Determinants of urogenital schistosomiasis among pregnant women and its association with pregnancy outcomes, neonatal deaths and child growth.
J Infect Dis
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BACKGROUND: Schistosoma haematobium is a parasitic helminth which causes urogenital pathology. The impact of urogenital schistosomiasis during pregnancy on birth outcomes and child growth is poorly understood. METHODS: Risk factors for urogenital schistosomiasis were characterized among 4,437 pregnant women enrolled in a cluster-randomised community-based trial in rural Zimbabwe. Infection was defined via urine microscopy (≥1 S. haematobium egg) and urinalysis (haematuria). Associations between infection and pregnancy outcomes were assessed in case-control analyses using conditional logistic regression. The association of maternal infection with birthweight and length-for-age Z scores (LAZ) at 1 and 18 months of age were assessed using generalised estimating equations. RESULTS: Urogenital schistosomiasis (egg-positive and/or haematuria-positive) was detected in 26.8% of pregnant women. Risk factors significantly associated with infection were: maternal age, education, marital status and religion; household drinking water source and latrine; study region; and season. Urogenital schistosomiasis was not significantly associated with adverse pregnancy outcomes (miscarriage, stillbirth, preterm, small-for-gestational age), birthweight, neonatal death or LAZ. CONCLUSIONS: Including pregnant women in anti-helminthic treatment programs would benefit a large number of women in rural Zimbabwe. However, clearance of the low intensity infections that predominate in this context is unlikely to have additive benefits for pregnancy outcomes or child growth.