Prevalence of Low Birth Weight and Gestational Maturity Associated with Trichomonas vaginalis Infection in Pregnant Women
Abstract
Introduction: Trichomonas vaginalis is a sexually transmitted protozoan known to contribute to adverse pregnancy outcomes, including low birth weight (LBW) and preterm birth. In Indonesia, where routine screening for this infection is limited, the relationship between T. vaginalis and neonatal health outcomes remains inadequately explored.
Objective: This study aims to evaluate the correlation between PCR-confirmed T. vaginalis infection and neonatal outcomes, particularly birth weight and gestational maturity, among pregnant women presenting with pathological vaginal discharge.
Methods: A cross-sectional study was conducted involving 167 pregnant women attending antenatal care. Sociodemographic and clinical data were recorded. Vaginal swabs were collected and analyzed using polymerase chain reaction (PCR) to detect T. vaginalis. Neonatal outcomes, including birth weight and gestational age, were assessed post-delivery. Bivariate analysis using Cramér’s V was performed to examine the strength of the association between infection status and outcomes.
Results: Out of 167 participants, 85 (50.9%) tested positive for T. vaginalis. Most infected women were between 20–35 years old (76.5%), from low-income households (55.3%), and had only primary education (71.8%). Among PCR-positive mothers, 20% delivered low-birth-weight infants, compared to 4.9% in the PCR-negative group (Cramér's V = 0.210), indicating a moderate correlation. Preterm births occurred in 16.5% of PCR-positive cases, compared to 9.8% among those who were negative (Cramér's V = 0.082), suggesting a weak association.
Conclusion: T. vaginalis infection during pregnancy is moderately associated with LBW and weakly associated with prematurity. These findings support the need for routine T. vaginalis screening during antenatal care to minimize neonatal complications related to untreated infections; however, given the cross-sectional design, causal inferences cannot be established."
References
CDS 2021. STD Facts - STDs & Pregnancy. Available from: https://www.cdc.gov/std/pregnancy/stdfact-pregnancy.htm.
Haruna N, Hatta M, Hamid F, Madjid B, Patellongi I, Farid MF. Fluor Albus Characteristics Associated with Sexually Transmitted Infection (STI) in Makassar Pregnant Women. Al-Sihah Public Heal Sci J. 2023 Dec 29;198–207.Available from: https://journal.uin-alauddin.ac.id/index.php/Al-Sihah/article/view/38797
Aishat AA, Gimba UN, Ibrahim K. Trichomoniasis Spread among Pregnant Women attending a Tertiary Institution Teaching Hospital for Antenatal Routine in Kwara State, Nigeria. J Appl Sci Environ Manag. 2024 Jan 30;28(1):263–8. Available from: https://www.ajol.info/index.php/jasem/article/view/264001
Juliana NCA, Deb S, Juma MH, Poort L, Budding AE, Mbarouk A, et al. The Vaginal Microbiota Composition and Genital Infections during and after Pregnancy among Women in Pemba Island, Tanzania. Microorganisms. 2022 Feb 25;10(3):509. Available from: https://www.mdpi.com/2076-2607/10/3/509
Sendeku FW, Beyene FY, Tesfu AA, Bante SA, Azeze GG. Preterm Birth and its associated factors in Ethiopia: A Systematic Review and Meta-Analysis. Afr Health Sci. 2021;21(3):1321–33. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8843273/
Ignacio M, Andrade J, Freitas A, Silva M, Duarte M. P3.147 Prevalence of sexually transmitted infections and associated factors in women who have sex with women. In BMJ; 2017. p. A148.1-A148. Available from: https://app.amanote.com/v4.3.9/research/note-taking?resourceId=Tq3FAnQBKQvf0Bhipr-s
Xu J-B, Lu S-J, Ke L-J, Qiu Z-E, Chen L, Zhang H-L, et al. Trichomonas vaginalis infection impairs anion secretion in vaginal epithelium. PLoS Negl Trop Dis. 2021 Apr 16;15(4):e0009319. Available from: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009319
Van Gerwen O, Craig?Kuhn M, Jones A, Schroeder J, Deaver J, Buekens P, et al. Trichomoniasis and adverse birth outcomes: a systematic review and meta?analysis. BJOG An Int J Obstet Gynaecol. 2021 Nov 27;128(12):1907–15. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16774
Addisu D, Melkie A, Biru S. Prevalence of Preterm Premature Rupture of Membrane and Its Associated Factors Among Pregnant Women Admitted in Debre Tabor General Hospital, North West Ethiopia: Institutional-Based Cross-Sectional Study. Obstet Gynecol Int. 2020;2020. Available from: https://onlinelibrary.wiley.com/doi/10.1155/2020/4034680
Nguyen QHV, Le HN, Ton Nu VA, Nguyen ND, Le MT. Lower genital tract infections in preterm premature rupture of Membranes and Preterm Labor: A Case-Control Study from Vietnam. J Infect Dev Ctries. 2021 Jun 30;15(06):805–11. Available from: https://www.jidc.org/index.php/journal/article/view/34242190
WHO. STD Guideline. WebPage. 2021. Available from: https://www.who.int/publications/i/item/9789240024168
Bongomin F, Olum R, Kyazze AP, Ninsiima S, Nattabi G, Nakyagaba L, et al. Anemia in Ugandan Pregnant Women: A Cross-Sectional, Systematic Review and Meta-Analysis Study. Trop Med Health. 2021 Dec 1;49(1). Available from: https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-021-00309-z
Davis A, Goddard-Eckrich D, Dasgupta A, El-Bassel N. Risk factors associated with sexually transmitted infections among women under community supervision in New York City. Int J STD AIDS. 2018 Jul 1;29(8):766–75. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6207943/
Mulinganya G, De Vulder A, Bisimwa G, Boelens J, Claeys G, De Keyser K, et al. Prevalence, risk factors, and adverse pregnancy outcomes of second-trimester bacterial vaginosis among pregnant women in Bukavu, Democratic Republic of the Congo. PLoS One. 2021 Oct 25;16(10):e0257939. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257939
Teasdale CA, Abrams EJ, Chiasson MA, Justman J, Blanchard K, Jones HE. Incidence of sexually transmitted infections during pregnancy. PLoS One. 2018 May 1;13(5). Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197696
Bairami A, Kabir K, Alaei BA, Bahadory S, Rezaeian M. Prevalence and clinical aspects of Trichomonas vaginalis infection among High-risk women in Karaj, Iran. Iran J Parasitol. 2024 Dec 8; Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11671828/
Moghadamizad Z, Khalili JY, Olfatifar M, Badri M, Khazaei S. The prevalence of Trichomonas vaginalis infection among the female population of Iran: a systematic review and meta-analysis. Int Health. 2024 May 1;16(3):240–51. Available from: https://www.mdpi.com/2414-6366/10/4/113
Li S, Xu J, Ru S, Hu C, Liu C, Sun X, et al. Prevalence of Trichomonas vaginalis among women in the Chinese population: A Systematic Review and meta-analysis. Trop Med Infect Dis. 2025 Apr 19;10(4):113. Available from : https://www.mdpi.com/2414-6366/10/4/113
Kissinger PJ, Gaydos CA, Seña AC, Scott McClelland R, Soper D, Secor WE, et al. Diagnosis and management of Trichomonas vaginalis: summary of evidence reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis. 2022 Apr 13;74(Supplement_2):S152–61. Available from: https://academic.oup.com/cid/article/74/Supplement_2/S152/6567967?login=false
Lara-Escandell M, Gamberini C, Juliana NCA, Al-Nasiry S, Morré SA, Ambrosino E. The association between non-viral sexually transmitted infections and pregnancy outcomes in Latin America and the Caribbean: A systematic review. Heliyon. 2024 Jan; 10(1):e23338. Available from: https://pubmed.ncbi.nlm.nih.gov/38187347/
Gamberini C, Juliana NCA, de Brouwer L, Vogelsang D, Al-Nasiry S, Morré SA, et al. The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review. Front Reprod Heal. 2023 Jun 7;5. Available from: https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1107931/full
Ahmed B, Konje JC. Screening for infections in pregnancy – An overview of where we are today. Eur J Obstet Gynecol Reprod Biol. 2021;263. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0301211521002736
Harfouche M, Gherbi WS, Alareeki A, Alaama AS, Hermez JG, Smolak A, et al. Epidemiology of Trichomonas vaginalis infection in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions. eBioMedicine. 2024 Aug;106:105250. Available from : https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(24)00286-X/fulltext
Chemaitelly H, Weiss HA, Smolak A, Majed E, Abu-Raddad LJ. Epidemiology of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 among female sex workers in the Middle East and North Africa: systematic review and meta-analytics. J Glob Health. 2019 Dec;9(2). Available from : https://pubmed.ncbi.nlm.nih.gov/31360448/
Achdiat PA, Dwiyana RF, Feriza V, Rowawi R, Effendi RA, Suwarsa O, et al. Prevalence of Trichomoniasis in Asymptomatic Pregnant Women Population in Bandung, West Java, Indonesia. Indones J Trop Infect Dis. 2019 Feb 22;7(4):57. Available from: https://e-journal.unair.ac.id/IJTID/article/view/8102
Putri W, Mita M, Rahmawati N. The Correlation Between Knowledge and Behaviour of Vulva Hygiene With Pathological Leukorrhea Incidence. J Matern Care Reprod Heal. 2024 Jun 10;7(2). Available from: https://www.researchgate.net/publication/381342519_T The Correlation Between Knowledge and Behaviour of Vulva Hygiene With Pathological Leukorrhea Incidence
Hafizhotul ‘Ummah H. Prevalence of Trichomonas vaginalis Based on Clinical Manifestation and Polymerase Chain Reaction among Reproductive Women. Int J Integr Heal Sci. 2019 Mar; 7(1):9–15. Available from: https://doaj.org/article/5372dc09bbb74b8299f03d991da0a659
Yalew GT, Muthupandian S, Hagos K, Negash L, Venkatraman G, Hagos YM, et al. Prevalence of Bacterial Vaginosis and Aerobic Vaginitis and their associated risk factors among Pregnant Women from Northern Ethiopia: A Cross-Sectional Study. PLoS One. 2022 Feb 25;17(2):e0262692. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262692
Holdcroft AM, Ireland DJ, Payne MS. The Vaginal Microbiome in Health and Disease—What Role Do Common Intimate Hygiene Practices Play? Microorganisms. 2023 Jan 23;11(2):298. Available from : https://www.mdpi.com/2076-2607/11/2/298
Daskalakis G, Psarris A, Koutras A, Fasoulakis Z, Prokopakis I, Varthaliti A, et al. Maternal Infection and Preterm Birth: From Molecular Basis to Clinical Implications. Children. 2023 May 22;10(5):907. Available from: https://pubmed.ncbi.nlm.nih.gov/37238455/
Toboso Silgo L, Cruz-Melguizo S, de la Cruz Conty ML, Encinas Pardilla MB, Muñoz Algarra M, Nieto Jiménez Y, et al. Screening for Vaginal and Endocervical Infections in the First Trimester of Pregnancy: A Study That Ignites an Old Debate. Pathogens. 2021 Dec 10;10(12):1610. Available from: https://www.mdpi.com/2076-0817/10/12/1610
Gragasin FS, Ospina MB, Serrano-Lomelin J, Kim SH, Kokotilo M, Woodman AG, et al. Maternal and cord blood hemoglobin as Determinants of Placental Weight: A Cross-Sectional Study. J Clin Med. 2021 Mar 1;10(5):1–10. Available from : https://www.mdpi.com/2077-0383/10/5/997
Adachi KN, Nielsen-Saines K, Klausner JD. Chlamydia t Available from :rachomatis Screening and Treatment in Pregnancy to Reduce Adverse Pregnancy and Neonatal Outcomes: A Review. Front Public Heal. 2021 Jun 10;9. Available from : https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.531073/full
Riley DE, Roberts MC, Takayama T, Krieger JN. Development of a polymerase chain reaction-Based Diagnosis of Trichomonas vaginalis. J Clin Microbiol. 1992 Feb;30(2):465–72. Available from : https://journals.asm.org/doi/10.1128/jcm.30.2.465-472.1992?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Op de Coul ELM, Peek D, van Weert YWM, Morré SA, Rours I, Hukkelhoven C, et al. Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections among pregnant women and Male Partners in Dutch Midwifery Practices: Prevalence, Risk Factors, and Perinatal Outcomes. Reprod Health. 2021 Dec 26;18(1):132. Available from : https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01179-8
Kamga YM Available from :, Ngunde JP, Akoachere J-FKT. Prevalence of Bacterial Vaginosis and associated risk factors in pregnant women receiving antenatal care at the Kumba Health District (KHD), Cameroon. BMC Pregnancy Childbirth. 2019 Dec 10;19(1):166. Available from : https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2312-9
Nyemba DC, Peters RPH, Medina-Marino A, Klausner JD, Ngwepe P, Myer L, et al. Impact of Aetiological Screening of sexually transmitted infections during pregnancy on Pregnancy Outcomes in South Africa. BMC Pregnancy Childbirth. 2022 Dec 9;22(1):194. Available from : https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04520-6
Van Gerwen OT, Opsteen SA, Graves KJ, Muzny CA. Trichomoniasis. Infect Dis Clin North Am. 2023 Jun; 37(2):245–65. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0891552023000119?via%3Dihub
Riddell MA, Vallely LM, Mengi A, Badman SG, Low N, Wand H, et al. Point-of-care testing and treatment of sexually transmitted and genital infections to improve birth outcomes in high-burden, low-resource settings (WANTAIM): a pragmatic cluster randomised crossover trial in Papua New Guinea. Lancet Glob Heal [Internet]. 2024 Apr 1;12(4):e641–51. Available from: https://doi.org/10.1016/S2214-109X(24)00004-4 Available from :
Sunmonu OH, Okunade KS, Adegbola O. Association between Trichomonas vaginalis infection and spontaneous preterm labor in Lagos, Nigeria: an analytical cross-sectional study. BMC Res Notes. 2025 Apr 5;18(1):142. Available from : https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-025-07196-1
Copyright (c) 2025 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
