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The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana

BACKGROUND: Vaginal discharge syndrome (VDS) is a common clinical diagnosis during pregnancy in Botswana; it is treated with broad-spectrum antibiotics using a syndromic approach. We evaluated associations between the syndromic management of VDS and adverse birth outcomes. METHODS: The Tsepamo Study...

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Autores principales: Fennell, Christina, Diseko, Modeigi, Zash, Rebecca, Mayondi, Gloria, Mabuta, Judith, Mmalane, Mompati, Davey, Sonya, Luckett, Rebecca, Morroni, Chelsea, Dintwa, Eldah N, Lockman, Shahin, Makhema, Joseph, Caniglia, Ellen, Shapiro, Roger
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351807/
https://www.ncbi.nlm.nih.gov/pubmed/34381845
http://dx.doi.org/10.1093/ofid/ofab366
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author Fennell, Christina
Diseko, Modeigi
Zash, Rebecca
Mayondi, Gloria
Mabuta, Judith
Mmalane, Mompati
Davey, Sonya
Luckett, Rebecca
Morroni, Chelsea
Dintwa, Eldah N
Lockman, Shahin
Makhema, Joseph
Caniglia, Ellen
Shapiro, Roger
author_facet Fennell, Christina
Diseko, Modeigi
Zash, Rebecca
Mayondi, Gloria
Mabuta, Judith
Mmalane, Mompati
Davey, Sonya
Luckett, Rebecca
Morroni, Chelsea
Dintwa, Eldah N
Lockman, Shahin
Makhema, Joseph
Caniglia, Ellen
Shapiro, Roger
author_sort Fennell, Christina
collection PubMed
description BACKGROUND: Vaginal discharge syndrome (VDS) is a common clinical diagnosis during pregnancy in Botswana; it is treated with broad-spectrum antibiotics using a syndromic approach. We evaluated associations between the syndromic management of VDS and adverse birth outcomes. METHODS: The Tsepamo Study performs birth outcomes surveillance at government hospitals throughout Botswana. Obstetric record data collected from August 2014 to March 2019 were analyzed. Chi-square tests were conducted to compare proportions of maternal characteristics and infant outcomes. To avoid immortal time bias, all analyses were conducted among women who presented to care before 24 weeks gestation, with VDS categorized as present or absent by 24 weeks gestation. Log-binomial regression models were generated to determine associations between treated VDS and infant outcomes. RESULTS: VDS was diagnosed in 36 731 (30.7%) pregnant women, of whom 33 328 (90.7%) received antibiotics. Adjusted analyses yielded a harmful association between treated VDS and very preterm delivery (adjusted risk ratio, 1.11; 95% CI, 1.02–1.21). This association remained when restricting to women with VDS who received the recommended antibiotic treatment regimen. Sensitivity analyses produced nonsignificant associations when women with treated VDS were compared with women without VDS who received antibiotics for other indications. CONCLUSIONS: A clinical diagnosis of VDS is common among pregnant women in Botswana, and the majority receive antibiotics in pregnancy. Although analyses of VDS occurring later in pregnancy are precluded by immortal time bias, a modest association between treated VDS and very preterm delivery was observed among women diagnosed with VDS by 24 weeks gestation.
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spelling pubmed-83518072021-08-10 The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana Fennell, Christina Diseko, Modeigi Zash, Rebecca Mayondi, Gloria Mabuta, Judith Mmalane, Mompati Davey, Sonya Luckett, Rebecca Morroni, Chelsea Dintwa, Eldah N Lockman, Shahin Makhema, Joseph Caniglia, Ellen Shapiro, Roger Open Forum Infect Dis Major Articles BACKGROUND: Vaginal discharge syndrome (VDS) is a common clinical diagnosis during pregnancy in Botswana; it is treated with broad-spectrum antibiotics using a syndromic approach. We evaluated associations between the syndromic management of VDS and adverse birth outcomes. METHODS: The Tsepamo Study performs birth outcomes surveillance at government hospitals throughout Botswana. Obstetric record data collected from August 2014 to March 2019 were analyzed. Chi-square tests were conducted to compare proportions of maternal characteristics and infant outcomes. To avoid immortal time bias, all analyses were conducted among women who presented to care before 24 weeks gestation, with VDS categorized as present or absent by 24 weeks gestation. Log-binomial regression models were generated to determine associations between treated VDS and infant outcomes. RESULTS: VDS was diagnosed in 36 731 (30.7%) pregnant women, of whom 33 328 (90.7%) received antibiotics. Adjusted analyses yielded a harmful association between treated VDS and very preterm delivery (adjusted risk ratio, 1.11; 95% CI, 1.02–1.21). This association remained when restricting to women with VDS who received the recommended antibiotic treatment regimen. Sensitivity analyses produced nonsignificant associations when women with treated VDS were compared with women without VDS who received antibiotics for other indications. CONCLUSIONS: A clinical diagnosis of VDS is common among pregnant women in Botswana, and the majority receive antibiotics in pregnancy. Although analyses of VDS occurring later in pregnancy are precluded by immortal time bias, a modest association between treated VDS and very preterm delivery was observed among women diagnosed with VDS by 24 weeks gestation. Oxford University Press 2021-07-09 /pmc/articles/PMC8351807/ /pubmed/34381845 http://dx.doi.org/10.1093/ofid/ofab366 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Articles
Fennell, Christina
Diseko, Modeigi
Zash, Rebecca
Mayondi, Gloria
Mabuta, Judith
Mmalane, Mompati
Davey, Sonya
Luckett, Rebecca
Morroni, Chelsea
Dintwa, Eldah N
Lockman, Shahin
Makhema, Joseph
Caniglia, Ellen
Shapiro, Roger
The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana
title The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana
title_full The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana
title_fullStr The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana
title_full_unstemmed The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana
title_short The Impact of Syndromic Management of Vaginal Discharge Syndrome on Adverse Birth Outcomes in Botswana
title_sort impact of syndromic management of vaginal discharge syndrome on adverse birth outcomes in botswana
topic Major Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351807/
https://www.ncbi.nlm.nih.gov/pubmed/34381845
http://dx.doi.org/10.1093/ofid/ofab366
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