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Reproductive tract non-viral mono- and co-infections in pregnancy: systematic literature review and meta-analysis
Journal article   Open access   Peer reviewed

Reproductive tract non-viral mono- and co-infections in pregnancy: systematic literature review and meta-analysis

Gustavo Yano Callado, Andre Luis Franco Cotia, Maria Celidonio Gutfreund, Luana Perrone Camilo, Patricia Deffune Celeghini, Romy Schmidt Brock Zacharias, Eduardo Felix Martins Santana, Michael B. Edmond and Alexandre R. Marra
Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e260
09/08/2026
DOI: 10.1017/ash.2026.10821
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1017/ash.2026.10821View
Published (Version of record) Open Access

Abstract

Objective: To compare maternal and neonatal outcomes between mono-infections and co-infections of the reproductive tract in pregnancy due to bacteria and Trichomonas. Methods: We conducted searches across MedLine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, Scopus, and Embase. Searches from database inception to August 5, 2024, for studies that compared reproductive tract bacterial and Trichomonas mono-infections and co-infections in pregnancy with regards to maternal and/or neonatal outcomes. Two independent investigators analyzed each study. Random-effect models were used to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs), and heterogeneity was assessed using the I 2 statistic. The Downs and Black scale was used to assess study quality and risk of bias. Results: Among 1,436 publications, nine studies met inclusion criteria. Mono-infections and co-infections showed no significant differences in delivery before the 34th week of gestation (OR 0.66, 95% CI 0.36-1.22), gestational hypertension (OR 1.30, 95% CI 0.72-2.33), preterm premature rupture of membranes (OR 0.89, 95% CI 0.50-1.58), or Apgar score < 7 at five minutes (OR 0.53, 95% CI 0.20-1.36). The analysis of birth before the 37th week rate (five studies) showed an advantage for the mono-infections group (OR 0.83, 95% CI 0.78-0.89). Mono-infections showed lower rates of neonatal death (OR 0.83, 95% CI 0.78-0.89) and intensive care unit admission (OR 0.16, 95% CI 0.03-0.86). Conclusions: Reproductive tract non-viral co-infections may exacerbate adverse neonatal outcomes compared to mono-infections. Future studies are needed to establish a more robust correlation between infections numbers and pregnancy outcomes.
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