Reproductive
Influence of preconception Chlamydia trachomatis seropositivity on fecundability, pregnancy loss and live birth among women attempting pregnancy with a history of pregnancy loss Yajnaseni Chakraborti* Yajnaseni Chakraborti Stefanie N. Hinkle Jørgen Skov Jensen Catherine L. Haggerty Toni Darville Sunni L. Mumford Enrique F Schisterman Brandie De Paoli Taylor
Background: Chlamydia trachomatis (CT) can lead to innate-immune dysregulation and is associated with tubal factor infertility, yet the impact of prior exposure to CT on other reproductive outcomes is understudied. Given the unprecedented increase in CT infections in the U.S. and the high prevalence of pregnancy loss, we examined the association between CT seropositivity and conception, live birth, and pregnancy loss.
Method: Using data (n=1228) from a prospective cohort study – the Effect of Aspirin in Gestation and Reproduction (EAGeR), preconception CT seropositivity was determined using a multi-peptide ELISA test at baseline. Time-to pregnancy (fecundability) defined as number of menstrual cycles to β-hCG-detected pregnancy, was modeled using discrete Cox proportional hazard models, accounting for left truncation and right censoring. Live births were determined from medical records, and pregnancy loss was defined as any loss post positive β-hCG test. Inverse-probability (via a Generalized Boosted Model) weighted quasi-Poisson and unweighted log-binomial models, were used for assessing risks of pregnancy loss and reduced live birth, respectively. All models were adjusted for baseline demographic and reproductive history variables.
Results: Seropositivity (~11%) was associated with a reduction in live birth (RR: 0.66, 95% CI: 0.50,0.87), and an increased risk of pregnancy loss (RR: 1.15, 95% CI: 1.05,1.26), but was not associated with reduced fecundability (HR: 0.83, 95% CI: 0.63,1.08).
Conclusions: The above findings support our overarching hypothesis that prior exposure to CT among women with a history of pregnancy loss may impact future reproductive outcomes. This is important as therapies to target recurrent pregnancy loss are limited. Our results edict the need of future studies exploring mechanisms by which CT may influence long-term reproductive function, as this may identify treatments to improve outcomes among those with a history of infection.