There are several studies in the literature reporting quite variable results for the prevalence of chlamydia trachomatis in pregnant women
18. In our study the prevalence of chlamydia among all pregnant women was 1.2% (2/157) and no statistically significant correlation was found between chlamydia trachomatis and preterm delivery or PROM. In a similar study by Silveria et al. on 2127 pregnant women the prevalence of chlamydia trachomatis was detected as 4.7% and chlamydia infection could not be linked to preterm labor
19. In another study by Karowicz et al. 400 pregnant women who had been hospitalized between 2005-2007 with suspicion of preterm labor had been screened with enzyme immunoassay (EIA) method and chlamydia trachomatis had not been detected at all
20. On the other hand Ramos and Polettini had screened the cervical secretions of 101 pregnant women in Brazil with PCR method and detected the prevalence of chlamydia trachomatis as 25.7%
21. As a result of their study they had emphasized the importance of screening in prevention of obstetrical and neonatal complications. This variability of prevalence of chlamydia trachomatis infection can be related to the risk factors of the infection. Being an adolescent or young adult is the most important risk factor. Other relevant risk factors include being single as the marital status, a positive history of a sexually transmitted disease, and the refusal of barrier contraception methods and the possession of multiple sexual partners.
In previous studies certain demographic features of the patients including smoking habits, increased BMI and maternal socio-economic status were reported to cause an increase in the risk for preterm labor18. However the comparison of both groups in our study regarding their demographic features did not reveal any statistically significant difference.
In our study 51 pregnant women experienced spontaneous abortion; the analysis of these patients with PCR revealed no sign of chlamydia trachomatis infection. The role of infections in the etiology of spontaneous abortion is controversial. Bacteria such as brucella, mycoplasma hominis, chlamydia trachomatis and listeria monocytogenes; viruses including CMV, rubella, HSV and parvovirus and toxoplasma gondii as a parasitic protozoa are well-known microorganisms accused with induction of abortion nevertheless their role in the etiology of abortion is not clear.In a study conducted by Wilkowska et al. the presence of chlamydia trachomatis in the cervical smear had been screened with PCR method and its relationship with the number of spontaneous abortions was analyzed22. The comparison of the 76 pregnant women having a history of one spontaneous abortion with the control group of 46 pregnant women without any obstetric complication revealed a statistically significant difference (p=0,029). In another similar study on 144 women with spontaneous abortion Dudkiewicz et al. had found out that C. trachomatis (18.7) was the most frequently isolated bacterial organism in the cervical smear23. On the other hand there are various other studies in the literature which have revealed that chlamydia trachomatis infection was not related to spontaneous abortion10,24. The results of our study also demonstrated a lack of correlation between these two parameters.
Chlamydia trachomatis infection often has an asymptomatic course nevertheless the presence of cervicitis symptoms in some cases might be regarded as an alarming feature. In our study 19 patients have been diagnosed with cervicitis following the pelvic examination and the PCR analysis of them revealed 2 cases of chlamydia trachomatis infection. On the other hand all of the pregnant women without cervicitis were PCR (-) thus a statistically significant difference ensued between the two groups. Presumably the best explanation for the reason of this finding is the relatively low quantity of patients included into the study and a probable exclusion of some of the asymptomatic chlamydia infections.
2005 in Turkey chlamydia trachomatis infection has been added to a list of distinctive diseases which should be reported to the local authorities “on first sight”. However there is still no screening program applicable to the pregnant women.
Pregnant women with certain comorbidities including gestational hypertension, diabetes mellitus and hypothyroidism were not excluded from the study and constituted a confounding factor. Although both the study and the control groups did match for the distribution of these patients, the possible influence of medical disorders on the risk of premature rupture of membranes and abortion was regarded as a limitation of our study.