Mycoplasma genitalium in pregnancy, including specific co-infections, is associated with lower birthweight: A prospective cohort study

Michelle J L Scoullar; Pele Melepia; Elizabeth Peach; Ruth Fidelis; Hadlee Supsup; Eliza M Davidson; Philippe Boeuf; Catriona S Bradshaw; Glenda Fehler; Priscah Hezeri; Dukduk Kabiu; Arthur Elijah; Peter M Siba; Elissa C Kennedy; Alexandra J Umbers; Leanne J Robinson; Andrew J Vallely; Steven G Badman; Lisa M Vallely; Freya J I Fowkes; Christopher J Morgan; William Pomat; Brendan S Crabb; James G Beeson

doi:10.1016/j.medj.2024.05.007

Mycoplasma genitalium in pregnancy, including specific co-infections, is associated with lower birthweight: A prospective cohort study

Med. 2024 Sep 13;5(9):1123-1136.e3. doi: 10.1016/j.medj.2024.05.007. Epub 2024 Jun 12.

Authors

Michelle J L Scoullar¹, Pele Melepia², Elizabeth Peach², Ruth Fidelis², Hadlee Supsup³, Eliza M Davidson⁴, Philippe Boeuf², Catriona S Bradshaw⁵, Glenda Fehler⁶, Priscah Hezeri², Dukduk Kabiu², Arthur Elijah⁷, Peter M Siba⁸, Elissa C Kennedy⁹, Alexandra J Umbers², Leanne J Robinson¹⁰, Andrew J Vallely¹¹, Steven G Badman¹², Lisa M Vallely¹², Freya J I Fowkes¹³, Christopher J Morgan¹⁴, William Pomat¹⁵, Brendan S Crabb¹³, James G Beeson¹⁶

Affiliations

¹ Burnet Institute, Melbourne, VIC, Australia. Electronic address: michelle.scoullar@burnet.edu.au.
² Burnet Institute, Melbourne, VIC, Australia.
³ East New Britain Provincial Health Authority, Kokopo, Papua New Guinea.
⁴ Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia.
⁵ University of Melbourne, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, VIC, Australia; Monash University, Clayton, VIC, Australia.
⁶ Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, VIC, Australia.
⁷ School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
⁸ Center for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea.
⁹ Burnet Institute, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹⁰ Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Monash University, Clayton, VIC, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
¹¹ Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; The Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
¹² The Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
¹³ Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Monash University, Clayton, VIC, Australia.
¹⁴ Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Jhpiego, a Johns Hopkins University affiliate, Baltimore, MD, USA.
¹⁵ Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
¹⁶ Burnet Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, Australia; Monash University, Clayton, VIC, Australia. Electronic address: james.beeson@burnet.edu.au.

PMID: 38870930
DOI: 10.1016/j.medj.2024.05.007

Abstract

Background: Mycoplasma genitalium infection in pregnancy is increasingly reported at similar frequencies to other sexually transmitted infections (STIs). Knowledge on its contribution to adverse pregnancy outcomes is very limited, especially relative to other STIs or bacterial vaginosis (BV). Whether M. genitalium influences birthweight remains unanswered.

Methods: Associations between birthweight and M. genitalium and other STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis) and BV in pregnancy were examined in 416 maternal-newborn pairs from a prospective cohort study in Papua New Guinea.

Findings: Compared to uninfected women, M. genitalium (-166.9 g, 95% confidence interval [CI]: -324.2 to -9.7 g, p = 0.038) and N. gonorrhoeae (-274.7 g, 95% CI: -561.9 to 12.5 g, p = 0.061) infections were associated with lower birthweight in an adjusted analysis. The association for C. trachomatis was less clear, and T. vaginalis and BV were not associated with lower birthweight. STI prevalence was high for M. genitalium (13.9%), N. gonorrhoeae (5.0%), and C. trachomatis (20.0%); co-infections were frequent. Larger effect sizes on birthweight occurred with co-infections of M. genitalium, N. gonorrhoeae, and/or C. trachomatis.

Conclusion: M. genitalium is a potential contributor to lower birthweight, and co-infections appear to have a greater negative impact on birthweight. Trials examining the impact of early diagnosis and treatment of M. genitalium and other STIs in pregnancy and preconception are urgently needed.

Funding: Funding was received from philanthropic grants, the National Health and Medical Research Council, and the Burnet Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Keywords: Mycoplasma genitalium; Papua New Guinea; Translation to patients; bacterial vaginosis; birthweight; co-infections; low birth weight; pregnancy; sexually transmitted infections; small vulnerable newborns.

MeSH terms

Adult
Birth Weight
Coinfection* / epidemiology
Female
Gonorrhea / epidemiology
Humans
Infant, Low Birth Weight
Infant, Newborn
Mycoplasma Infections* / epidemiology
Mycoplasma genitalium* / isolation & purification
Papua New Guinea / epidemiology
Pregnancy
Pregnancy Complications, Infectious* / epidemiology
Pregnancy Complications, Infectious* / microbiology
Prevalence
Prospective Studies
Vaginosis, Bacterial / epidemiology
Vaginosis, Bacterial / microbiology
Young Adult