Disparities in Prenatal Sexually Transmitted Infections among a Diverse Population of Foreign-Born and US-Born Women

Abstract

This study examined association between foreign-born (FB) status and a sexually transmitted infection (STI) diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, or syphilis among a cohort of expecting mothers, and stratified by race/ethnicity. As a secondary analysis, subsequent adverse birth outcomes following STIs were examined. We used data from a large perinatal database to conduct a retrospective cohort study of 37,211 singleton births. Logistic regression was used to determine the association between FB status and STIs. We adjusted for maternal demographics, prior complications, and chronic disease. As a secondary analysis, we examined the association between STIs, and adverse birth outcomes stratified by FB status. FB women had lower odds of STI diagnosis (OR_adj 0.81, 95% CI 0.71-0.93); this was observed for each STI. Among Hispanic women, FB status did not reduce odds of STIs (OR_adj 0.89, 95% CI 0.76-1.04). However, FB Black women had reduced odds of STIs (OR_adj 0.53, 95% CI 0.36-0.79). Secondary analyses revealed that STIs increased odds of adverse birth outcomes among US-born Black women but not US-born Hispanic women. Among FB Black women, STIs increased odds of medically indicated preterm birth (OR_adj 3.77, 95% CI 1.19-12.00) and preeclampsia (OR_adj 2.35, 95% CI 1.02-5.42). This was not observed among FB Hispanic women. Previous studies suggest that FB women are less likely to have adverse birth outcomes; our study extends this observation to risk of prenatal STIs. However, FB status does not protect Black women against adverse birth outcomes following an STI.

Keywords: Adverse pregnancy outcome; Health disparities; Immigrant health; Sexually transmitted infections.

Fig. 1

Flow chart of study population including exclusion criteria and composition. This figure shows the total number of births in the Peribank dataset between 2011 and 2020. After exclusions of multiple births, and missing country of birth, the total study population was 37,221

Fig. 2

The association between FB status and adverse maternal outcomes. Results are adjusted for race, age, marital status, insurance, education, substance use, smoking, chronic health conditions, and pregnancy complications. Adjusted odds ratio (point estimate) of FB status and different adverse maternal outcomes are denoted by black dots; the grey dots represent the upper and lower limits of the 95% confidence interval. GDM, gestational diabetes Mellitus; ICU, intensive care unit; PTB, preterm birth; HDP, hypertensive disorders of pregnancy, GH, gestational hypertension; PE, preeclampsia