Prevalence of Sexually Transmitted Diseases in Pregnant Women:

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Prevalence of Sexually Transmitted Diseases in
Pregnant Women Miami-Dade County, 2004-2005
Maria Bustamante, MPH, Rodlescia Sneed, MPH, Erin
O'Connell, MPH, Guoyan Zhang, MD, MPH, Fermin
Leguen, MD, MPH Miami-Dade County Health
Department, Florida
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Objectives

• To explore the prevalence of chlamydia,
  gonorrhea, and syphilis during pregnancy among
  women in Miami-Dade County
• To examine associations between STD prevalence
  among pregnant women and age, race/ethnicity,
  marital status, preterm birth, and low birth
  weight

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Background

• Sexually transmitted diseases (STDs) can
  contribute to a number of adverse pregnancy
  outcomes
• Early onset of labor
• Ectopic pregnancy
• Stillbirth
• Low birth weight
• Conjunctival infection of newborn
• The CDC 2006 Guidelines for Treatment of Sexually
  Transmitted Diseases recommend pregnant women be
  screened for STDs on their first prenatal visit
  including
• Chlamydia Hepatitis B
• Gonorrhea Hepatitis C
• Syphilis HIV

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Background

• Chlamydia and gonorrhea
• Transmitted during delivery as baby passes birth
  canal
• Syphilis
• Transmitted during pregnancy by crossing the
  placenta and infecting the baby in the uterus
• All three (chlamydia, gonorrhea, and syphilis)
  can be treated and cured during pregnancy with
  antibiotics
• Estimated number of pregnant women in the United
  States infected each year
• Chlamydia 200,000
• Gonorrhea 40,000
• Syphilis 8,000

Data Source CDC, Division of STD Prevention
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Chlamydia Rates among Females 1996 2005
Data Source CDC (US), FL Dept. of Health
(Miami-Dade and Florida)
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Gonorrhea Rates among Females 1996 2005
Data Source CDC (US), FL Dept. of Health
(Miami-Dade and Florida)
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• Infectious (Primary and Secondary) Syphilis Rates
  among Females 1996 2005

Data Source CDC (US), FL Dept. of Health
(Miami-Dade and Florida)
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Methods

• Data was obtained from live birth certificates
  (2004 revision) for calendar years 2004 and 2005
• 64,410 live births
• Chi-square test was used to examine associations
  between STD prevalence among pregnant women and
• Maternal characteristics ? STDs
• age chlamydia
• race/ethnicity gonorrhea
• marital status syphilis
• Newborn characteristics
• preterm birth (lt37 weeks)
• low birth weight (lt2,500 grams)

Data Source Miami-Dade County Health Department
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Results
Data Source Miami-Dade County Health Department
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p-value lt.001
p-value lt.001
p-value .0147
Data Source Miami-Dade County Health Department
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p-value lt.001
p-value lt.001
p-value lt.001
Data Source Miami-Dade County Health Department
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p-value lt.001
p-value lt.001
p-value lt.001
Data Source Miami-Dade County Health Department
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Prevalence Rates of Low Birth Weight Infants
(lt2,500 grams) by Mother's STD Status
Miami-Dade County, 2004-2005
p-value .0553
p-value .0031
p-value .0008
Data Source Miami-Dade County Health Department
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p-value .0841
p-value .0012
p-value .0029
Data Source Miami-Dade County Health Department
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Conclusions

• There are clear disparities with respect to age,
  race/ethnicity, and marital status for STD
  prevalence during pregnancy
• 10-19 years of age
• Non-Hispanic Blacks and Haitians
• Unwed mothers
• The presence of gonorrhea and syphilis during
  pregnancy can contribute to adverse pregnancy
  outcomes such as low birth weight and preterm
  birth.
• Increased preconception screening for STDs,
  especially in high-risk populations, may prove
  useful
• The new Medical and Health Information section
  on the 2004 revision of the live birth
  certificate concerning infections present and/or
  treated during pregnancy could be useful tool for
  studying STDs among pregnant women

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Limitations

• STDs present and/or treated during pregnancy were
  reported by physician at time of birth
• Mother may have changed providers during
  pregnancy
• Unable to adjust for race/ethnicity when
  examining prevalence rates of preterm births and
  low birth weight by mothers STD status
• Small sample size after stratification by
  race/ethnicity
• Unable to evaluate the sensitivity and
  specificity of birth certificate STD data
• Lack of identifiers on STD Surveillance data,
  unable to link databases

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Number of STD Cases Identified by Data Source