Article Text
Abstract
Introduction Several bacterial sexually transmitted and genital mycoplasma infections during pregnancy have been associated with poor pregnancy and perinatal outcomes. Comprehensive and systematic information about associations between sexually transmitted infections (STI) and genital infections in pregnancy and adverse perinatal outcomes is needed to improve understanding about the evidence for causal associations between these infections and adverse pregnancy and neonatal outcomes. Our primary objective is to systematically review the literature about associations between: (1) Neisseria gonorrhoeae in pregnancy and preterm birth; (2) Mycoplasma genitalium in pregnancy and preterm birth; (3) M. hominis, Ureaplasma urealyticum and/or U. parvum in pregnancy and preterm birth.
Methods and analysis We will undertake a systematic search of Medline, Excerpta Medica database and the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature. Following an initial screening of titles by one reviewer, abstracts will be independently assessed by two reviewers before screening of full-text articles. To exclude a manuscript, both reviewers need to agree on the decision. Any discrepancies will be resolved by discussion, or the adjudication of a third reviewer. Studies will be included if they report testing for one or more of N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum and/or U. parvum during pregnancy and report pregnancy and/or birth outcomes. In this review, the primary outcome is preterm birth. Secondary outcomes are premature rupture of membranes, low birth weight, spontaneous abortion, stillbirth, neonatal mortality and ophthalmia neonatorum. We will use standard definitions, or definitions reported by study authors. We will examine associations between exposure and outcome in forest plots, using the I2 statistic to examine between study heterogeneity. Where appropriate, we will use meta-analysis to combine results of individual studies.
Ethics and dissemination This systematic review of published literature does not require ethical committee approval. Results of this review will be published in a peer reviewed, open access journal.
PROSPERO registration number CRD42016050962.
- sexually transmitted infections
- adverse pregnancy outcome
- systematic review
- genital mycoplasmas
- preterm birth
- meta analysis
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Footnotes
LMV and DE-G contributed equally.
Contributors LMV is the guarantor of the protocol manuscript. LMV, DE-G, NL and AJV conceived the study and developed the review protocol. CSEH gave advice about the pregnancy outcomes. NL gave advice about the infection outcomes and systematic review methods. HW reviewed and advised on the statistical analyses. LV wrote the first draft of the manuscript. DE-G, NL and AJV helped to revise the manuscript. WP, RG, HW, CSEH, BS, AR and JMK contributed to the development and design of the protocol and in revising the manuscript. All authors read, provided feedback and approved the final manuscript.
Funding LMV receives salary support from the Australian National Health and Medical Research Council (NHMRC), through an early career fellowship. DE-G received salary support from r4d programme (Swiss Programme for Research on Global Issues for Development), grant number IZ07Z0-160909. These funders played no role in the development of the protocol or the planned analyses.
Competing interests None declared.
Patient consent Not required.
Ethics approval This systematic review does not use individual personal data and therefore does not require ethical committee approval.
Provenance and peer review Not commissioned; externally peer reviewed.