Adverse pregnancy and perinatal outcomes associated with Mycoplasma genitalium: systematic review and meta-analysis

Abstract

Objective: To examine associations between Mycoplasma genitalium infection during pregnancy and adverse outcomes.

Methods: We did a systematic review of observational studies. We searched Medline, EMBASE, the Cochrane Library and CINAHL up to 11 August 2021. Studies were included if they compared preterm birth, spontaneous abortion, premature rupture of membranes, low birth weight or perinatal death between women with and without M. genitalium. Two reviewers independently assessed articles for inclusion and extracted data. We used random-effects meta-analysis to estimate summary ORs and adjusted ORs, with 95% CIs, where appropriate. Risk of bias was assessed using established checklists.

Results: We identified 116 records and included 10 studies. Women with M. genitalium were more likely to experience preterm birth in univariable analyses (summary unadjusted OR 1.91, 95% CI 1.29 to 2.81, I²=0%, 7 studies). The combined adjusted OR was 2.34 (95% CI 1.17 to 4.71, I²=0%, 2 studies). For spontaneous abortion, the summary unadjusted OR was 1.00 (95% CI 0.53 to 1.89, I²=0%, 6 studies). The adjusted OR in one case-control study was 0.9 (95% CI 0.2 to 3.8). Unadjusted ORs for premature rupture of membranes were 7.62 (95% CI 0.40 to 145.86, 1 study) and for low birth weight 1.07 (95% CI 0.02 to 10.39, 1 study). For perinatal death, the unadjusted OR was 1.07 (95% CI 0.49 to 2.36) in one case-control and 38.42 (95% CI 1.45 to 1021.43) in one cohort study. These two ORs were not combined, owing to heterogeneity. The greatest risk of bias was the failure in most studies to control for confounding.

Conclusion: M. genitalium might be associated with an increased risk of preterm birth. Further prospective studies, with adequate control for confounding, are needed to understand the role of M. genitalium in adverse pregnancy outcomes. There is insufficient evidence to indicate routine testing and treatment of asymptomatic M. genitalium in pregnancy.

Prospero registration number: CRD42016050962.

Keywords: meta-analysis; mycoplasma; pregnancy; systematic review.

Figure 1

Random-effects meta-analysis of studies reporting on the association between Mycoplasma genitalium during pregnancy and preterm birth. Forest plots show effect estimates for each study for unadjusted estimates (A) and adjusted estimates (B). In studies reporting multivariable analyses, the numbers of events or total number of observations included were not reported (NR). For each study, the solid diamond is the point estimate, the lines either side are the 95% CIs. A line ending in an arrow means that the confidence limit lies beyond the values of the x-axis. The open diamond is the summary estimate. The lines either side of the open diamond show the prediction interval if there are three or more studies in the meta-analysis. The x-axis is on the log scale.

Figure 2

Random-effects meta-analysis of studies reporting an unadjusted association between Mycoplasma genitalium during pregnancy and spontaneous abortion. Forest plots show effect estimates for each study. For each study, the solid diamond is the point estimate, the lines either side are the 95% CIs. A line ending in an arrow means that the confidence limit lies beyond the values of the x-axis. The open diamond is the summary estimate. The lines either side of the open diamond show the prediction interval. The x-axis is on the log scale. Only one study reported a multivariable analysis (adjusted OR 0.90, 95% CI 0.2 to 3.8) (ref 26).