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Associations of Chlamydia Trachomatis Serology with Fertility-Related and Pregnancy Adverse Outcomes: A Systematic Review and Meta-Analysis of Observational Studies
19 Pages Posted: 22 Mar 2023
More...Abstract
Background: Chlamydia trachomatis (CT) infection has an increased risk for fertility-related and pregnancy adverse outcomes partly due to mechanism related to pro-inflammatory response to CT-, or cHSP60-induced delayed hypersensitivity. This study was aimed to uptake the evidence on association between CT serology with the adverse outcomes.
Methods: PubMed/Medline, Embase and Web of Science databases were searched for observational studies on association of CT-specific antibodies with infertility, tubal factor infertility (TFIF), ectopic pregnancy (EP), spontaneous abortion (SA), or preterm labor (PL) that were published from the database inception to 31 August 2022. Pooled adjusted odds ratios or relative risks with corresponding 95% confidence intervals were calculated using a random effects model. This study was registered with PROSPERO (CRD42022368366).
Findings: We identified 128 studies met the inclusion criteria, comprising 87 case-control, 34 cross-sectional and 7 cohort studies, to have 167 records involving 128 625 participants for including into meta-analyses. Based on the adjusted estimates, it was found that CT-specific IgG was significantly associated with TFIF (pooled adjusted OR=1.83, 95% CI 1.15-2.93) or EP (pooled adjusted OR=3.67, 95% CI 1.91-7.05). Analyses of the unadjusted estimates indicated the significant associations between CT-specific IgG and infertility, TFIF, EP or SA (pooled unadjusted OR ranging between 1.63 and 5.31); IgA and infertility, TFIF, EP (pooled unadjusted OR ranging between 3.64 and 4.93); IgM and TFIF (pooled unadjusted OR=5.70, 95% CI 1.58-20.56); or cHSP60 and TFIF (pooled unadjusted OR=7.43, 95% CI 5.81-9.49).
Interpretation: There is a broad range of CT-specific antibodies studied in association with fertility-related and pregnancy adverse outcomes. However, our study identified a low- or moderate-quality evidence for association of CT serology with the outcomes. There are substantial research gaps in relation to clinical implications of CT serological biomarkers for management of the outcomes.
Funding: The work was supported by the Chinese Academy of Medical Sciences Initiative for Innovative Medicine (2016-I2M-3-021).
Declaration of Interest: We declare no competing interests.
Keywords: Chlamydia trachomatis, serology, outcome, meta-analysis
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