Comparison of Sexually Transmitted Infections and Adverse Perinatal Outcomes in Underserved Pregnant Patients Before vs During the COVID-19 Pandemic in Texas
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Authors
Stafford, Irene A.
Coselli, Jennie O.
Wilson, Danielle F.
Wang, Courtney Y.
Sibai, Baha M.
Issue Date
2022-02-15
Type
Article
Language
en_US
Keywords
Sexually Transmitted Infections , Adverse Perinatal Outcomes , Underserved Pregnant Patients , COVID-19 Pandemic
Alternative Title
Abstract
Introduction:
Before the COVID-19 pandemic, the US experienced record high rates of many reportable sexually transmitted infections (STI).1 The association between the pandemic and STI rates among pregnant women remains understudied, especially for underserved populations of racial and ethnic minority groups who have disproportionately experienced COVID-19 infection.2 We sought to determine rates of STI and associated adverse perinatal outcomes among underserved pregnant patients before (July 2019 to February 2020) and during the pandemic (March 2020 to April 2021) in a public health system in Southeastern Texas.
Methods:
A retrospective cohort study was performed of pregnant patients between July 2019 and April 2021 within a public health system in Southeastern Texas. The University of Texas Health Science Center-McGovern Medical School institutional review board approved this study with waiver of informed consent granted because it involved materials that had been previously collected. Medical record review was performed for all patients who underwent routine STI screening during pregnancy and delivered during the study period. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.
Coprimary outcomes included a comparison of rates of individual and composite STI before the pandemic and during the pandemic along with a composite of STI-associated adverse maternal and neonatal outcomes. Rates of STI according to COVID-19 positive status were also calculated. Demographic, obstetric, and neonatal outcomes were recorded, including antenatal STI and COVID-19 infection (eMethods in the Supplement).
The maternal composite included hypertensive disorders, infectious morbidity, emergency postpartum visits, or death. The neonatal composite included neonatal intensive care admission, 5-minute Apgar score less than 7, sepsis, seizures, necrotizing enterocolitis, intraventricular hemorrhage, hydrops fetalis, or death. The χ2 test and multivariable regression were used for analysis. Models were adjusted for insurance, parity, prenatal care, body mass index, and group B Streptococcus status. Statistical significance was set at a 2-sided unpaired P < .05. Data were analyzed using STATA, version 15.0 (StataCorp).
Results:
The study population included 6413 patients (mean [SD] age, 29.2 [6.6] years), of which 87% (5565) had analyzable data. Of these, 2412 patients (43%) delivered before the pandemic and 3153 patients (57%) delivered during the pandemic. There were no significant differences in baseline demographic and obstetrical variables between groups. Seven percent (226 of 5565) tested positive for COVID-19 infection during pregnancy.
There was no increase in composite or individual STI over time, except for syphilis infection, which nearly doubled across periods (prepandemic, 0.9% [22 of 2412] vs postpandemic, 1.5% [48 of 3152]; P < .004) (adjusted relative risk, 1.73; 95% CI, 1.04-2.86) (Table 1). Syphylis infection tripled among individuals with COVID-19 positivity during the pandemic (COVID-19 negativity, 1.3% [39 of 2936] vs COVID-19 positivity, 4.2% [9 of 216]; P < .001) (adjusted relative risk, 2.82; 95% CI, 1.37-5.79) (Table 2).
Between the prepandemic-and during-pandemic periods, there were no differences in the risk of STI-associated composite maternal adverse outcomes (prepandemic, 11.4% [12 of 105] vs postpandemic, 17.9% [29 of 162]; P = .15) (adjusted relative risk, 1.27; 95% CI, 0.67-2.41). There were no differences in the risk of STI-associated composite neonatal adverse outcomes (prepandemic, 14.3% [15 of 105] vs postpandemic,14.5% [23 of 159]; P = .97) (adjusted risk ratio, 1.02; 95% CI, 0.54-1.93).
Description
Citation
Stafford, I. A., Coselli, J. O., Wilson, D. F., Wang, C. Y., & Sibai, B. M. (2022). Comparison of Sexually Transmitted Infections and Adverse Perinatal Outcomes in Underserved Pregnant Patients Before vs During the COVID-19 Pandemic in Texas. JAMA network open, 5(2), e220568. https://doi.org/10.1001/jamanetworkopen.2022.0568
Publisher
JAMA Network Open