Preconception Chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes

Yajnaseni Chakraborti; Stefanie N Hinkle; Jørgen Skov Jensen; Catherine L Haggerty; Toni Darville; Sunni L Mumford; Enrique F Schisterman; Robert M Silver; Brandie DePaoli Taylor

doi:10.1016/j.fertnstert.2024.12.017

Preconception Chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes

Fertil Steril. 2024 Dec 17:S0015-0282(24)02448-8. doi: 10.1016/j.fertnstert.2024.12.017. Online ahead of print.

Authors

Yajnaseni Chakraborti¹, Stefanie N Hinkle², Jørgen Skov Jensen³, Catherine L Haggerty⁴, Toni Darville⁵, Sunni L Mumford², Enrique F Schisterman², Robert M Silver⁶, Brandie DePaoli Taylor⁷

Affiliations

¹ Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark.
⁴ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
⁵ Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT, USA.
⁷ Department of Obstetrics and Gynecology, University of Texas Medical Branch., Galveston, TX,; Advocate Aurora Research Institute, Milwaukee, WI, USA. Electronic address: brandie.taylor@aah.org.

PMID: 39701359
DOI: 10.1016/j.fertnstert.2024.12.017

Abstract

Objective: To study the impact of preconception Chlamydia trachomatis seropositivity on fecundability, live birth, and pregnancy loss and to assess the effect of low-dose aspirin therapy (81 mg/day) on live birth and pregnancy loss.

Design: Preconception cohort study conducted using data and specimens from the Effects of Aspirin in Gestation and Reproduction (EAGeR) study - a randomized placebo-controlled trial.

Subjects: 1228 individuals with proven fecundity and a history of 1-2 pregnancy losses.

Exposure: Preconception C. trachomatis seropositivity determined using an ELISA based synthetic peptide assay at baseline.

Main outcome measures: Time-to pregnancy (fecundability) was defined as number of menstrual cycles to β-hCG-detected pregnancy; live birth status was determined from medical record abstraction; pregnancy loss was defined as any loss post positive β-hCG test.

Results: After adjusting for confounders (baseline demographic and reproductive history variables), C. trachomatis seropositivity (n=134/1228, 11%) was associated with a reduced live birth likelihood (RR: 0.77, 95% CI: 0.59, 0.99) and an increased risk of pregnancy loss (RR: 1.16, 95% CI: 1.04, 1.29), but was not associated with fecundability (FOR: 0.92, 95% CI: 0.71, 1.20). Among a subset of C. trachomatis seropositive individuals with chronic inflammation indicated by increased C-reactive protein levels ≥ 1.95 but ≤ 10 mg/L (n = 50/134, 37.3%), low-dose aspirin therapy improved live birth rates (RR: 1.68, 95% CI: 0.96, 2.92) and reduced the risk of pregnancy loss (RR: 0.83, 95% CI: 0.65, 1.10). However, the sample size reduced precision.

Conclusions: Prior exposure to C. trachomatis among women with a history of pregnancy loss may impact risk of pregnancy loss. Our results indicate the need for future studies exploring mechanisms by which C. trachomatis may influence long-term reproductive function, as this may identify treatments to improve outcomes among those with a history of infection.