Teasdale_columbia_0054D_12777.pdf [article]

2017
Pregnancy and acquisition of sexually transmitted infections: risk behaviors and incidence Chloe A. Teasdale This dissertation had three primary aims. The first aim was to systematically review evidence documenting incidence of sexually transmitted infections (STI) during pregnancy. Eighteen papers were included in the final review which reported incidence of five STIs: chlamydia, gonorrhea, human papillomavirus (HPV), herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus (HIV).
more » ... he review found that there are very limited data on incidence of STIs during pregnancy and even fewer data comparing risk between pregnant and non-pregnant women. Although data are limited, studies suggest that women continue to acquire STIs during pregnancy, with incidence varying by type of infection, population of interest and geographic setting. Highest incidence was found for HPV and chlamydia although some studies of chlamydia showed low proportions of pregnant women infected. Studies in which partners were known to be infected with HSV-2 and HIV showed higher rates of acquisition in pregnant women compared to studies where partner status was not known. The second aim of this dissertation was to describe the impact of pregnancy on behavioral risk factors and vaginal practices that are associated with increased risk of STI acquisition. Data for this and the following aim came from the Methods for Improving Reproductive Health in Africa (MIRA) study, a randomized clinical trial conducted in South Africa and Zimbabwe 2003-2006. The analysis for the second aim included women in the MIRA trial who had a pregnancy during follow-up. Pregnancy was found to decrease sexual activity, particularly in the third trimester, but women were more likely to report sex without condoms while pregnant. There were lower reports by women during pregnancy of other risk factors for STI acquisition, including anal sex, concurrent sexual relationships and new sex partners. Vaginal wiping and insertion of material into the vagina, potentially important mechanisms for Appendix 3.1 Characteristics at enrollment, MIRA subjects included in the analysis and those excluded, N=4,802___________________________________________________________________________138 Appendix 4.1 Enrollment characteristics enrollment of 4,935 MIRA participants included excluded in analysis ___________________________________________________________________________140 Appendix 4.2 Risk behaviors reported at follow-up visits by 4,549 women and the association with pregnancy status using the broader definition of pregnancy (unadjusted odds ratios) (N=24,337 visits) ____________________________________________________________________142 Appendix 4.3 Incidence rates of four STIs by pregnancy and hormonal contraceptive exposure group _____________________________________________________________________________144 Appendix 4.4a Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident chlamydia infections using broader definition of pregnancy (all lab and reported) (N=4,549) _________________________________________________________________________145 Appendix 4.4b Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident gonorrhea infections using broader definition of pregnancy (all lab and reported) (N=4,549) _________________________________________________________________________146 iv Appendix 4.4c Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident trichomoniasis infections using broader definition of pregnancy (all lab and reported) (N=4,549) _________________________________________________________________________147 Appendix 4.4d Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident HI infections using broader definition of pregnancy (all lab and reported) (N=4,549) _________________________________________________________________________148 Appendix 4.5a Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident chlamydia infections using only those women with complete data (N=3,518) _________________________________________________________________________149 Appendix 4.5b Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident gonorrhea infections using only those women with complete data (N=3,518) _________________________________________________________________________150 Appendix 4.5c Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident trichomoniasis infections using only those women with complete data (N=3,518) _________________________________________________________________________151 Appendix 4.5d Unadjusted and adjusted hazard ratios estimating the relationship between pregnancy status and incident HIV infections using only those women with complete data (N=3,518) _________________________________________________________________________152 Appendix 4.6 Enrollment characteristics and risk behaviors reported at follow-up visits by 4,549 women and the association with location (N=24,337 visits) __________________________________153 Appendix 4.7 Incidence rates of four STIs by pregnancy and hormonal contraceptive exposure group by location_________________________________________________________________________153 Appendix 4.8 Post-hoc power calculations_______________________________________________154 v
doi:10.7916/d85x2hkg fatcat:rlcqed3zt5bilokyvbmko5elau