Sexually transmitted diseases and pregnancy-related infections remain amongst the most neglected health issues throughout history and continue to be one of the most common reasons for early mortality in mothers and pregnant females. Multiple surveys and global statistics have shown high rates of maternal and infant deaths throughout the world, and the burden continues to increase. (1) One of the infections which is more closely associated with mortality and morbidity in new mothers and infants is Chlamydia Trachomatis. This article explores the risks and possible compilations in females testing positive for Chlamydia while pregnant.
What is Chlamydia, and How Does It Affect The Body?
Chlamydia Trachomatis is amongst the most common types of sexually transmitted diseases all over the world. According to the World Health Organization, at least 130 individuals get infected with Chlamydia every year. This is a unique bacteria which is able to affect the human epithelial cells and may exist in the body in both resting and infectious forms. (2) (3) It has the ability to not only prevent detection by the host immune cells but also their attempt of removal – which ultimately results in complications and adverse symptoms. It may remain symptomless in females, however in other cases; it may present with the following common symptoms:
- Cervicitis
- Urethritis
- Pelvic Inflammatory Disease
- Salpingitis
- Endometritis
- Tuboovarian Abscess
- Pelvic Peritonitis
- Perihepatitis
- Periappendicitis
Complications Of Contracting Chlamydia in Pregnancy
Females who contract Chlamydia while pregnant may be at risk for a number of negative consequences to their and their baby’s health. Since this infection closely infects the reproductive tract, it may lead to adverse pregnancy outcomes, which may include stillbirths, miscarriage and early labour. (4) (5)
Studies have shown that pregnant females who tested positive for chlamydia infection may encounter a sudden termination of their pregnancy before they reach the gestational age of 24 weeks. They may also experience stillbirth, where the fetus in their womb may die before reaching 28 weeks of gestation. Chlamydia trachomatis may also lead to placental damage and severe maternal illness, which may cause preterm labour before the baby reaches 37 weeks of gestation. The exact mechanism through which Chlamydia infection is able to lead to all these complications has been vastly studied in the past few years. While it is still not completely understood, certain experts believe that it may be due to infection of the fetus. When the fetus gets infected with Chlamydia, it may lead to a strong inflammatory response causing large numbers of cytokines to be released. These cytokines may eventually cause rupture of the membranes, miscarriage or even premature labour. (6)
Stillbirths After Contracting Chlamydia in Pregnancy
Maternal infection with Chlamydia while pregnant is considered one of the more common causes of stillbirths. Data shows that this may be a cause of up to 50% of the cases of stillbirths in low-income countries, while it is a cause of 10 to 25% of stillbirths in high-income countries. Numerous studies have investigated the association between maternal Chlamydia infection and stillbirths. One such study showed at least 33.3% of the cases with mothers having stillbirths were found to contain the Chlamydia Trachomatis antibodies in their systems. (7) (8)
Ectopic Pregnancy After Contracting Chlamydia While Pregnant
Infections of the genital tract that eventually lead to conditions like pelvic inflammatory disease have been considered a significant cause of Ectopic pregnancies. This is because infections like Chlamydia can lead to severe damage to the tubal structures of the genital tract, which may cause tubal infertility and increase the chances of the embryo getting implanted at the incorrect sites. Some studies show that sexually transmitted infections like these may increase the chances of ectopic pregnancy by 3 to 4 times. (9) In other studies, the association between ectopic pregnancies and Chlamydia infection was proven by the females with ectopic pregnancies testing positive for the Chlamydia antibodies, Chlamydia antigenic material and Chlamydial heat shock proteins. (10)
Premature Labor In Females Contracting Chlamydia While Pregnant
Early labour, also referred to as preterm or premature labour, may be caused by a number of factors – one of which is getting infected with Chlamydia while pregnant. Studies show that females infected with genital tract infections may be at a 40% greater risk for preterm birth than a pregnant female who is not infected. This makes infections like Chlamydia trachomatis an important contributing factor to early labour. (11) (12)
Complications in Babies when Mothers Contract Chlamydia in Pregnancy
Chlamydia Trachomatis can be a great source of distress for the expecting female and may affect their fertility and labour. However, this infection is not only a source of morbidity for the mother and the baby while in the womb, but it may also lead to negative effects on the baby after it comes into the world. This is because of the vertical transmission of Chlamydia from the mother to the child. Data shows that more than 50% of females who have Chlamydia at the time of labour are able to transfer the infection to the newborn. The vertical transmission of Chlamydia may lead to Conjunctivitis in 30 to 50% of the babies, while at least 10 t 20% may suffer from pneumonia. (13)
Neonatal Conjunctivitis With Mothers Contracting Chlamydia While Pregnant
Neonatal Conjunctivitis in babies whose mothers are infected with Chlamydia while pregnant is also referred to as Chlamydial Conjunctivitis. This form of Conjunctivitis may be seen to develop after one to two weeks in the babies. The symptoms may vary from case to case. The mild symptoms may include a conjunctival infection with minor discharge, while a severe infection may include mucopurulent Conjunctivitis, which occurs alongside pseudomembranous formation. (14) Scarring and vision loss are other rare complications of neonatal Conjunctivitis. Neonatal Pneumonia With Mothers Contracting Chlamydia While Pregnant
New pneumonia mothers who get infected with Chlamydia while pregnant are said to have chlamydial pneumonia. Babies with neonatal pneumonia may start to show symptoms by the time they reach their first month of life. Some babies may take as long as three months before showing their first symptom. (15) While Chlamydia pneumonia is afebrile in most babies, those born prematurely may demonstrate more severe symptoms. 25% of premature babies with chlamydial pneumonia may also require hospitalization. (16)
Ways To Prevent Complications Of Chlamydia While Pregnant
One of the most effective ways to prevent complications of Chlamydia in females who are pregnant is to get an early antenatal screening and early treatment. With the increasing cases of Chlamydial complications, more and more studies have been conducted on the advantages of antenatal screening and early treatment of Chlamydia while pregnant. (17) Since it is a sexually transmitted infection, one may pay special attention to other preventative measures include using protection before any sexual activity and refraining from sharing sex toys.
The Bottom Line
Females who get infected with Chlamydia while pregnant are not only at risk for complications related to their own health, but it may also end up endangering their babies. These complications may include stillbirth, miscarriage, preterm labour, neonatal Conjunctivitis and pneumonia. This is why there is a need for awareness about the importance of early screening and treatment of Chlamydia in the general public.
References
Glasier, A., Gülmezoglu, A. M., Schmid, G. P., Moreno, C. G., & Van Look, P. F. (2006). Sexual and reproductive health: a matter of life and death. Lancet (London, England), 368(9547), 1595–1607. https://doi.org/10.1016/S0140-6736(06)69478-6
Paavonen, J., & Eggert-Kruse, W. (1999). Chlamydia trachomatis: impact on human reproduction. Human reproduction update, 5(5), 433–447. https://doi.org/10.1093/humupd/5.5.433
Currie, M. J., & Bowden, F. J. (2007). The importance of chlamydial infections in obstetrics and gynaecology: an update. The Australian & New Zealand journal of obstetrics & gynaecology, 47(1), 2–8. https://doi.org/10.1111/j.1479-828X.2006.00670.x
McGregor, J. A., French, J. I., Lawellin, D., & Todd, J. K. (1988). Preterm birth and infection: pathogenic possibilities. American journal of reproductive immunology and microbiology : AJRIM, 16(3), 123–132. https://doi.org/10.1111/j.1600-0897.1988.tb00181.x
Baud, D., Regan, L., & Greub, G. (2008). Emerging role of Chlamydia and Chlamydia-like organisms in adverse pregnancy outcomes. Current opinion in infectious diseases, 21(1), 70–76. https://doi.org/10.1097/QCO.0b013e3282f3e6a5
Baud, D., & Greub, G. (2011). Intracellular bacteria and adverse pregnancy outcomes. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 17(9), 1312–1322. https://doi.org/10.1111/j.1469-0691.2011.03604.x
Gencay, M., Koskiniemi, M., Ammälä, P., Fellman, V., Närvänen, A., Wahlström, T., Vaheri, A., & Puolakkainen, M. (2000). Chlamydia trachomatis seropositivity is associated both with stillbirth and preterm delivery. APMIS : acta pathologica, microbiologica, et immunologica Scandinavica, 108(9), 584–588. https://doi.org/10.1034/j.1600-0463.2000.d01-101.x
Slattery, M. M., & Morrison, J. J. (2002). Preterm delivery. Lancet (London, England), 360(9344), 1489–1497. https://doi.org/10.1016/S0140-6736(02)11476-0
Farquhar C. M. (2005). Ectopic pregnancy. Lancet (London, England), 366(9485), 583–591. https://doi.org/10.1016/S0140-6736(05)67103-6
Mårdh P. A. (2002). Influence of infection with Chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring. Best practice & research. Clinical obstetrics & gynaecology, 16(6), 847–864. https://doi.org/10.1053/beog.2002.0329
Baud, D., Regan, L., & Greub, G. (2008). Emerging role of Chlamydia and Chlamydia-like organisms in adverse pregnancy outcomes. Current opinion in infectious diseases, 21(1), 70–76. https://doi.org/10.1097/QCO.0b013e3282f3e6a5
Pararas, M. V., Skevaki, C. L., & Kafetzis, D. A. (2006). Preterm birth due to maternal infection: Causative pathogens and modes of prevention. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 25(9), 562–569. https://doi.org/10.1007/s10096-006-0190-3
Schachter, J., Grossman, M., Holt, J., Sweet, R., Goodner, E., & Mills, J. (1979). Prospective study of chlamydial infection in neonates. Lancet (London, England), 2(8139), 377–380. https://doi.org/10.1016/s0140-6736(79)90400-8
Darville T. (2005). Chlamydia trachomatis infections in neonates and young children. Seminars in pediatric infectious diseases, 16(4), 235–244. https://doi.org/10.1053/j.spid.2005.06.004
Workowski, K. A., Berman, S., & Centers for Disease Control and Prevention (CDC) (2010). Sexually transmitted diseases treatment guidelines, 2010. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 59(RR-12), 1–110.
Schachter, J., Sweet, R. L., Grossman, M., Landers, D., Robbie, M., & Bishop, E. (1986). Experience with the routine use of erythromycin for chlamydial infections in pregnancy. The New England journal of medicine, 314(5), 276–279. https://doi.org/10.1056/NEJM198601303140503
Martin, D. H., Eschenbach, D. A., Cotch, M. F., Nugent, R. P., Rao, A. V., Klebanoff, M. A., Lou, Y., Rettig, P. J., Gibbs, R. S., Pastorek Ii, J. G., Regan, J. A., & Kaslow, R. A. (1997). Double-Blind Placebo-Controlled Treatment Trial of Chlamydia trachomatis Endocervical Infections in Pregnant Women. Infectious diseases in obstetrics and gynecology, 5(1), 10–17. https://doi.org/10.1155/S1064744997000057
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