A Propensity Score Matching Analysis of Selected Maternal Sexually Transmitted Diseases and Preterm Birth in the United States, 2016 to 2018 Open Access

Cao, Yichun (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/6q182m19n?locale=en
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Abstract

Background: Preterm birth, defined as gestational age less than 37 complete weeks, is an important public health outcome. This thesis consists of fifteen substudies: each substudy examined the association between preterm birth and each of five maternal sexually transmitted diseases (STDs) acquired prior to pregnancy from 2016 to 2018. STDs examined were hepatitis B and C, gonorrhea, syphilis and chlamydia.

Methods: Data were taken from National Center of Health Statistics (NCHS) natality database. The participants of this study consisted of married and unmarried women who had a live birth from 2016 to 2018. The relative risk (RR) of preterm birth was calculated for each of the five STDs. To control for confounding, a propensity score was estimated for each STD using known confounders available in the same database, and women with similar propensity scores were matched. The analysis was conducted separately for each of the three years -- 2016, 2017 and 2018 -- to check the reliability of the RR estimate.

Results: In 2018, 11.24% of the births in the original (unmatched) population were preterm. Hepatitis C had the highest risk ratio associated with preterm birth (aRR: 1.39, 95% CI: 1.33 to 1.46), followed by syphilis (aRR: 1.34, 95% CI: 1.22 to 1.49), gonorrhea (aRR: 1.23, 95% CI: 1.16 to 1.31), chlamydia (aRR: 1.18, 95% CI: 1.15 to 1.21) and hepatitis B (aRR: 1.10, 95% CI: 1.01 to 1.20). The findings in 2016 and 2017 were similar.

Conclusions: After adjusting for confounders collected in the NCHS database, women with hepatitis B, hepatitis C, gonorrhea, syphilis or chlamydia had a higher risk of preterm birth every year from 2016 to 2018. In all three years, infection with hepatitis C had the highest risk ratio. Tailoring public health prevention strategies to individuals with STDs is needed to mitigate the risk of preterm birth.

Table of Contents

Introduction..........................................................................................................................1

Methods................................................................................................................................3

Data Sources and Participants..............................................................................................3

Overcomes............................................................................................................................3

Statistical Analysis...............................................................................................................4

Results..................................................................................................................................5

Discussion............................................................................................................................9

References..........................................................................................................................34

Tables and Figures

Tables.................................................................................................................................11

Table 1: 2016 Baseline Characteristics...............................................................................11

Table 2: 2017 Baseline Characteristics...............................................................................16

Table 3: 2018 Baseline Characteristics...............................................................................21

Table 4: Risk Ratios of Preterm Birth.................................................................................26

Supplement Table: Missing Value......................................................................................27

Figures................................................................................................................................30

Figure 1: Flow Diagram.......................................................................................................30

Figure 2: Success of Propensity Score Matching.................................................................31

Figure 3: Risk Ratios of Preterm Birth................................................................................33

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