TOPLINE:

Mycoplasma genitalium (MG) infection shows an association with prior spontaneous preterm birth (sPTB) in high-risk pregnancies but does not increase the risk for recurrent sPTB or previable delivery due to cervical insufficiency. Among 229 participants with prior sPTB, 14.8% tested positive for MG, yet infection status did not predict adverse outcomes in the current pregnancy.

METHODOLOGY:

• Researchers conducted a prospective cohort study at the University of Texas Health Science Center in Houston between July 2023 and December 2024, enrolling 499 pregnant individuals with singleton intrauterine pregnancies at less than 24 weeks of gestation and a history of adverse pregnancy outcomes including sPTB.
• Participants underwent vaginal swab testing for MG using the FDA-cleared Aptima transcription-mediated amplification assay with sensitivity of 90%-99% and specificity ≥ 97%, while participants and providers remained blinded to results.
• Analysis included 490 participants (98%) with available testing data, of whom 230 (46.9%) had prior sPTB and 229 (99.6%) had delivery outcome data available for evaluation.
• The primary outcome was a composite of recurrent sPTB (delivery between 20 0/7 and 36 6/7 weeks following preterm labor with cervical change) or cervical insufficiency-related second-trimester previable delivery, defined as painless cervical dilation between 16 0/7-24 0/7 weeks without contractions, infection, or placental abruption.
• Multivariable logistic regression estimated associations between MG and the primary outcome, adjusting for race, ethnicity, marital status, insurance, and syphilis co-infection, with short cervix (≤ 25 mm) and cerclage evaluated as effect modifiers.

TAKEAWAY:

• In 490 participants with available testing data, 57 (12%) tested positive for MG, and MG infection was significantly associated with prior sPTB (P < .04).
• Of 229 participants with prior sPTB and delivery outcome data, 34 (14.8%) tested positive for MG, with the primary composite outcome occurring in 14 of 34 (41.2%) MG-positive participants vs 90 of 195 (46.2%) MG-negative participants (P = .55).
• After multivariable adjustment for race, ethnicity, marital status, insurance status, and syphilis diagnosis during pregnancy, MG infection was not associated with the primary outcome (adjusted odds ratio, 0.79; 95% CI, 0.36-1.70).
• Short cervix and cerclage showed no interaction with MG infection status (P for interaction > .40), suggesting these factors did not modify the relationship between MG infection and adverse pregnancy outcomes.

IN PRACTICE:

“M genitalium infection was associated with prior sPTB but not recurrent sPTB or previable preterm delivery due to cervical insufficiency. This may reflect increased susceptibility during incident infection, when individuals are serologically naive,” the authors of the study wrote.

SOURCE:

The study was led by Irene A. Stafford, MD, MS, MPH, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston. It was published online in American Journal of Obstetrics and Gynecology.

LIMITATIONS:

According to the authors, although this prospective study is among the first to evaluate MG infection in a high-risk cohort, infrequent outcomes resulted in wide confidence intervals and limited power to detect modest associations. The study’s sample size, while substantial for a prospective design, may not have been sufficient to identify smaller effect sizes or interactions between MG infection and other risk factors such as short cervix or cerclage. The findings may have limited generalizability beyond high-risk pregnant individuals with prior sPTB, as the cohort was specifically selected for this characteristic. Additionally, participants and providers were blinded to MG test results, meaning no treatment was provided, which prevented assessment of whether treating MG infection might alter pregnancy outcomes.

DISCLOSURES:

Hologic Inc, San Diego, California, provided funding for testing supplies, reagents, and research coordinator support. The authors reported no conflicts of interest. Hologic did not conduct the experimental tests, perform data analysis, or participate in interpretation of results.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.