjusting for insurance, race/ethnicity, co-infection with chlamydia, syphilis, or HIV, maternal age, and smoking. Relative excess risk due to interaction (RERI) for ORs was used to identify if maternal pregnancy characteristics (maternal age, obesity, foreign-born, race/ethnicity, chronic health conditions, gravidity, and fetal sex) interacted with gonorrhea. Analyses were stratified by these variables if RERI indicated a possible interaction.

Results: Over 95% were screened for N. gonorrhoeae and a total of 188 cases were identified. Prenatal gonorrhea was not significantly associated with preterm PE (OR 2.00, 95% CI 0.85-4.75) or term PE (OR 0.82, 95% CI 0.45-1.51). However, RERI suggested interaction between prenatal gonorrhea and maternal age >24, foreign-born status, and male fetal sex. We found trends towards increase in odds of preterm PE among individuals >24 years of age (OR 3.37, 95% CI 1.23-9.20), foreign-born (OR 4.7, 95% CI 1.49-14.80), and those with a male fetus (OR 3.89, 95% CI 1.5-9.8). This was not observed for term PE.

Conclusions: Given the rising rates of N. gonorrhoeae, there is a need to optimize screening and prevention strategies in pregnant individuals. We found that in a population with high screening rates and presumed treatment, certain maternal and pregnancy characteristics may enhance odds for preterm PE. Further research is needed to determine the burden of STIs on hypertensive disorders of pregnancy, including investigations into biological effects during pregnancy.