ORCID
https://orcid.org/0000-0003-3908-4136
Date of Award
Spring 2025
Embargo Period
3-27-2027
Document Type
Dissertation
Degree Name
Doctor of Public Health (DrPH)
College/School/Department
Department of Health Policy, Management and Behavior
Program
Public Health
First Advisor
Tomoko Udo
Committee Members
Alexa Freedman, Rachel Hart-Malloy, Meredith Howley
Keywords
sexually transmitted infections, birth defects, pregnancy
Subject Categories
Public Health
Abstract
Background: New York State (NYS), and the United States overall, has recently experienced increases in the three nationally notifiable bacterial sexually transmitted infections (STIs), chlamydia, gonorrhea, and syphilis. These infections, particularly chlamydia and gonorrhea, may not always present with apparent symptoms, but remain transmissible until treated. There are potential long-term reproductive consequences of STI infections, including infertility and ectopic pregnancy. There is also prior evidence of adverse perinatal or infant outcomes associated with STI infections during pregnancy, including stillbirth and birth defects. This aims of this research were to: 1) describe the burden of and disparities in birth defects among persons infected with STIs during pregnancy in NYS between 2010 and 2020, 2) assess the impact of adequate STI treatment during early pregnancy on risk of birth defects among pregnant persons with chlamydia diagnoses, and 3) describe potential implications for public health programming and policy with regard to prevention of birth defects associated with STIs and/or their treatment in NYS.
Methods: This study utilized de-identified matched data from the NYS STI Surveillance Registry and live births reported to the NYS Birth Defects Registry from 2010 to 2020. Descriptive analyses were conducted to investigate the burden of clinically-relevant birth defects associated with STI infections and to identify characteristics associated with clinically-relevant birth defects. A retrospective cohort study was conducted among pregnancies in NYS with only one chlamydia diagnosis during the first trimester of pregnancy between 2010 and 2020 to assess the impact of adequate chlamydia treatment during this timeframe on the risk of birth defects. Potential implications for public health programming and policy with regard to the prevention of birth defects associated with STIs and/or their treatment in NYS were identified based on the results of descriptive and log-binomial regression analyses.
Results: Clinically-relevant birth defects were more common among pregnant persons diagnosed with chlamydia, persons aged 20-24 years, persons who were non-Hispanic White, and persons residing in high poverty level zip codes at the time of their STI diagnosis. Pregnancies with evidence of adequate treatment for chlamydia diagnoses during the first trimester were more likely to have an infant with at least one clinically-relevant birth defect, though this finding did not hold in sensitivity analyses with chlamydia diagnoses or with adequate chlamydia treatment not restricted to the first trimester. Potential implications include tailored STI prevention, STI screening and treatment, and birth defects education for patients and providers; policy considerations such as required reporting of pregnancy status and negative STI test results as well as universal chlamydia and gonorrhea screening for persons of childbearing capacity of all age groups; and directions for future research to explore the role of STI treatment on birth defects.
Conclusion: Overall, we found disparities in clinically-relevant birth defects among pregnant persons with one diagnosis of chlamydia during pregnancy by age group, racial/ethnic groups, and zip code-level poverty categories. These results provide insight into populations within NYS with STI diagnoses during pregnancy who may be more impacted by clinically-relevant birth defects and, thus, may benefit from tailored education on STI prevention and birth defects for providers and patients. An increased risk of clinically-relevant birth defects among pregnancies with evidence of adequate chlamydia treatment during the first trimester may be biased by the restriction to live births and other limitations of these surveillance registries. However, the results provide important directions for future research into the role of individual STI treatment medications and timing of treatment during early pregnancy on the development of birth defects. This study also adds to the limited literature on STI treatment and birth defects and underscores the need for improved data reporting policies and further research in this area.
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Boos, Elizabeth M., "The Impact of Sexually Transmitted Infections (STI) and STI Treatment during Pregnancy on Birth Defects in New York State" (2025). Electronic Theses & Dissertations (2024 - present). 122.
https://scholarsarchive.library.albany.edu/etd/122