DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194363

Prevalence of Chlamydia pneumoniae seropositivity in early pregnancy and its association with preeclampsia among primigravidae in Indian population

Lavi Sindhu, Bindoo Yadav, Aruna Batra

Abstract


Background: Preeclampsia (PE) is a multifactorial disease that might be caused by a concurrent or preceding inflammatory stimulus. Inflammatory changes similar to those reported in chronic Chlamydia pneumoniae infection are seen in PE. It is suggested that persistent or chronic Chlamydia pneumoniae infection might have a role in the pathogenesis of PE and antichlamydial treatment in early pregnancy may prevent reactivation of infection and hence the development of preeclampsia.

Methods: This randomized interventional study was conducted to determine the prevalence of C.pneumoniae IgG seropositivity in early pregnancy, its association with PE and the effect of treatment with oral azithromycin. A total of 330 primigravidae included in the study were followed up till delivery. C.pneumoniae IgG antibodies measured by ELISA technique at 14-20 weeks of gestation revealed seropositivity in 32.4%. These women were at higher risk of developing severe PE (odds’ ratio 3.2) as compared to the C. pneumoniae seronegative cases.

Results: Treatment with oral azithromycin resulted in reduction in the occurrence of PE amongst the C.pneumoniae seropositive cases; as well as significant reduction in the incidence of low birth weight babies in the C.pneumonie seropositive group (p<0.001, ARR= 0.204).

Conclusions: Pregnant women who were C.pneumonia IgG seropositive are at higher risk of developing severe preeclmapsia as compared to the C.pneumoniae seronegative cases. This association needs to be further evaluated.


Keywords


Azithromycin, C.pneumonia, IgG sero-positivity, Prevalence, Pre-eclampsia, Primigravida

Full Text:

PDF

References


Lerberghe WV, Manuel A, Matthews Z. Make every mother and child count. Geneva, Switzerland: World Health Organization; 2005:230.

Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol. 1998;179(5):1359-75.

Roberts JM, Taylor RN, Musci TJ, Rodgers GM, Hubel CA, Mclaughlin MK. Pre-eclampsia: an endothelial cell disorder. Am J Obstet Gynecol. 1989;161(5):1200-4.

Sacks GP, Studena K, Sargent IL, Redman CW. Normal pregnancy and pre-eclampsia both produce inflammatory changes in peripheral blood leukocytes akin to those of sepsis. Am J Obstet Gynecol. 1998;179(1):80-6.

Rustveld LO, Kelsey SF, Sharma R. Association between maternal infections and preeclampsia: a systematic review of epidemiologic studies. Matern Child Health J. 2008; 12(2):223-42.

Conde-Agudelo A, Villar J, Lindheimer M. Maternal infection and risk of preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol. 2008;198(1):7-22.

Kalayoglu MV, Libby P, Byrne GI. Chlamydia pneumoniae as an emerging risk factor in cardiovascular disease. JAMA. 2002;288(21):2724-31.

Gouda EA, Elharoun AS, Abdella MA. Involvement of Chlamydia Pneumoniae in atherosclerosis: Importance of methodology in determination the relation between them. Menoufiya Med J. 2008;21(1):55-66.

Sessa R, Nicoletti M, Di Pietro M, Schiavoni G, Santino I, Zagaglia C, et al. Chlamydia pneumoniae and atherosclerosis: current state and future prospectives. Int J Immunopathol Pharmacol. 2009;22(1):9-14.

Sattar N, Bedomir A, Berry C, Shepherd J, Greer I, Packard CJ. Lipoprotein subfraction concentrations in preeclampsia. Pathogenic parallels to atherosclerosis. Obstet Gynecol. 1997;89(3):403-8.

De Wolf F, Robertson WB, Brosens I. The ultrastructure of acute atherosis in hypertensive pregnancy. Am J Obstet Gynecol. 1975;123(2):164-74.

Dadelszen PV, Magee LA, Krajden M, Alasaly K, Popovska V, Devarakond RM, et al. Levels of antibodies against cytomegalovirus and Chlamydophila pneumoniae are increased in early onset pre-eclampsia. BJOG. 2003;110(8):725-30.

Heine RP, Ness RB, Roberts JM. Seroprevalence of antibodies to Chlamydia pneumonia in women with preeclampsia. Obstet Gynecol. 2003;101(2):221-6.

Goulis DG, Chappell L, Gibbs RG, Williams D, Dave JR, Taylor P, et al. Association of raised titres of antibodies to Chlamydia pneumoniae with a history of pre-eclampsia. BJOG. 2005;112(3):299-305.

Aral M, Guven MA, Kocturk SA. Chlamydia pneumoniae seropositivity in women with preeclampsia. Int J Gynaecol Obstet. 2006;92(1):77-8.

Karinen L, Leinonen M, Bloigu A, Paldanius M, Koskela P, Saikku P, et al. Maternal serum Chlamydia pneumoniae antibodies and CRP levels in women with preeclampsia and gestational hypertension. Hypertens Preg. 2008;27(2):143-58.

El-Shourbagy MA, El-Refaie TA, Sayed KK, Wahba KA, El-Din AS, Fathy MM. Impact of seroconversion and antichlamydial treatment on the rate of pre-eclampsia among Egyptian primigravidae. Int J Gynecol Obstet. 2011;113(2):137-40.

Awoleke JO, Ajayi GO, Adegbola O. Prevalence of Chlamydophila pneumonie antibodies in women with pre-Eclampsia in Lagos, Nigeria. West Afr J Med. 2012;31(4):253-8.

Gomez LM, Parry S. Trophoblast infection with Chlamydia pneumoniae and adverse pregnancy outcomes associated with placental dysfunction. Am J Obstet Gynecol. 2009;200(5):526.

Teran E, Escudero C, Calle A. Seroprevalence of antibodies to Chlamydia pneumoniae in women with preeclampsia. Obstet Gynecol. 2003;102(1):198-9.

Raynor DB, Bonney EA, Jang KT, Coto W, Garcia MS. Preeclampsia and Chlamydia pneumoniae: Is there a link? Hypertens Preg. 2004;23(2):129-34.

Chrisoulidou A, Goulis DG, lliadou PK, Dave JR, Bili H, Simms C, et al. Acute and chronic Chlamydia pneumoniae infection in pregnancy complicated with preeclampsia. Hypertens Preg. 2011;30(2):164-8.

Xie F, Hu Y, Magee LA, Money DM, Patrick DM, Brunham RM, et al. Chlamydia pneumoniae infection in preeclampsia. Hypertens Preg. 2010;29(4):468-77.

Mosbah, Nabiel Y. Helicobacter pylori, Chlamydiae pneumoniae and trachomatis as probable etiological agents of preeclampsia. J Matern Fetal Neonatal Med. 2016;29(10):1607-12.

Bouwman JJ, Visseren FL, Bouter KP, Diepersloot RJ. Infection-induced inflammatory response of adipocytes in vitro. Int J Obes. 2008;32(6):892-901.

Shi Y, Liu Y, Murdin A, Raudonikiene-Mancevski A, Ayach BB, Yu Z, et al. Chlamydophila pneumoniae inhibits differentiation of progenitor adipose cells and impairs insulin signaling. J Infect Dis. 2008;197(3):439-48.