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March 6, 1987, Vol 257, No. 9 >
ARTICLE | March 6, 1987

Low Birth Weight, Prematurity, and Postpartum Endometritis: Title and subTitle BreakAssociation With Prenatal Cervical Mycoplasma hominis and Chlamydia trachomatis Infections FREE

Stuart M. Berman, MD; H. Robert Harrison, DPhil, MD, MPH; W. Thomas Boyce, MD; William J. J. Haffner, MD; Marguerite Lewis, RN; Julia Barney Arthur, RN
[+] Author Affiliations

Reprint requests to the Technical Information Services, Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333.


JAMA. 1987;257(9):1189-1194. doi:10.1001/jama.1987.03390090061025
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References

We studied associations of Mycoplasma hominis, Ureaplasma urealyticum, and Chlamydia trachomatis genital infections with pregnancy outcomes, controlling by logistic and multiple linear regression for known risk factors and for the presence of the other two infections. A sample of 1204 Navajo women enrolling for prenatal care had endocervical C trachomatis, M hominis, and U urealyticum cultures and serum samples taken at enrollment and when possible after 30 weeks. Low birth weight (<2500 g) was associated with M hominis infection among women with a history of spontaneous abortion. Mycoplasma hominis infection was also associated with postpartum endometritis, but only among women undergoing a cesarean section (odds ratio, 4.7; 95% confidence intervals, 1.22 to 18.3). Although women with recent C trachomatis infection (IgM titer>1:32 on either sample or IgG seroconversion) were at greater risk of low birth weight (19% [3/16]) than women with chronic infection (4.5% [6/133]; relative risk, 4.2), this subgroup at risk was small (11% of women with classifiable C trachomatis infection). Mycoplasma hominis and C trachomatis infections may be important preventable causes of adverse pregnancy outcomes in identifiable subgroups of women.

(JAMA 1987;257:1189-1194)

REFERENCES

1 +
McCormick MC:  The contribution of low birthweight to infant and childhood morbidity . N Engl J Med 1985;;312:82-90.
2 +
Elder HA, Santamarina BAG, Smith S, et al:  The natural history of asymptomatic bacteriuria during pregnancy: The effect of tetracyline on the clinical course and the outcome of pregnancy . Am J Obstet Gynecol 1971;;111:441-462.
3 +
Cassell GH, Cole BC:  Mycoplasmas as agents of human disease . N Engl J Med 1981;;304:80-89.
4 +
Alexander ER, Harrison HR:  Role of Chlamydia trachomatis in perinatal infection . Rev Infect Dis 1983;;5:713-719.
5 +
Martin DH, Koutsky L, Eschenbach DA, et al:  Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydia trachomatis infections . JAMA 1982;;247:1585-1588.
6 +
Braun P, Lee YH, Klein JO, et al:  Birth weight and genital mycoplasmas in pregnancy . N Engl J Med 1971;;284:167-170.
7 +
Kundsin RB, Driscoll SG, Monson RR, et al:  Association of Ureaplasma urealyticum in the placenta with perinatal morbidity and mortality . N Engl J Med 1984;;310:941-945.
8 +
Wager GP, Martin DH, Koutsky L, et al:  Puerperal infectious morbidity: Relationship to route of delivery and to antepartum Chlamydia trachomatis infection . Am J Obstet Gynecol 1980;;138:1028-1033.
9 +
Gravett MG, Nelson HP, DeRouen T, et al:  Independent associations of bacterial vaginosis and Chlamydia trachomatis with adverse pregnancy outcome . JAMA 1986;;256:1899-1903.
10 +
Ross JM, Furr PM, Taylor-Robinson D, et al:  The effect of genital mycoplasmas on human fetal growth . Br J Obstet Gynaecol 1981;;88:749-755.
11 +
Harrison HR, Alexander ER, Weinstein L, et al:  Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy: epidemiology and outcomes . JAMA 1983;;250:1721-1727.
12 +
Munday PE, Porter R, Falder PF, et al:  Spontaneous abortion: An infectious aetiology? Br J Obstet Gynaecol 1984;;91:1177-1180.
13 +
Harrison HR:  Prospective studies of Mycoplasma hominis infection in pregnancy . Sex Transm Dis 1983;;10:311-317.
14 +
Edelman R:  Summary of a workshop on maternal genitourinary infections and the outcome of pregnancy . J Infect Dis 1983;;147:596-605.
15 +
Wentworth BB, Alexander ER:  Isolation of Chlamydia trachomatis by use of 5-iodo-2-deoxyuridine-treated cells . Appl Microbiol 1974;;27: 912-916.
16 +
Kenny GE:  Mycoplasmata , in Lenette EH, Balows A, Hansler WJ, et al (eds): Manual of Clinical Microbiology . Washington, DC, American Society for Microbiology, 1980;, pp 365-370.
17 +
Yoder BL, Stamm WE, Koester CM, et al:  A microtest procedure for isolation of C trachomatis . J Clin Microbiol 1981;;13:1036-1039.
18 +
Wang SP, Grayston JT, Alexander ER, et al:  Simplified microimmunofluorescence test with trachoma-lymphogranuloma venereum (Chlamydia trachomatis)antigens for use as a screening test for antibody . J Clin Microbiol 1975;;1:250-255.
19 +
Rothman KJ, Boice JD: Epidemiologic analysis with a programmable calculator . National Institutes of Health Publication 79-1649. US Dept of Health, Education, and Welfare, 1979;.
20 +
Cox DR:  Analysis of binary data , in Methuen's Monographs on Applied Probability and Statistics . London, Methuen & Co, 1970;.
21 +
Kleinbaum DG, Kupper LL, Morgenstern H:  Modeling: Analysis strategy , in Epidemiologic Research . Belmont, Calif, Lifetime Learning Publications, 1982;, pp 447-456.
22 +
Schachter J.  Biology of Chlamydia trachomatis , in Holmes KK, Mardh P-A, Sparling PF, Wiesner PJ (eds): Sexually Transmitted Diseases . McGraw-Hill International Book Co, 1984;, p 252.
23 +
Eschenbach DA:  New concepts of obstetric and gynecologic infection . Arch Intern Med 1982;;142: 2039-2044.
24 +
Kass EH, McCormack WM, Lin JS, et al:  Genital mycoplasmas as a cause of excess premature delivery . Trans Assoc Am Phys 1981;;94: 261-266.
25 +
Harrison HR, Boyce WT, Haffner HJ, et al:  The prevalence of genital Chlamydia trachomatis and mycoplasmal infections during pregnancy in an American Indian population . Sex Transm Dis 1983;;10:184-186.
26 +
Klein JO, Buckland D, Finland M:  Colonization of newborn infants by mycoplasmas . N Engl J Med 1969;;280:1025-1030.
27 +
Koutsky LA, Stamm WE, Brunham RC, et al:  Persistence of Mycoplasma hominis after therapy: Importance of tetracycline resistance and of coexisting vaginal flora . Sex Transm Dis 1983;;10( (suppl 4) ):374-381.
28 +
Minkoff H, Grunebaum AN, Schwarz RH, et al:  Risk factors for prematurity and premature rupture of membranes: A prospective study of the vaginal flora in pregnancy . Am J Obstet Gynecol 1984;;150:965-972.

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1 +
McCormick MC:  The contribution of low birthweight to infant and childhood morbidity . N Engl J Med 1985;;312:82-90.
2 +
Elder HA, Santamarina BAG, Smith S, et al:  The natural history of asymptomatic bacteriuria during pregnancy: The effect of tetracyline on the clinical course and the outcome of pregnancy . Am J Obstet Gynecol 1971;;111:441-462.
3 +
Cassell GH, Cole BC:  Mycoplasmas as agents of human disease . N Engl J Med 1981;;304:80-89.
4 +
Alexander ER, Harrison HR:  Role of Chlamydia trachomatis in perinatal infection . Rev Infect Dis 1983;;5:713-719.
5 +
Martin DH, Koutsky L, Eschenbach DA, et al:  Prematurity and perinatal mortality in pregnancies complicated by maternal Chlamydia trachomatis infections . JAMA 1982;;247:1585-1588.
6 +
Braun P, Lee YH, Klein JO, et al:  Birth weight and genital mycoplasmas in pregnancy . N Engl J Med 1971;;284:167-170.
7 +
Kundsin RB, Driscoll SG, Monson RR, et al:  Association of Ureaplasma urealyticum in the placenta with perinatal morbidity and mortality . N Engl J Med 1984;;310:941-945.
8 +
Wager GP, Martin DH, Koutsky L, et al:  Puerperal infectious morbidity: Relationship to route of delivery and to antepartum Chlamydia trachomatis infection . Am J Obstet Gynecol 1980;;138:1028-1033.
9 +
Gravett MG, Nelson HP, DeRouen T, et al:  Independent associations of bacterial vaginosis and Chlamydia trachomatis with adverse pregnancy outcome . JAMA 1986;;256:1899-1903.
10 +
Ross JM, Furr PM, Taylor-Robinson D, et al:  The effect of genital mycoplasmas on human fetal growth . Br J Obstet Gynaecol 1981;;88:749-755.
11 +
Harrison HR, Alexander ER, Weinstein L, et al:  Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy: epidemiology and outcomes . JAMA 1983;;250:1721-1727.
12 +
Munday PE, Porter R, Falder PF, et al:  Spontaneous abortion: An infectious aetiology? Br J Obstet Gynaecol 1984;;91:1177-1180.
13 +
Harrison HR:  Prospective studies of Mycoplasma hominis infection in pregnancy . Sex Transm Dis 1983;;10:311-317.
14 +
Edelman R:  Summary of a workshop on maternal genitourinary infections and the outcome of pregnancy . J Infect Dis 1983;;147:596-605.
15 +
Wentworth BB, Alexander ER:  Isolation of Chlamydia trachomatis by use of 5-iodo-2-deoxyuridine-treated cells . Appl Microbiol 1974;;27: 912-916.
16 +
Kenny GE:  Mycoplasmata , in Lenette EH, Balows A, Hansler WJ, et al (eds): Manual of Clinical Microbiology . Washington, DC, American Society for Microbiology, 1980;, pp 365-370.
17 +
Yoder BL, Stamm WE, Koester CM, et al:  A microtest procedure for isolation of C trachomatis . J Clin Microbiol 1981;;13:1036-1039.
18 +
Wang SP, Grayston JT, Alexander ER, et al:  Simplified microimmunofluorescence test with trachoma-lymphogranuloma venereum (Chlamydia trachomatis)antigens for use as a screening test for antibody . J Clin Microbiol 1975;;1:250-255.
19 +
Rothman KJ, Boice JD: Epidemiologic analysis with a programmable calculator . National Institutes of Health Publication 79-1649. US Dept of Health, Education, and Welfare, 1979;.
20 +
Cox DR:  Analysis of binary data , in Methuen's Monographs on Applied Probability and Statistics . London, Methuen & Co, 1970;.
21 +
Kleinbaum DG, Kupper LL, Morgenstern H:  Modeling: Analysis strategy , in Epidemiologic Research . Belmont, Calif, Lifetime Learning Publications, 1982;, pp 447-456.
22 +
Schachter J.  Biology of Chlamydia trachomatis , in Holmes KK, Mardh P-A, Sparling PF, Wiesner PJ (eds): Sexually Transmitted Diseases . McGraw-Hill International Book Co, 1984;, p 252.
23 +
Eschenbach DA:  New concepts of obstetric and gynecologic infection . Arch Intern Med 1982;;142: 2039-2044.
24 +
Kass EH, McCormack WM, Lin JS, et al:  Genital mycoplasmas as a cause of excess premature delivery . Trans Assoc Am Phys 1981;;94: 261-266.
25 +
Harrison HR, Boyce WT, Haffner HJ, et al:  The prevalence of genital Chlamydia trachomatis and mycoplasmal infections during pregnancy in an American Indian population . Sex Transm Dis 1983;;10:184-186.
26 +
Klein JO, Buckland D, Finland M:  Colonization of newborn infants by mycoplasmas . N Engl J Med 1969;;280:1025-1030.
27 +
Koutsky LA, Stamm WE, Brunham RC, et al:  Persistence of Mycoplasma hominis after therapy: Importance of tetracycline resistance and of coexisting vaginal flora . Sex Transm Dis 1983;;10( (suppl 4) ):374-381.
28 +
Minkoff H, Grunebaum AN, Schwarz RH, et al:  Risk factors for prematurity and premature rupture of membranes: A prospective study of the vaginal flora in pregnancy . Am J Obstet Gynecol 1984;;150:965-972.

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