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Evaluating Chlamydia trachomatis and Neisseria gonorrhoeae screening among asymptomatic pregnant women to prevent preterm birth and low birth weight in Gaborone, Botswana: A non-randomized, cluster-controlled trial.
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  • Adriane Wynn,
  • Aamirah Mussa,
  • Rebecca Ryan,
  • Chibuzor M. Babalola,
  • Emily Hansman,
  • Kehumile Ramontshonyana,
  • Lefhela Tamuthiba,
  • Neo Ndlovu,
  • Melissa Wilson,
  • Doreen Ramogola-Masire,
  • Jeffrey D. Klausner,
  • Chelsea Morroni
Adriane Wynn
University of California San Diego

Corresponding Author:[email protected]

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Aamirah Mussa
Botswana-Harvard AIDS Institute Partnership
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Rebecca Ryan
Botswana-Harvard AIDS Institute Partnership
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Chibuzor M. Babalola
University of Southern California Keck School of Medicine
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Emily Hansman
University of California Los Angeles David Geffen School of Medicine
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Kehumile Ramontshonyana
Botswana-Harvard AIDS Institute Partnership
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Lefhela Tamuthiba
Botswana-Harvard AIDS Institute Partnership
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Neo Ndlovu
Botswana-Harvard AIDS Institute Partnership
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Melissa Wilson
University of Southern California Keck School of Medicine
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Doreen Ramogola-Masire
University of Botswana
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Jeffrey D. Klausner
University of Southern California Keck School of Medicine
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Chelsea Morroni
Botswana-Harvard AIDS Institute Partnership
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Abstract

ABSTRACT Objective To evaluate the impact of screening and treating asymptomatic pregnant women for C. trachomatis and N. gonorrhoeae infections on the frequency of preterm birth or low birth weight infants in Botswana. Design Non-randomized, cluster-controlled trial. Setting Four antenatal care clinics in Gaborone, Botswana. Population Pregnant women aged ≥15 years, attending a first antenatal care visit, ≤27 weeks gestation, and without urogenital symptoms were eligible. Methods Participants in the intervention clinics received screening (GeneXpert®, Cepheid) during pregnancy and at the post-natal visit. Participants in the standard-of-care clinics received screening at the postnatal visit only. We used multivariable logistic regression and post-estimation predictive margins analysis. Post-hoc analysis was conducted among sub-samples stratified by parity. Main outcome measures Preterm birth (<37 weeks gestation) and low birth weight (<2500g). Results After controlling for parity, hypertension, antenatal care visits, and clinic site, the predicted prevalence of preterm or low birth weight was lower in the intervention arm (11%) compared to the standard-of-care (16%) (AOR: 0.59; 95% CI: 0.28 to 1.24), but confidence intervals were wide. In post-hoc analysis, the intervention was more effective than the standard-of-care (AOR: 0.20; 95% CI: 0.07-0.64) among nulliparous participants. Conclusion A C. trachomatis and N. gonorrhoeae infection screening and treatment intervention among asymptomatic pregnant women did not significantly reduce preterm or low birth weight outcomes. Post hoc analysis found the intervention reduced adverse outcomes among nulliparous participants.
07 Aug 2023Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
11 Aug 2023Submission Checks Completed
11 Aug 2023Assigned to Editor
11 Aug 2023Review(s) Completed, Editorial Evaluation Pending
18 Aug 2023Reviewer(s) Assigned
09 Nov 2023Editorial Decision: Revise Major