Maternal Chlamydia Infection During Pregnancy Among Younger Mothers and Risk of Gastroschisis in Singleton Births Open Access

Abstract

BACKGROUND: Gastroschisis is a congenital birth defect characterized by the protrusion of the intestines through an opening in the abdominal wall and without a membrane covering. Prevalence of gastroschisis has been increasing in the United States (US) since the 1980s and younger women are at increased risk for delivering offspring with gastroschisis. Genital infection with Chlamydia, a bacterial sexually-transmitted disease, has also been increasing in prevalence over the last several years worldwide, particularly among young women. The etiology of gastroschisis is unknown, ongoing research suggests multiple causal factors may be involved, including infectious agents such as Chlamydia.

METHODS: We conducted a case-control study to examine the association between prenatal Chlamydia exposure in women 16 to 25 years of age and gastroschisis in their offspring (restricting to singleton births) from the 2014 US vital statistics data. Cases consisted of live births with gastroschisis (n=806) and controls were singleton births with no major birth defects (n=1,260,293). We performed unconditional logistic regression analysis to estimate crude and adjusted odds ratios (cOR and aOR) and 95% confidence intervals (CI) for all gastroschisis combined and isolated gastroschisis (without other selected major congenital malformations).

RESULTS: Among all cases, 4.5% of women reported an infection with Chlamydia during pregnancy compared to 3.6% of control women (P=0.21). Women who delivered babies with gastroschisis were significantly more likely to be younger (16-20 years of age) at the time of delivery compared to control mothers (P<0.0001). Our unadjusted analysis did not yield a statistically significant association between maternal exposure to Chlamydia and gastroschisis, either among all gastroschisis cases (cOR=1.24; 95% CI=0.89, 1.73) or isolated gastroschisis cases (cOR=1.24; 95% CI=0.88, 1.74). The effect estimates were further attenuated after controlling for potential confounders (all gastroschisis: aOR=1.06; 95% CI=0.66, 1.70 and isolated gastroschisis aOR=1.08; 95% CI=0.67, 1.73).

CONCLUSION: Our study was based on recent data including births occurring in the US in 2014. We were unable to find support for our hypothesis that there is a significant positive association between prenatal exposure to Chlamydia and gastroschisis in the offspring born to younger mothers in the US. We recommend that future studies investigate the hypothesis using other population-based studies.

Table of Contents

INTRODUCTION....................................................................................................1

METHODS.............................................................................................................8

RESULTS...............................................................................................................12

DISCUSSION.........................................................................................................15

REFERENCES........................................................................................................21

Table 1.................................................................................................................26

Table 2a...............................................................................................................28

Table 2b...............................................................................................................30

Table 3.................................................................................................................32

Table 4.................................................................................................................34

Table 5.................................................................................................................36

APPENDIX SAS CODES.........................................................................................38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	gastroschisis maternal chlamydia
Committee Chair / Thesis Advisor	Kancherla, Vijaya , Emory University
Committee Members	Binongo, Jose N, Emory University

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