Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight
Identifieur interne : 004774 ( Istex/Corpus ); précédent : 004773; suivant : 004775Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight
Auteurs : Madeline Y. Sutton ; Maya Sternberg ; Malanda Nsuami ; Frieda Behets ; Ann Marie Nelson ; Michael E. St. LouisSource :
- American Journal of Obstetrics and Gynecology [ 0002-9378 ] ; 1999.
English descriptors
- KwdEn :
- Adverse birth outcomes, Bacterial vaginosis, Birth outcomes, Birth weight, Bivariate, Bivariate analyses, Bivariate analysis, Chorioamnionitis, Confidence interval, Democratic republic, Disease control, Gestational, Gonorrhea, Gynecol, Human immunodeficiency, Human immunodeficiency virus, Immunodeficiency, Infection, Infection status, Kinshasa, Multivariate analysis, Obstet, Obstet gynecol, Odds ratio, Other risk factors, Parturient women, Placental, Placental malaria, Pregnancy, Pregnancy outcomes, Pregnant women, Premature rupture, Preterm, Preterm delivery, Previous studies, Reagin, Risk factors, Routine screening, Socioeconomic status, Study group, Sutton, Trichomonas, Trichomonas vaginalis, Trichomoniasis, Vaginal trichomoniasis, Vaginalis, Vaginalis infection, low birth weight, trichomoniasis.
- Teeft :
- Adverse birth outcomes, Bacterial vaginosis, Birth outcomes, Birth weight, Bivariate, Bivariate analyses, Bivariate analysis, Chorioamnionitis, Confidence interval, Democratic republic, Disease control, Gestational, Gonorrhea, Gynecol, Human immunodeficiency, Human immunodeficiency virus, Immunodeficiency, Infection, Infection status, Kinshasa, Multivariate analysis, Obstet, Obstet gynecol, Odds ratio, Other risk factors, Parturient women, Placental, Placental malaria, Pregnancy, Pregnancy outcomes, Pregnant women, Premature rupture, Preterm, Preterm delivery, Previous studies, Reagin, Risk factors, Routine screening, Socioeconomic status, Study group, Sutton, Trichomonas, Trichomonas vaginalis, Trichomoniasis, Vaginal trichomoniasis, Vaginalis, Vaginalis infection.
Abstract
Abstract: Objective: We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. Study Design: We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. Results: Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. Conclusion: These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. (Am J Obstet Gynecol 1999;181:656-62.)
Url:
DOI: 10.1016/S0002-9378(99)70509-0
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ISTEX:DB8180086B3D229A12850E33BBFC2A1931F663F8Le document en format XML
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Sutton</name><affiliation><mods:affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</mods:affiliation></affiliation></author><author><name sortKey="Sternberg, Maya" sort="Sternberg, Maya" uniqKey="Sternberg M" first="Maya" last="Sternberg">Maya Sternberg</name><affiliation><mods:affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</mods:affiliation></affiliation></author><author><name sortKey="Nsuami, Malanda" sort="Nsuami, Malanda" uniqKey="Nsuami M" first="Malanda" last="Nsuami">Malanda Nsuami</name><affiliation><mods:affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</mods:affiliation></affiliation></author><author><name sortKey="Behets, Frieda" sort="Behets, Frieda" uniqKey="Behets F" first="Frieda" last="Behets">Frieda Behets</name><affiliation><mods:affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</mods:affiliation></affiliation></author><author><name sortKey="Nelson, Ann Marie" sort="Nelson, Ann Marie" uniqKey="Nelson A" first="Ann Marie" last="Nelson">Ann Marie Nelson</name><affiliation><mods:affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</mods:affiliation></affiliation></author><author><name sortKey="St Louis, Michael E" sort="St Louis, Michael E" uniqKey="St Louis M" first="Michael E." last="St. Louis">Michael E. 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St. Louis</name><affiliation><mods:affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">American Journal of Obstetrics and Gynecology</title><title level="j" type="abbrev">YMOB</title><idno type="ISSN">0002-9378</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">181</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="656">656</biblScope><biblScope unit="page" to="662">662</biblScope></imprint><idno type="ISSN">0002-9378</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9378</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adverse birth outcomes</term><term>Bacterial vaginosis</term><term>Birth outcomes</term><term>Birth weight</term><term>Bivariate</term><term>Bivariate analyses</term><term>Bivariate analysis</term><term>Chorioamnionitis</term><term>Confidence interval</term><term>Democratic republic</term><term>Disease control</term><term>Gestational</term><term>Gonorrhea</term><term>Gynecol</term><term>Human immunodeficiency</term><term>Human immunodeficiency virus</term><term>Immunodeficiency</term><term>Infection</term><term>Infection status</term><term>Kinshasa</term><term>Multivariate analysis</term><term>Obstet</term><term>Obstet gynecol</term><term>Odds ratio</term><term>Other risk factors</term><term>Parturient women</term><term>Placental</term><term>Placental malaria</term><term>Pregnancy</term><term>Pregnancy outcomes</term><term>Pregnant women</term><term>Premature rupture</term><term>Preterm</term><term>Preterm delivery</term><term>Previous studies</term><term>Reagin</term><term>Risk factors</term><term>Routine screening</term><term>Socioeconomic status</term><term>Study group</term><term>Sutton</term><term>Trichomonas</term><term>Trichomonas vaginalis</term><term>Trichomoniasis</term><term>Vaginal trichomoniasis</term><term>Vaginalis</term><term>Vaginalis infection</term><term>low birth weight</term><term>trichomoniasis</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Adverse birth outcomes</term><term>Bacterial vaginosis</term><term>Birth outcomes</term><term>Birth weight</term><term>Bivariate</term><term>Bivariate analyses</term><term>Bivariate analysis</term><term>Chorioamnionitis</term><term>Confidence interval</term><term>Democratic republic</term><term>Disease control</term><term>Gestational</term><term>Gonorrhea</term><term>Gynecol</term><term>Human immunodeficiency</term><term>Human immunodeficiency virus</term><term>Immunodeficiency</term><term>Infection</term><term>Infection status</term><term>Kinshasa</term><term>Multivariate analysis</term><term>Obstet</term><term>Obstet gynecol</term><term>Odds ratio</term><term>Other risk factors</term><term>Parturient women</term><term>Placental</term><term>Placental malaria</term><term>Pregnancy</term><term>Pregnancy outcomes</term><term>Pregnant women</term><term>Premature rupture</term><term>Preterm</term><term>Preterm delivery</term><term>Previous studies</term><term>Reagin</term><term>Risk factors</term><term>Routine screening</term><term>Socioeconomic status</term><term>Study group</term><term>Sutton</term><term>Trichomonas</term><term>Trichomonas vaginalis</term><term>Trichomoniasis</term><term>Vaginal trichomoniasis</term><term>Vaginalis</term><term>Vaginalis infection</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Objective: We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. Study Design: We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. Results: Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. Conclusion: These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. 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Sutton MD, MPHa</name><affiliations><json:string>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</json:string></affiliations></json:item><json:item><name>Maya Sternberg PhDa</name><affiliations><json:string>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</json:string></affiliations></json:item><json:item><name>Malanda Nsuami MD, MPHb</name><affiliations><json:string>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</json:string></affiliations></json:item><json:item><name>Frieda Behets MPHb</name><affiliations><json:string>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</json:string></affiliations></json:item><json:item><name>Ann Marie Nelson MDb, c</name><affiliations><json:string>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</json:string></affiliations></json:item><json:item><name>Michael E. St. Louis MDa, b</name><affiliations><json:string>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Human immunodeficiency virus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>low birth weight</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>trichomoniasis</value></json:item></subject><articleId><json:string>99914</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Objective: We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. Study Design: We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. Results: Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. Conclusion: These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. (Am J Obstet Gynecol 1999;181:656-62.)</abstract><qualityIndicators><score>6.457</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>3</keywordCount><abstractCharCount>1491</abstractCharCount><pdfWordCount>4129</pdfWordCount><pdfCharCount>27544</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>194</abstractWordCount></qualityIndicators><title>Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight</title><pii><json:string>S0002-9378(99)70509-0</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>American Journal of Obstetrics and Gynecology</title><language><json:string>unknown</json:string></language><publicationDate>1999</publicationDate><issn><json:string>0002-9378</json:string></issn><pii><json:string>S0002-9378(05)X7095-8</json:string></pii><volume>181</volume><issue>3</issue><pages><first>656</first><last>662</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>obstetrics & gynecology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>obstetrics & reproductive medicine</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string><json:string>gynecologie. andrologie. obstetrique</json:string></inist></categories><publicationDate>1999</publicationDate><copyrightDate>1999</copyrightDate><doi><json:string>10.1016/S0002-9378(99)70509-0</json:string></doi><id>DB8180086B3D229A12850E33BBFC2A1931F663F8</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/DB8180086B3D229A12850E33BBFC2A1931F663F8/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/DB8180086B3D229A12850E33BBFC2A1931F663F8/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/DB8180086B3D229A12850E33BBFC2A1931F663F8/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1999 Mosby, Inc.</p></availability><date>1999</date></publicationStmt><notesStmt><note>From the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention,a Projet SIDA (Project AIDS),b and the Armed Forces Institute of Pathology.c</note><note>Reprint requests: Madeline Y. Sutton, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-02, Atlanta, GA 30333.</note><note>6/1/99914</note><note type="content">Table I: Selected characteristics of HIV-infected and uninfected study patients stratified by T vaginalis infection status</note><note type="content">Table III: Risk factors for LBW outcome among parturient women in Kinshasa from 1989-1990*</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight</title><author xml:id="author-0000"><persName><forename type="first">Madeline Y.</forename><surname>Sutton</surname></persName><roleName type="degree">MD, MPHa</roleName><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Maya</forename><surname>Sternberg</surname></persName><roleName type="degree">PhDa</roleName><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Malanda</forename><surname>Nsuami</surname></persName><roleName type="degree">MD, MPHb</roleName><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Frieda</forename><surname>Behets</surname></persName><roleName type="degree">MPHb</roleName><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Ann Marie</forename><surname>Nelson</surname></persName><roleName type="degree">MDb, c</roleName><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Michael E.</forename><surname>St. Louis</surname></persName><roleName type="degree">MDa, b</roleName><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation></author><idno type="istex">DB8180086B3D229A12850E33BBFC2A1931F663F8</idno><idno type="DOI">10.1016/S0002-9378(99)70509-0</idno><idno type="PII">S0002-9378(99)70509-0</idno><idno type="ArticleID">99914</idno></analytic><monogr><title level="j">American Journal of Obstetrics and Gynecology</title><title level="j" type="abbrev">YMOB</title><idno type="pISSN">0002-9378</idno><idno type="PII">S0002-9378(05)X7095-8</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999"></date><biblScope unit="volume">181</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="656">656</biblScope><biblScope unit="page" to="662">662</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1999</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objective: We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. Study Design: We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. Results: Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. Conclusion: These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. (Am J Obstet Gynecol 1999;181:656-62.)</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Human immunodeficiency virus</term></item><item><term>low birth weight</term></item><item><term>trichomoniasis</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1998-09-29">Modified</change><change when="1999">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/DB8180086B3D229A12850E33BBFC2A1931F663F8/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en" version="5.0"><item-info><jid>YMOB</jid><aid>99914</aid><ce:pii>S0002-9378(99)70509-0</ce:pii><ce:doi>10.1016/S0002-9378(99)70509-0</ce:doi><ce:copyright type="full-transfer" year="1999">Mosby, Inc.</ce:copyright></item-info><ce:floats><ce:table id="tab1" colsep="0" rowsep="0" frame="topbot"><ce:label>Table I</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0010">Selected characteristics of HIV-infected and uninfected study patients stratified by <ce:italic>T vaginalis</ce:italic> infection status</ce:simple-para></ce:caption><tgroup cols="4"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><thead><row><entry></entry><entry align="center">HIV-infected patients (n = 215; mean ± SEM)</entry><entry align="center">HIV-uninfected patients (n = 206; mean ± SEM)</entry><entry align="center">Statistical significance</entry></row></thead><tbody><row><entry><ce:italic>T vaginalis</ce:italic> –positive patients (n = 61)</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Age (y)</entry><entry align="center">25.4 ± 0.8</entry><entry align="center">26.0 ± 1.0</entry><entry align="center"><ce:italic>P</ce:italic> = .6</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>CD4 T cells/mm<ce:sup loc="post">3</ce:sup></entry><entry align="center">593.7 ± 75.2</entry><entry align="center">898.7 ± 149.6</entry><entry align="center"><ce:italic>P</ce:italic> = .05</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>CD8 T cells/mm<ce:sup loc="post">3</ce:sup></entry><entry align="center">1107.4 ± 102.2</entry><entry align="center">596.5 ± 64.7</entry><entry align="center"><ce:italic>P</ce:italic> = .0001</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Gravidity</entry><entry align="center">2.9 ± 0.3</entry><entry align="center">3.4 ± 0.5</entry><entry align="center"><ce:italic>P</ce:italic> = .2</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Birth weight (g)</entry><entry align="center">2766.3 ± 82.2</entry><entry align="center">2932.4 ± 96.8</entry><entry align="center"><ce:italic>P</ce:italic> = .2</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Gestational age (wk)</entry><entry align="center">38.8 ± 0.4</entry><entry align="center">39.7 ± 0.6</entry><entry align="center"><ce:italic>P</ce:italic> = .2</entry></row><row><entry><ce:italic>T vaginalis</ce:italic> –negative patients (n = 360)</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Age (y)</entry><entry align="center">26.9 ± 0.4</entry><entry align="center">27.3 ± 0.36</entry><entry align="center"><ce:italic>P</ce:italic> = .4</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>CD4 T cells/mm<ce:sup loc="post">3</ce:sup></entry><entry align="center">621.1 ± 39.1</entry><entry align="center">1093.2 ± 42.0</entry><entry align="center"><ce:italic>P</ce:italic> < .0001</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>CD8 T cells/mm<ce:sup loc="post">3</ce:sup></entry><entry align="center">1209.9 ± 62.4</entry><entry align="center">873.3 ± 46.3</entry><entry align="center"><ce:italic>P</ce:italic> < .0001</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Gravidity</entry><entry align="center">3.2 ± 0.1</entry><entry align="center">3.7 ± 0.2</entry><entry align="center"><ce:italic>P</ce:italic> = .04</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Birth weight (g)</entry><entry align="center">2932.7 ± 41.3</entry><entry align="center">3086.0 ± 33.3</entry><entry align="center"><ce:italic>P</ce:italic> = .004</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Gestational age (wk)</entry><entry align="center">38.6 ± 0.2</entry><entry align="center">39.6 ± 0.2</entry><entry align="center"><ce:italic>P</ce:italic> = .0005</entry></row></tbody></tgroup></ce:table><ce:table id="tab3" colsep="0" rowsep="0" frame="topbot"><ce:label>Table III</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0015">Risk factors for LBW outcome among parturient women in Kinshasa from 1989-1990*</ce:simple-para></ce:caption><tgroup cols="7"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><thead><row><entry morerows="1"></entry><entry namest="col2" nameend="col3" align="center">With characteristic</entry><entry namest="col4" nameend="col5" align="center">With LBW</entry><entry colname="col6" morerows="1" align="center">Odds ratio</entry><entry morerows="1" align="center">95% Confidence interval</entry></row><row><entry colname="col2" align="center">No.</entry><entry align="center">%</entry><entry align="center">No.</entry><entry align="center">%</entry></row></thead><tbody><row><entry>HIV-positive patients</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Malaria</entry><entry align="center">22</entry><entry align="center">11</entry><entry align="center">11</entry><entry align="center">50</entry><entry align="center">4.3</entry><entry align="center">1.7-10.9</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:italic>T vaginalis</ce:italic></entry><entry align="center">40</entry><entry align="center">19</entry><entry align="center">13</entry><entry align="center">33</entry><entry align="center">2.1</entry><entry align="center">1.0-4.4</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Chorioamnionitis</entry><entry align="center">85</entry><entry align="center">44</entry><entry align="center">23</entry><entry align="center">27</entry><entry align="center">1.6</entry><entry align="center">0.8-3.2</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Unmarried</entry><entry align="center">106</entry><entry align="center">50</entry><entry align="center">23</entry><entry align="center">22</entry><entry align="center">1.1</entry><entry align="center">0.6-2.1</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Low socioeconomic status</entry><entry align="center">94</entry><entry align="center">44</entry><entry align="center">24</entry><entry align="center">26</entry><entry align="center">1.5</entry><entry align="center">0.8-2.9</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Age <25 y</entry><entry align="center">101</entry><entry align="center">47</entry><entry align="center">16</entry><entry align="center">16</entry><entry align="center">0.5</entry><entry align="center">0.3-1.0</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Primigravidity</entry><entry align="center">43</entry><entry align="center">21</entry><entry align="center">9</entry><entry align="center">21</entry><entry align="center">0.9</entry><entry align="center">0.4-2.1</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Tobacco use</entry><entry align="center">4</entry><entry align="center">2</entry><entry align="center">1</entry><entry align="center">25</entry><entry align="center">1.2</entry><entry align="center">0.1-12.2</entry></row><row><entry>HIV-negative patients</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Malaria</entry><entry align="center">10</entry><entry align="center">6</entry><entry align="center">2</entry><entry align="center">20</entry><entry align="center">4.2</entry><entry align="center">0.8-22.9</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:italic>T vaginalis</ce:italic></entry><entry align="center">21</entry><entry align="center">10</entry><entry align="center">3</entry><entry align="center">14</entry><entry align="center">2.0</entry><entry align="center">0.5-7.8</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Chorioamnionitis</entry><entry align="center">49</entry><entry align="center">29</entry><entry align="center">4</entry><entry align="center">8</entry><entry align="center">1.5</entry><entry align="center">0.4-5.2</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Unmarried</entry><entry align="center">62</entry><entry align="center">30</entry><entry align="center">5</entry><entry align="center">8</entry><entry align="center">1.0</entry><entry align="center">0.3-2.8</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Low socioeconomic status</entry><entry align="center">85</entry><entry align="center">41</entry><entry align="center">5</entry><entry align="center">6</entry><entry align="center">0.6</entry><entry align="center">0.2-1.7</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Age <25 y</entry><entry align="center">101</entry><entry align="center">47</entry><entry align="center">16</entry><entry align="center">16</entry><entry align="center">0.5</entry><entry align="center">0.3-1.0</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Primigravidity</entry><entry align="center">31</entry><entry align="center">16</entry><entry align="center">2</entry><entry align="center">7</entry><entry align="center">1.0</entry><entry align="center">0.2-4.6</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Tobacco use</entry><entry align="center">1</entry><entry align="center">0.5</entry><entry align="center">0</entry><entry align="center"></entry><entry align="center">1.1</entry><entry align="center">1.0-1.1</entry></row><row><entry namest="col1" nameend="col7">*Bivariate analysis.</entry></row></tbody></tgroup></ce:table></ce:floats><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>From the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention,<ce:sup loc="post">a</ce:sup> Projet SIDA (Project AIDS),<ce:sup loc="post">b</ce:sup> and the Armed Forces Institute of Pathology.<ce:sup loc="post">c</ce:sup></ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para>Reprint requests: Madeline Y. Sutton, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-02, Atlanta, GA 30333.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para><ce:bold><ce:italic>6/1/99914</ce:italic></ce:bold></ce:note-para></ce:article-footnote><ce:title>Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight</ce:title><ce:author-group><ce:author><ce:given-name>Madeline Y.</ce:given-name><ce:surname>Sutton</ce:surname><ce:degrees>MD, MPH<ce:sup loc="post">a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Maya</ce:given-name><ce:surname>Sternberg</ce:surname><ce:degrees>PhD<ce:sup loc="post">a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Malanda</ce:given-name><ce:surname>Nsuami</ce:surname><ce:degrees>MD, MPH<ce:sup loc="post">b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Frieda</ce:given-name><ce:surname>Behets</ce:surname><ce:degrees>MPH<ce:sup loc="post">b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Ann Marie</ce:given-name><ce:surname>Nelson</ce:surname><ce:degrees>MD<ce:sup loc="post">b, c</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Michael E.</ce:given-name><ce:surname>St. Louis</ce:surname><ce:degrees>MD<ce:sup loc="post">a, b</ce:sup></ce:degrees></ce:author><ce:affiliation><ce:textfn>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</ce:textfn></ce:affiliation></ce:author-group><ce:date-received day="9" month="7" year="1998"></ce:date-received><ce:date-revised day="29" month="9" year="1998"></ce:date-revised><ce:date-accepted day="8" month="5" year="1999"></ce:date-accepted><ce:abstract class="author"><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0020"><ce:bold>Objective:</ce:bold> We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. <ce:bold>Study Design:</ce:bold> We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. <ce:bold>Results:</ce:bold> Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. <ce:bold>Conclusion:</ce:bold> These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. (Am J Obstet Gynecol 1999;181:656-62.)</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Human immunodeficiency virus</ce:text></ce:keyword><ce:keyword><ce:text>low birth weight</ce:text></ce:keyword><ce:keyword><ce:text>trichomoniasis</ce:text></ce:keyword></ce:keywords></head><body view="all"><ce:sections><ce:para view="all" id="para.0010"><ce:italic>Trichomonas vaginalis</ce:italic> infection is one of the most common sexually transmitted diseases (STDs), with an estimated 180 million persons worldwide infected each year and 3 million persons infected annually in the United States.<ce:cross-ref refid="bib1"><ce:sup loc="post">1</ce:sup></ce:cross-ref> Trichomoniasis is an important condition in pregnancy, during which it is associated with adverse birth outcomes, such as preterm delivery, premature rupture of the membranes, and low birth weight (LBW).<ce:cross-refs refid="bib2 bib3 bib4"><ce:sup loc="post">2-4</ce:sup></ce:cross-refs> In the recent Vaginal Infections and Prematurity study conducted by the National Institutes of Health,<ce:cross-ref refid="bib5"><ce:sup loc="post">5</ce:sup></ce:cross-ref> the prevalence rate of trichomoniasis in 13,816 pregnant US women sampled was 12.6%. In this and previous studies, <ce:italic>T vaginalis</ce:italic> infection in pregnancy was independently associated with adverse birth outcomes, such as premature membrane rupture, preterm delivery, and LBW.<ce:cross-refs refid="bib2 bib3 bib6"><ce:sup loc="post">2,3,6</ce:sup></ce:cross-refs></ce:para><ce:para view="all" id="para.0015">Despite the growing body of evidence of the effects of trichomoniasis on pregnancy outcomes, it is not yet standard practice in the United States or in developing countries to screen women for trichomoniasis during pregnancy. Women without symptoms often go without diagnosis or treatment during pregnancy unless <ce:italic>T vaginalis</ce:italic> is noted on a routine Papanicolaou smear. Because asymptomatic trichomoniasis has been documented to account for as much as 50% of cases of LBW among women infected with <ce:italic>T vaginalis</ce:italic> , routine screening of pregnant women to detect even asymptomatic cases of this STD, which has been associated with adverse sequelae, might prove useful.<ce:cross-refs refid="bib5 bib7 bib8"><ce:sup loc="post">5,7,8</ce:sup></ce:cross-refs> In addition, vaginal trichomoniasis has been associated with increased human immunodeficiency virus (HIV) seroconversion in women.<ce:cross-ref refid="bib9"><ce:sup loc="post">9</ce:sup></ce:cross-ref> This suggests an additional reason to consider routine screening for trichomoniasis because timely treatment may serve as an additional prevention measure for HIV seroconversion.</ce:para><ce:para view="all" id="para.0020">During pregnancy, HIV infection, like trichomoniasis, has been associated with certain adverse outcomes, such as LBW, premature delivery, and as much as 8% to 40% transmission of HIV to the neonate.<ce:cross-refs refid="bib10 bib11 bib12"><ce:sup loc="post">10-12</ce:sup></ce:cross-refs> The estimated seroprevalence of HIV infection in American women of childbearing age examined in selected prenatal and STD clinics is as high as 2.2%.<ce:cross-ref refid="bib10"><ce:sup loc="post">10</ce:sup></ce:cross-ref> There are few data on how HIV infection and trichomoniasis interact to influence adverse birth outcomes. Because HIV infection and trichomoniasis are highly prevalent in some areas of the world, we examined prevalence of and risk factors for trichomoniasis, as well as pregnancy outcomes, in HIV-infected and HIV-uninfected pregnant women in Kinshasa, Democratic Republic of Congo (formerly Zaire).</ce:para><ce:section view="all" id="section.0010"><ce:section-title>Material and methods</ce:section-title><ce:section view="all" id="section.0015"><ce:section-title>Study population</ce:section-title><ce:para view="all" id="para.0025">This analysis was designed as a nested case-control study of mothers of singletons, with trichomoniasis data available within the previously described Projet SIDA Perinatal HIV transmission cohort study.<ce:cross-ref refid="bib13"><ce:sup loc="post">13</ce:sup></ce:cross-ref> The Projet SIDA perinatal study was a collaborative effort by the Centers for Disease Control and Prevention, the National Institutes of Health, the Armed Forces Institute of Pathology, and the Ministry of Health of Zaire to evaluate how maternal and obstetric factors interact to influence mother-to-child transmission of HIV-1 in Kinshasa, Democratic Republic of Congo. Between October 1989 and April 1990, all pregnant women presenting for delivery at 2 large hospitals in Kinshasa were offered HIV-1 counseling and testing, according to a protocol approved by the Ethical Committee of the Ministry of Health of Zaire. All women who tested positive at delivery for HIV-1 antibody by rapid test (Du Pont, Wilmington, Del) and by enzyme immunoassay (Ortho Diagnostics, Raritan, NJ) and whose test results were confirmed by Western blot (Du Pont) were considered HIV-infected. Consenting HIV-infected women and their children were recruited for follow-up. HIV-seronegative control subjects who were frequency matched for age and parity were enrolled into the parent Projet SIDA study within 1 or 2 days after delivery and over a 4-month period, and they were retested for HIV seroconversion 12 months later. The one initially HIV-seronegative woman who underwent seroconversion to HIV-seropositive by 12 months after delivery was excluded from this analysis.</ce:para><ce:para view="all" id="para.0030">There were a total of 578 women enrolled in the parent study (324 HIV-infected women and 254 HIV-uninfected women). All enrolled women completed questionnaires, underwent physical examinations, and had serologic tests and genital examinations performed within 1 to 2 days after delivery. For purposes of estimating socioeconomic status, questionnaire information regarding the presence or absence of electricity in the home, source of electricity if present, and the ownership of a radio and electric stove were used, and composite scores were generated. For purposes of bivariate analysis in this nested study, socioeconomic status was treated as a dichotomous variable by using low versus middle-high status for comparison.</ce:para><ce:para view="all" id="para.0035">Syphilis serologic testing was performed by using the rapid plasma reagin and <ce:italic>Treponema pallidum</ce:italic> hemagglutination tests. Maternal trichomoniasis and gonorrhea cultures and cervical swab specimens for chlamydia antigen (Abbott, North Chicago, Ill) were obtained within 1 to 2 days after birth. For detection of <ce:italic>T vaginalis</ce:italic> , specimens were collected with cotton-tipped swabs that were placed in Kupferberg medium that had previously been warmed to room temperature. The specimens were incubated at 36°C for 3 days. If a microscopic examination of the swab did not reveal motile trichomonads, the specimen was reincubated and reexamined after 6 days. The Kupferberg medium used was commercially available (Difco, Detroit, Mich, or BBL, Laurel, Md). Standard procedures were followed, which stipulate adding 5% sterile human serum, penicillin, and streptomycin to the basic medium.<ce:cross-ref refid="bib14"><ce:sup loc="post">14</ce:sup></ce:cross-ref> For purposes of quality control, sterility of medium was checked by incubating noninoculated medium, and adequacy of medium was checked by culturing trichomoniasis-positive specimens. Those study patients with no trichomoniasis information available either were not willing to undergo genital cultures in the immediate postpartum period or were not available for examination when the study team members were present.</ce:para><ce:para view="all" id="para.0040">Placentas were processed immediately after delivery, and chorioamnionitis was diagnosed histologically, as previously described.<ce:cross-ref refid="bib13"><ce:sup loc="post">13</ce:sup></ce:cross-ref> Briefly, chorioamnionitis was diagnosed if ≥10 polymorphonuclear leukocytes were present in 10 nonadjacent 400-power fields. Placental malaria, which has been shown to be of greater significance for LBW than peripheral blood parasitemia, was defined as parasites visible on the thick smears of placental sections.</ce:para><ce:para view="all" id="para.0045">Gestational ages were estimated by obstetric dates and infant Ballard scores<ce:cross-ref refid="bib15"><ce:sup loc="post">15</ce:sup></ce:cross-ref> within 48 hours of delivery according to the Projet SIDA study protocol. Infants who required medical attention with hospitalization immediately after birth for >48 hours were not able to be assessed by the study protocol. Prematurity was defined as delivery before 37 completed weeks of gestation, and LBW was defined as birth weight of <2500 g.</ce:para><ce:para view="all" id="para.0050">HIV infection in children was defined as a polymerase chain reaction test result positive for HIV-1 deoxyribonucleic acid, positive viral culture on ≥2 peripheral blood specimens, or a persistently positive HIV antibody assay at 15 months or later, as previously described.<ce:cross-ref refid="bib13"><ce:sup loc="post">13</ce:sup></ce:cross-ref> Uninfected children were defined as those who had no HIV antibodies and whose virologic assay results were all negative.</ce:para></ce:section><ce:section view="all" id="section.0020"><ce:section-title>Statistical analysis</ce:section-title><ce:para view="all" id="para.0055">Data from the nested trichomoniasis study group were analyzed with SAS statistical software. Associations between trichomoniasis, available risk factors, and adverse pregnancy outcomes were first identified in a bivariate fashion by using χ<ce:sup loc="post">2</ce:sup> statistics for categoric outcome measures and <ce:italic>t</ce:italic> test values for continuous outcome measures. Bivariate analyses were conducted by using Mantel-Haenszel statistics. <ce:italic>P</ce:italic> < .05 was considered significant. Multiple logistic regression analysis with backward elimination was performed to determine whether <ce:italic>T vaginalis</ce:italic> remained associated with an adverse birth outcome after adjusting for potential confounders, such as HIV status, placental malaria, low socioeconomic status, and unmarried status. <ce:italic>Neisseria gonorrhoeae</ce:italic> , <ce:italic>Chlamydia trachomatis</ce:italic> , rapid plasma reagin results, and cigarette use were not included as covariates for the multivariate analysis because of incomplete data and low frequency of occurrence.</ce:para></ce:section></ce:section><ce:section view="all" id="section.0025"><ce:section-title>Results</ce:section-title><ce:para view="all" id="para.0060">Trichomoniasis data were available for 215 HIV-infected (patients) and 206 HIV-uninfected (control subjects) mothers of singletons who were enrolled within 1 to 2 days after delivery (73% of the parent Projet SIDA Perinatal study population). Those patients with and those without <ce:italic>T vaginalis</ce:italic> cultures performed did not differ significantly in terms of age, number of cigarettes smoked, infant gestational age at delivery, or infant birth weight. No patient data were collected on trichomoniasis symptoms at the time of this study. Cigarette smoking, although previously correlated with trichomoniasis in several studies, was an uncommon occurrence in the nested study group, with only 5 (1.2%) patients admitting cigarette use. Three smokers were infected with HIV and smoked an average of 20.5 cigarettes per year; 2 smokers were not infected with HIV and smoked an average of 29.0 cigarettes per year (<ce:italic>P</ce:italic> = .03). Those patients without trichomoniasis evaluations had a significantly lower mean gravidity (2.5 vs 3.4 pregnancies, <ce:italic>P</ce:italic> < .005), even after we controlled for HIV infection status. The reason for this difference is unclear. HIV-seronegative women who were not tested for <ce:italic>T vaginalis</ce:italic> were significantly younger than those who were tested (24.4 and 27.2 years, respectively; <ce:italic>P</ce:italic> = .005).</ce:para><ce:para view="all" id="para.0065">As expected, there were significant differences between HIV-infected and HIV-uninfected patients when stratified by trichomoniasis infection status for CD4<ce:sup loc="post">+</ce:sup> and CD8<ce:sup loc="post">+</ce:sup> T-cell counts (Table I).
<ce:float-anchor refid="tab1"></ce:float-anchor>HIV-infected patients in both groups had lower mean gravidity, mean birth weight, and mean gestational age at delivery (<ce:cross-ref refid="tab1">Table I</ce:cross-ref>).</ce:para><ce:para view="all" id="para.0070">Within the study group, the prevalence of trichomoniasis was 18.6% (40/215) for HIV-positive and 10.2% (21/206) for HIV-negative women (odds ratio, 2.0; 95% confidence interval, 1.1-3.6). In bivariate analyses other risk factors that appeared to be associated with trichomoniasis, in addition to HIV infection, were age of ≤25 years, unmarried status, a rapid plasma reagin test result of ≥1:4 at delivery, and low socioeconomic status (Table II).
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot" id="table.0010"><ce:label>Table II</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0025">Risk factors for <ce:italic>T vaginalis</ce:italic> infection among parturient women in Kinshasa, 1989-1990*</ce:simple-para></ce:caption><tgroup cols="7"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><colspec colname="col6" colsep="0"></colspec><colspec colname="col7" colsep="0"></colspec><thead><row><entry morerows="1"></entry><entry namest="col2" nameend="col3" align="center">With characteristic</entry><entry namest="col4" nameend="col5" align="center">With trichomoniasis</entry><entry colname="col6" morerows="1" align="center">Odds ratio</entry><entry morerows="1" align="center">95% Confidence interval</entry></row><row><entry colname="col2" align="center">No.</entry><entry align="center">%</entry><entry align="center">No.</entry><entry align="center">%</entry></row></thead><tbody><row><entry>HIV-positive patients</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Age ≤25 y</entry><entry align="center">101</entry><entry align="center">47</entry><entry align="center">24</entry><entry align="center">24</entry><entry align="center">1.9</entry><entry align="center">1.0-3.8</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Unmarried</entry><entry align="center">106</entry><entry align="center">50</entry><entry align="center">24</entry><entry align="center">23</entry><entry align="center">1.7</entry><entry align="center">0.8-3.4</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Low socioeconomic status</entry><entry align="center">94</entry><entry align="center">44</entry><entry align="center">22</entry><entry align="center">23</entry><entry align="center">1.7</entry><entry align="center">0.9-3.5</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Primigravidity</entry><entry align="center">43</entry><entry align="center">21</entry><entry align="center">11</entry><entry align="center">26</entry><entry align="center">1.6</entry><entry align="center">0.7-3.5</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Other STDs</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp>Rapid plasma reagin >1:4</entry><entry align="center">11</entry><entry align="center">5</entry><entry align="center">3</entry><entry align="center">27</entry><entry align="center">1.7</entry><entry align="center">0.4-6.6</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp>Gonorrhea</entry><entry align="center">4</entry><entry align="center">2</entry><entry align="center">1</entry><entry align="center">25</entry><entry align="center">1.5</entry><entry align="center">0.1-14.3</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp>Chlamydia</entry><entry align="center">10</entry><entry align="center">8</entry><entry align="center">2</entry><entry align="center">20</entry><entry align="center">1.0</entry><entry align="center">0.2-5.0</entry></row><row><entry>HIV-negative patients</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Age ≤25 y</entry><entry align="center">84</entry><entry align="center">41</entry><entry align="center">11</entry><entry align="center">13</entry><entry align="center">1.7</entry><entry align="center">0.7-4.2</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Unmarried</entry><entry align="center">62</entry><entry align="center">30</entry><entry align="center">8</entry><entry align="center">13</entry><entry align="center">1.5</entry><entry align="center">0.6-3.7</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Low socioeconomic status</entry><entry align="center">85</entry><entry align="center">41</entry><entry align="center">10</entry><entry align="center">12</entry><entry align="center">1.3</entry><entry align="center">0.5-3.3</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Primigravidity</entry><entry align="center">31</entry><entry align="center">16</entry><entry align="center">2</entry><entry align="center">6</entry><entry align="center">0.5</entry><entry align="center">0.1-2.4</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>Other STDs</entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry><entry align="center"></entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp>Rapid plasma reagin >1:4</entry><entry align="center">7</entry><entry align="center">3</entry><entry align="center">3</entry><entry align="center">43</entry><entry align="center">7.9</entry><entry align="center">1.6-38.0</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp>Gonorrhea</entry><entry align="center">2</entry><entry align="center">1</entry><entry align="center">0</entry><entry align="center"></entry><entry align="center">1.1</entry><entry align="center">1.1-1.2</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp><ce:hsp sp="1.0"></ce:hsp>Chlamydia</entry><entry align="center">4</entry><entry align="center">3</entry><entry align="center">0</entry><entry align="center"></entry><entry align="center">1.1</entry><entry align="center">1.1-1.2</entry></row><row><entry namest="col1" nameend="col7">*Bivariate analysis.</entry></row></tbody></tgroup></ce:table></ce:display>In multivariate analysis, with trichomoniasis infection as the outcome, only maternal HIV infection remained as a significant risk factor (odds ratio, 1.8; 95% confidence interval, 1.0-3.3). In HIV-infected women, 69% of whom had CD4<ce:sup loc="post">+</ce:sup> T-lymphocyte counts available, trichomoniasis was not significantly associated with severe immunosuppression (CD4<ce:sup loc="post">+</ce:sup> T-lymphocyte counts, <200 cells/mm<ce:sup loc="post">3</ce:sup>; odds ratio, 0.6; 95% confidence interval, 0.1-2.6). Unmarried women were more likely to have HIV than were married women (odds ratio, 2.3; 95% confidence interval, 1.5-3.4).</ce:para><ce:para view="all" id="para.0075">In bivariate analyses for birth outcomes, trichomoniasis was associated with LBW as an adverse birth outcome (odds ratio, 2.4; 95% confidence interval, 1.3-4.6) but was not shown to be associated with chorioamnionitis or prematurity (odds ratio, 1.0 and 1.2, respectively). After stratifying by HIV infection status, trichomoniasis and placental malaria remained associated with LBW (Table III).
<ce:float-anchor refid="tab3"></ce:float-anchor>Placental malaria, which has been associated with LBW in several studies in malaria-endemic areas, had an overall prevalence of 8% in our study population. None of the patients were receiving malarial chemoprophylaxis at the time of this study. Results of bivariate analyses for other known LBW risk factors are also shown in <ce:cross-ref refid="tab3">Table III</ce:cross-ref>.</ce:para><ce:para view="all" id="para.0080">Overall, LBW had a prevalence of 21.4% and 8.3% in HIV-infected women and in HIV-uninfected women and 26.2% and 13.1% in women with and without trichomoniasis, respectively. Trichomoniasis and HIV as coinfections were associated with an increased prevalence of LBW compared with either infection alone (Fig 1).
<ce:display><ce:figure id="figure.0010"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0030">Percentages of total births with LBW outcomes by maternal HIV and trichomoniasis status in Kinshasa from 1989 to 1990.</ce:simple-para></ce:caption><ce:link locator="gr1"></ce:link></ce:figure></ce:display>In a multivariate analysis with trichomoniasis and HIV infections as independent variables and LBW as the dependent variable, no significant statistical interaction between trichomoniasis and HIV was noted, suggesting that the association of trichomoniasis with LBW was independent of and not influenced by HIV infection status of the patient and that the 2 risk factors were approximately additive on the logit scale in their increasing risk for LBW.</ce:para><ce:para view="all" id="para.0085">In multivariate analyses trichomoniasis remained associated with LBW while other known LBW risk factors were adjusted for, such as HIV infection, placental malaria, chorioamnionitis, low socioeconomic status, young age, and primigravidity (Table IV).
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot" id="table.0015"><ce:label>Table IV</ce:label><ce:caption><ce:simple-para view="all" id="simple-para.0035">Multiple logistic regression for LBW outcome among parturient women in Kinshasa, 1989-1990</ce:simple-para></ce:caption><tgroup cols="3"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><thead><row><entry></entry><entry align="center">Adjusted odds ratio</entry><entry align="center">95% Confidence interval</entry></row></thead><tbody><row><entry>Maternal HIV infection</entry><entry align="center">5.7</entry><entry align="center">2.5-12.8</entry></row><row><entry>Malaria</entry><entry align="center">2.5</entry><entry align="center">0.9-6.9</entry></row><row><entry>Trichomoniasis</entry><entry align="center">2.1</entry><entry align="center">1.0-4.7</entry></row><row><entry>Chorioamnionitis</entry><entry align="center">1.7</entry><entry align="center">0.9-3.4</entry></row><row><entry>Age ≤25 y</entry><entry align="center">1.2</entry><entry align="center">0.6-2.1</entry></row><row><entry>Primigravidity</entry><entry align="center">0.5</entry><entry align="center">0.2-1.5</entry></row><row><entry>Low socioeconomic status</entry><entry align="center">0.7</entry><entry align="center">0.4-1.5</entry></row></tbody></tgroup></ce:table></ce:display>Rapid plasma reagin test reactivity, gonorrhea, chlamydial infection, and cigarette use were removed from the final model because of low prevalence or incomplete data.</ce:para><ce:para view="all" id="para.0090">Gestational age data were available for 333 (79%) of 421 of the nested case-control study group, and the prevalence of preterm delivery was 14% among this group. In multivariate analyses only maternal HIV infection remained significantly associated with preterm delivery as an outcome (odds ratio, 2.8; 95% confidence interval, 1.4-5.7), while trichomoniasis, marital status, age, and socioeconomic status were adjusted for. However, our gestational age data and their usefulness for information on preterm delivery were limited by the fact that the data were based on reported menstrual dates by the patient and Ballard score estimates of the baby at delivery and were not supported by either fundal height measurements, fetal heart tones, or ultrasonography. Twenty-nine percent of the LBW infants lacked gestational age data compared with 18% of the normal birth weight infants (odds ratio, 1.8; 95% confidence interval, 1.0-3.3), supporting the fact that LBW infants more frequently required hospitalization after delivery and were therefore unable to be assessed for gestational age estimates by study protocol. Very LBW (<1500 g) infants made up only 3 (0.7%) of 421 of all the enrolled infants; 1.2% of those had missing gestational age data, and 0.6% of those had gestational age data available.</ce:para><ce:para view="all" id="para.0095">The mother-to-child HIV transmission rates were similar for those with and for those without trichomoniasis (23.5% and 27.6%, <ce:italic>P</ce:italic> = .63).</ce:para></ce:section><ce:section view="all" id="section.0030"><ce:section-title>Comment</ce:section-title><ce:para view="all" id="para.0100">Vaginal trichomoniasis is highly prevalent in pregnant women in the Democratic Republic of Congo and was detected almost twice as often in HIV-seropositive women (18.6%) as in HIV-negative women (10.2%). The prevalence of trichomoniasis in this group of pregnant women in the Democratic Republic of Congo is similar to estimates of trichomoniasis in HIV-uninfected pregnant US women.<ce:cross-ref refid="bib5"><ce:sup loc="post">5</ce:sup></ce:cross-ref> Also, finding a higher prevalence of trichomoniasis in HIV-infected women is consistent with data from previous studies.<ce:cross-refs refid="bib9 bib16 bib17"><ce:sup loc="post">9,16,17</ce:sup></ce:cross-refs> Because of the cross-sectional nature of this study, inferences regarding trichomoniasis as a predisposing factor for HIV infection cannot be made. In light of the recent association between vaginal trichomoniasis and increased HIV seroconversion, future longitudinal cohort studies should further examine the role of trichomoniasis in facilitating sexual transmission of HIV.</ce:para><ce:para view="all" id="para.0105">In our study significant risk factors for trichomoniasis included single marital status, age of ≤25 years, HIV infection, and a rapid plasma reagin test result of ≥1:4 at delivery. Presence of another STD, including HIV, has been associated with <ce:italic>T vaginalis</ce:italic> infections in previous studies.<ce:cross-refs refid="bib4 bib7 bib16"><ce:sup loc="post">4,7,16</ce:sup></ce:cross-refs> Another risk factor known to be associated with trichomoniasis, multiple sex partners,<ce:cross-refs refid="bib4 bib7"><ce:sup loc="post">4,7</ce:sup></ce:cross-refs> was not directly measured in this study. However, marital status information revealed a higher rate of trichomoniasis in unmarried women compared with their married counterparts. In this Congolese culture marriage implies a greater likelihood of one sex partner and therefore a decreased likelihood of acquiring an STD.</ce:para><ce:para view="all" id="para.0110">Bacterial vaginosis is known to frequently coexist with trichomoniasis, and often both are present when adverse birth outcomes are noted.<ce:cross-refs refid="bib2 bib17 bib18"><ce:sup loc="post">2,17,18</ce:sup></ce:cross-refs> No assessment for bacterial vaginosis was done in Kinshasa at the time of this study, which is an unfortunate limitation of the study. However, the recent antenatal prevalence of bacterial vaginosis in a similar urban setting in South Africa was 52%.<ce:cross-ref refid="bib19"><ce:sup loc="post">19</ce:sup></ce:cross-ref> It has been documented that trichomoniasis and bacterial vaginosis may act as independent risk factors for adverse birth outcomes, although they frequently are coinfections.<ce:cross-ref refid="bib2"><ce:sup loc="post">2</ce:sup></ce:cross-ref> Future studies should include information on both infections so that the attributable risk of trichomoniasis to the specific outcome can be calculated. Other sexually transmitted infections, such as gonorrhea and chlamydia, are also frequently seen with trichomoniasis and have been shown to increase the risk for premature delivery.<ce:cross-refs refid="bib20 bib21"><ce:sup loc="post">20,21</ce:sup></ce:cross-refs> In this study group tests for chlamydial infection were performed less consistently; among 242 (57%) of 421 women with chlamydia tests performed, 14 (5.8%) had positive test results. The tests for gonorrhea were performed consistently, but disease was uncommon; in 416 (99%) of 421 with gonorrhea tests performed, 6 (1.4%) had positive test results.</ce:para><ce:para view="all" id="para.0115">Our data support an association between trichomoniasis and LBW independent of HIV infection status and other risk factors. Previous studies, with evaluation for trichomoniasis done at midgestation and the third trimester, have shown associations with adverse birth outcomes, such as LBW, preterm delivery, and premature rupture of membranes.<ce:cross-refs refid="bib2 bib3 bib6 bib22"><ce:sup loc="post">2,3,6,22</ce:sup></ce:cross-refs> Our study is different in that it examines untreated vaginal trichomoniasis that is present at delivery, rather than at earlier points in gestation. One limitation of this postpartum testing is the uncertainty of length of time of <ce:italic>T vaginalis</ce:italic> infection during the pregnancy. Therefore caution must be used when the extent to which the presence of <ce:italic>T vaginalis</ce:italic> affected these pregnancies is interpreted.</ce:para><ce:para view="all" id="para.0120">On the other hand, an advantage of this study design is that it shows more clearly the impact of untreated trichomoniasis during late pregnancy because women were enrolled when they presented in labor, and testing and treatment could be done only in the immediate postnatal period. Had the women been enrolled and screened during pregnancy, they would have been treated appropriately for any noted infections during pregnancy.</ce:para><ce:para view="all" id="para.0125"><ce:italic>T vaginalis</ce:italic> produces extracellular proteases that may play a role in the ability of the parasite to adhere to the vaginal epithelium.<ce:cross-ref refid="bib23"><ce:sup loc="post">23</ce:sup></ce:cross-ref> It has also been shown, by means of in vitro electron microscopy, that a minimum of 6 hours of contact between <ce:italic>T vaginalis</ce:italic> and epithelial cells of the human amnion membrane is adequate for cellular interaction.<ce:cross-ref refid="bib24"><ce:sup loc="post">24</ce:sup></ce:cross-ref> This direct contact or the released proteases themselves may be mechanisms by which <ce:italic>T vaginalis</ce:italic> adversely affects birth outcomes by directly causing inflammatory changes in the cervix, decidua, or fetal membranes or by impairing fetal membrane strength and elasticity.<ce:cross-ref refid="bib22"><ce:sup loc="post">22</ce:sup></ce:cross-ref> It is hoped that future studies will shed light on the multiple mechanisms by which <ce:italic>T vaginalis</ce:italic> may affect birth outcomes.</ce:para><ce:para view="all" id="para.0130">Our study did not completely examine the effect of trichomoniasis on preterm delivery as a separate adverse birth outcome. However, the ascertainment of our gestational age data was biased toward healthier babies, as demonstrated by the statistically significant higher frequency of missing gestational age data for LBW infants who required hospitalization. The association observed between trichomoniasis and LBW may be caused by the effects of trichomoniasis on prematurity, and our inability to show this was probably caused by some imprecision and bias in the estimation of gestational age, whereas birth weight was more consistently and accurately measured in our study setting in Kinshasa. Premature rupture of membranes as an adverse outcome also could not be reliably assessed in this study because of the lack of complete data.</ce:para><ce:para view="all" id="para.0135">At the time of data collection for this study and at the present, most pregnant women receiving antenatal care in the Democratic Republic of Congo are not routinely screened serologically for STDs other than syphilis because of a lack of resources. Therefore many STDs, including trichomoniasis and HIV infection, are undetected and untreated during pregnancy, creating missed opportunities for interventions to help improve pregnancy outcomes. An ideal low-cost, culturally acceptable trichomoniasis screening method might consider utilization of self-obtained vaginal or introital specimens for <ce:italic>T vaginalis</ce:italic> culture. Recent studies have shown that these self-obtained introital or vaginal specimens for culture are as valid as clinician-collected specimens and may be more socially and financially acceptable in areas with limited resources or in groups in which speculum examinations are not feasible.<ce:cross-refs refid="bib10 bib25 bib26"><ce:sup loc="post">10,25,26</ce:sup></ce:cross-refs></ce:para><ce:para view="all" id="para.0140">As in the Democratic Republic of Congo, The American College of Obstetricians and Gynecologist’s recommendations for prenatal care screening in the United States do not include routine screening for vaginal trichomoniasis; trichomoniasis had not, until recently, been documented to be highly prevalent among pregnant US women or to significantly affect birth outcomes. Women are evaluated and treated for trichomoniasis in the United States on the basis of symptoms or findings of a routine Papanicolaou smear. The findings from this and previous studies suggest a need to evaluate screening for trichomoniasis as part of routine prenatal care. 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<ce:italic>Trichomonas vaginalis</ce:italic> prevalence</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Lancet</sb:maintitle></sb:title><sb:volume-nr>345</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>131</sb:first-page><sb:last-page>132</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference></ce:bibliography-sec></ce:bibliography></tail></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Trichomoniasis in pregnant human immunodeficiency virus–infected and human immunodeficiency virus–uninfected Congolese women: Prevalence, risk factors, and association with low birth weight</title></titleInfo><name type="personal"><namePart type="given">Madeline Y.</namePart><namePart type="family">Sutton</namePart><namePart type="termsOfAddress">MD, MPHa</namePart><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Maya</namePart><namePart type="family">Sternberg</namePart><namePart type="termsOfAddress">PhDa</namePart><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Malanda</namePart><namePart type="family">Nsuami</namePart><namePart type="termsOfAddress">MD, MPHb</namePart><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Frieda</namePart><namePart type="family">Behets</namePart><namePart type="termsOfAddress">MPHb</namePart><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ann Marie</namePart><namePart type="family">Nelson</namePart><namePart type="termsOfAddress">MDb, c</namePart><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael E.</namePart><namePart type="family">St. Louis</namePart><namePart type="termsOfAddress">MDa, b</namePart><affiliation>Atlanta, Georgia, Washington, D.C., and Kinshasa, Democratic Republic of Congo</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1999</dateIssued><dateModified encoding="w3cdtf">1998-09-29</dateModified><copyrightDate encoding="w3cdtf">1999</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: Objective: We sought to assess the prevalence of and risk factors for vaginal trichomoniasis in human immunodeficiency virus–infected and human immunodeficiency virus–uninfected pregnant Congolese women and its relationship to pregnancy outcomes. Study Design: We performed a nested case-control study of 215 infected and 206 uninfected mothers who responded to questionnaires, underwent sexually transmitted disease testing (including culture for trichomoniasis shortly after delivery), and underwent assessment of infant outcomes. Maternal variables and birth outcomes were assessed according to presence or absence of trichomoniasis and human immunodeficiency virus. Results: Trichomoniasis was present in 18.6% of human immunodeficiency virus–positive and 10.2% of human immunodeficiency virus–negative women, respectively (odds ratio, 2.0; 95% confidence interval, 1.1-3.6), and was significantly associated with low birth weight (odds ratio, 2.4; 95% confidence interval, 1.2-4.5). In multivariate analyses trichomoniasis remained associated with low birth weight, and adjustments were made for other risk factors associated with low birth weight. Conclusion: These findings suggest an association between trichomoniasis and low birth weight independent of human immunodeficiency virus infection and other risk factors. Further studies are needed to assess the impact of antenatal screening and treatment for trichomoniasis on pregnancy outcomes. (Am J Obstet Gynecol 1999;181:656-62.)</abstract><note>From the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention,a Projet SIDA (Project AIDS),b and the Armed Forces Institute of Pathology.c</note><note>Reprint requests: Madeline Y. Sutton, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-02, Atlanta, GA 30333.</note><note>6/1/99914</note><note type="content">Table I: Selected characteristics of HIV-infected and uninfected study patients stratified by T vaginalis infection status</note><note type="content">Table III: Risk factors for LBW outcome among parturient women in Kinshasa from 1989-1990*</note><subject lang="en"><genre>Keywords</genre><topic>Human immunodeficiency virus</topic><topic>low birth weight</topic><topic>trichomoniasis</topic></subject><relatedItem type="host"><titleInfo><title>American Journal of Obstetrics and Gynecology</title></titleInfo><titleInfo type="abbreviated"><title>YMOB</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">199909</dateIssued></originInfo><identifier type="ISSN">0002-9378</identifier><identifier type="PII">S0002-9378(05)X7095-8</identifier><part><date>199909</date><detail type="volume"><number>181</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue-pages"><start>22A</start></extent><extent unit="issue-pages"><start>513</start><end>770</end></extent><extent unit="pages"><start>656</start><end>662</end></extent></part></relatedItem><identifier type="istex">DB8180086B3D229A12850E33BBFC2A1931F663F8</identifier><identifier type="ark">ark:/67375/6H6-SZ6LW52X-8</identifier><identifier type="DOI">10.1016/S0002-9378(99)70509-0</identifier><identifier type="PII">S0002-9378(99)70509-0</identifier><identifier type="ArticleID">99914</identifier><accessCondition type="use and reproduction" contentType="copyright">©1999 Mosby, Inc.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Mosby, Inc., ©1999</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/DB8180086B3D229A12850E33BBFC2A1931F663F8/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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