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. 2014 Nov;124(5):969-977.
doi: 10.1097/AOG.0000000000000470.

Epidemiologic factors and urogenital infections associated with preterm birth in a midwestern U.S. population

William A Agger  1 , Danish Siddiqui, Steven D Lovrich, Steven M Callister, Andrew J Borgert, Kenneth W Merkitch, Tina C Mason, Dennis J Baumgardner, James K Burmester, Sanjay K Shukla, Joseph D Welter, Katharina S Stewart, M J Washburn, Howard H Bailey
Affiliations

Epidemiologic factors and urogenital infections associated with preterm birth in a midwestern U.S. population

William A Agger et al. Obstet Gynecol. 2014 Nov.

Abstract

Objective: To correlate epidemiologic factors with urogenital infections associated with preterm birth.

Methods: Pregnant women were sequentially included from four Wisconsin cohorts: large urban, midsize urban, small city, and rural city. Demographic, clinical, and current pregnancy data were collected. Cervical and urine specimens were analyzed by microscopy, culture, and polymerase chain reaction for potential pathogens.

Results: Six hundred seventy-six women were evaluated. Fifty-four (8.0%) had preterm birth: 12.1% (19/157) large urban, 8.8% (15/170) midsize urban, 9.4% (16/171) small city, and 2.3% (4/178) rural city. Associated host factors and infections varied significantly among sites. Urogenital infection rates, especially Mycoplasma hominis and Ureaplasma parvum, were highest at the large urban site. Large urban site, minority ethnicity, multiple infections, and certain historical factors were associated with preterm birth by univariable analysis. By multivariable analysis, preterm birth was associated with prior preterm birth (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 1.27-6.02) and urinary tract infection (aOR 2.62, 95% CI 1.32-519), and negatively associated with provider-assessed good health (aOR 0.42, 95% CI 0.23-0.76) and group B streptococcal infection treatment (surrogate for health care use) (aOR 0.38, 95% CI 0.15-.99). Risk and protective factors were similar for women with birth at less than 35 weeks, and additionally associated with M hominis (aOR 3.6, 95% CI 1.4-9.7).

Conclusion: These measured differences among sites are consistent with observations that link epidemiologic factors, both environmental and genetic, with minimally pathogenic vaginal bacteria, inducing preterm birth, especially at less than 35 weeks of gestation.

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Conflict of interest statement

Financial Disclosure: The authors did not report any potential conflicts of interest.

Figures

Figure 1
Figure 1
A. Distribution of all births by week gestation and urogenital mollicute carriage. B. Distribution of births at less than 35 weeks of gestation by week gestation and urogenital mollicute carriage.
See this image and copyright information in PMC

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