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Adverse Birth Outcomes and Maternal Neisseria gonorrhoeae Infection: A Population-Based Cohort Study in Washington State

Heumann, Christine L. MD, MPH; Quilter, Laura A.S. MD; Eastment, McKenna C. MD, MPH; Heffron, Renee PhD; Hawes, Stephen E. PhD

Sexually Transmitted Diseases: May 2017 - Volume 44 - Issue 5 - p 266–271
doi: 10.1097/OLQ.0000000000000592
Original Study

Background Neisseria gonorrhoeae (gonorrhea) remains an important cause of reproductive and obstetric complications. There has been limited population-based research to evaluate the association between maternal gonorrhea and adverse birth outcomes.

Methods A population-based retrospective cohort study was conducted of women with singleton pregnancies in Washington State from 2003 to 2014 using linked birth certificate and birth hospitalization discharge data. The exposed cohort consisted of women with gonorrhea diagnosed during pregnancy. The unexposed group, defined as pregnant women without gonorrhea, was selected by frequency-matching by birth year in a 4:1 ratio. Logistic regression was used to determine crude and adjusted odds ratios (OR) for the association of maternal gonorrhea and adverse birth outcomes.

Results Women with gonorrhea during pregnancy (N = 819) were more likely to be younger, black, single, less educated, multiparous, and smokers compared with women without gonorrhea (N = 3276). Maternal gonorrhea was significantly associated with a 40% increased odds (adjusted OR, 1.4; 95% confidence interval [CI], 1.0–1.8) of low birth weight infants compared with women without gonorrhea when adjusted for marital and smoking status. Maternal gonorrhea was associated with a 60% increased odds (OR, 1.6; 95% CI, 1.3–2.0) of small for gestational age infants compared with women without gonorrhea.

Conclusions This analysis showed that pregnant women with gonorrhea were more likely to have low birth weight infants, consistent with prior literature, and provided new evidence that maternal gonorrhea is associated with small for gestational age infants. These findings support increased public health efforts to prevent, identify, and treat gonorrhea infection during pregnancy.

Maternal Neisseria gonorrhoeae infection was associated with low birth weight infants and small for gestational age infants in a population-based cohort study in Washington State.

From the *Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI; †Division of Allergy and Infectious Diseases, Department of Medicine, ‡Department of Global Health, and §Department of Epidemiology, University of Washington, Seattle, WA

M.C.E., C.L.H. and L.A.S.Q. are co-first authors.

Conflicts of Interest: None declared.

C.L.H. was funded by the National Institutes of Health Host Defense Training in Allergy and Infectious Diseases Grant (T32 AI007044-40). L.A.S.Q. received grant funding from the Centers for Disease Control and Prevention (1U 62 PS 004584-01). M.C.E was funded by the National Institutes of Health STD & AIDS Research Training Program (T32 AI07140). R.H. and S.E.H. do not have additional funding sources to report related to this work.

Correspondence: Laura Quilter, MD, 1959 NE Pacific St, Box 356423, Seattle, WA 98195-6423. E-mail:

Received for publication November 8, 2016, and accepted January 4, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association