Objective
To examine associations between
Neisseria gonorrhoeae
(NG) infection during pregnancy and the risk of
preterm birth, spontaneous abortion, premature
rupture of membranes, perinatal mortality, low
birth weight and ophthalmia neonatorum.
Data sources
We searched Medline, EMBASE, the Cochrane
Library and Cumulative Index to Nursing and Allied
Health Literature for studies published between
1948 and 14 January 2020.
Methods
Studies were included if they reported
testing for NG during pregnancy and compared
pregnancy, perinatal and/or neonatal outcomes
between women with and without NG. Two reviewers
independently assessed papers for inclusion and
extracted data. Risk of bias was assessed using
established checklists for each study design.
Summary ORs with 95% CIs were generated using
random effects models for both crude and, where
available, adjusted associations.
Results
We identified 2593 records and included 30
in meta-analyses. Women with NG were more likely
to experience preterm birth (OR 1.55, 95% CI 1.21
to 1.99, n=18 studies); premature rupture of
membranes (OR 1.41, 95% CI 1.02 to 1.92, n=9);
perinatal mortality (OR 2.16, 95% CI 1.35 to 3.46,
n=9); low birth weight (OR 1.66, 95% CI 1.12 to
2.48, n=8) and ophthalmia neonatorum (OR 4.21,
95% CI 1.36 to 13.04, n=6). Summary adjusted ORs
were, for preterm birth 1.90 (95% CI 1.14 to 3.19,
n=5) and for low birth weight 1.48 (95% CI 0.79 to
2.77, n=4). In studies with a multivariable
analysis, age was the variable most commonly
adjusted for. NG was more strongly associated with
preterm birth in low-income and middle-income
countries (OR 2.21, 95% CI 1.40 to 3.48, n=7) than
in high-income countries (OR 1.38, 95% CI 1.04 to
1.83, n=11).
Conclusions
NG is associated with a number of adverse
pregnancy and newborn outcomes. Further research
should be done to determine the role of NG in
different perinatal mortality outcomes because
interventions that reduce mortality will have the
greatest impact on reducing the burden of disease
in low-income and middle-income
countries.
PROSPERO registration
number
CRD42016050962.