Association of delayed treatment of chlamydial infection and gonorrhea in pregnancy and preterm birth

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Article (peer-reviewed)

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Background: Treating chlamydia and gonorrhea in pregnancy has been shown to decrease the associated risk of preterm birth in some studies. Delayed treatment of these infections among non-pregnant patients carries known consequences. It is unclear whether delayed treatment in pregnancy similarly increases adverse outcomes. Methods: We conducted a retrospective cohort study of women who delivered at a safety-net hospital from July 2016 to June 2018. Women with at least one visit who were tested for chlamydia and gonorrhea were included. Women diagnosed after 36 weeks (preterm analysis) or 31 weeks (early preterm analysis) were excluded. We used multivariable logistic regression to examine the association between no infection, timely treatment ( < 1 week), and delayed treatment ( > 1 week, not treated) with preterm ( < 37 weeks) and early preterm ( < 32 weeks) birth. Results: Among 3,154 deliveries, 389 (12%) were preterm. Among 3,107 deliveries, 74 (2%) were early preterm. In adjusted models, women with timely (aOR 1.7, 95% CI 1.0-2.7) and delayed (aOR 1.7, 95% CI 1.1-2.5) treatment had increased odds of preterm birth. Similarly, women with timely (aOR 2.5, 95% CI 1.0-6.2) and delayed (aOR 2.4, 95% CI 1.2-4.9) treatment had increased odds of early preterm birth. Among women who tested positive, multiple infections was not associated with an increase in preterm birth (preterm: 17% vs. 20%, p = 0.53; early preterm: 5% vs. 6%, p = 0.74). Conclusions: Chlamydia and gonorrhea are associated with preterm and early preterm birth, regardless of time to treatment. Creative solutions are needed to improve prevention of these infections in pregnancy.