Session: Pathogenesis and prevention of Chlamydia trachomatis infections
O15.5 - Evaluating Chlamydia trachomatis and Neisseria Gonorrhoeae screening among asymptomatic pregnant women to prevent preterm birth and low birth weight in Gaborone, Botswana.
Assistant Professor University of California, San Diego La Jolla, California, United States
Introduction
Chlamydia trachomatis (CT) and Neisseria Gonorrhoeae (NG) infections increase risks for adverse birth outcomes. Most countries use syndromic management to identify CT/NG and miss asymptomatic infections. There is an absence of evidence demonstrating that CT/NG screening can reduce adverse birth outcomes. We evaluated the impact of screening asymptomatic pregnant women for CT/NG on preterm birth and low birth weight.
Methods
The Maduo study was a cluster-controlled trial to evaluate the effect of CT and NG screening on post-delivery prevalence compared to the standard-of-care (SoC) in Botswana (February 2021-December 2022). Pregnant women aged ≥15 years, attending first antenatal care (ANC) visit, ≤27 weeks gestation, and asymptomatic for CT/NG infection (not identified for syndromic management) were eligible. The intervention arm received CT and NG testing (Cepheid GeneXpert®) at first antenatal care, third trimester, and at 6-8 weeks post-delivery. The SoC arm received CT and NG testing at postnatal visit only. We evaluated the impact of screening on preterm birth (< 37 weeks gestation) and low birth weight (< 2500g) using multivariable logistic regression and post-estimation predictive margins analysis.
Results
Among 500 participants, 436 (87%) had live birth outcome data (20 miscarriages, 11 stillbirths, 7 twins, and 26 lost to follow-up were excluded) with 58 (13%) babies preterm and/or low birth weight (41 [9%] preterm; 39 [9%] low birth weight). In models that controlled for first pregnancy, hypertension, ANC visits, and clinic; the predicted prevalence of preterm/low birth weight was higher in the SoC (15%) compared to the intervention arm (11%); however, the risk difference had confidence intervals that crossed zero (RD: -4.3; 95% CI: -12 to 3.2). Results were similar for preterm birth (RD:-2.8; 95% CI: -8.7 to 3.1) and low birth (RD: -4.3; 95% CI: -11.1 to 2.4).
Conclusion
A CT/NG screening intervention among asymptomatic pregnant women reduced preterm and/or low birth weight infants compared to the SoC; however, results were not statistically significant and confidence intervals were wide. As prematurity is a leading cause of preventable death for children under five, more research powered to detect differences in birth outcomes is needed for evaluating effectiveness of antenatal CT/NG screening interventions.
