History of Live Birth Predicts Sexually Transmitted Infection Acquisition over 6 Months of Follow-up Among African American Girls Recruited from Juvenile Detention Centers

Background:  We previously reported that pregnancy history predicts sexually transmitted infection (STI) acquisition among detained girls.  Although pregnancy outcomes may differentiate unique populations of girls, studies have not assessed prior pregnancy outcomes and STI acquisition among detained girls.  The objective was to examine two prior pregnancy outcomes (live birth and terminated pregnancy/stillbirth) as predictors of STI acquisition over 6 months among African American girls recruited from juvenile detention centers.

Methods: Non-pregnant, sexually active, detained African American girls (n=188), 13-17 years, were enrolled in an HIV/STI prevention trial.  At baseline, 3- and 6-month assessments, participants completed audio computer-assisted self-interviews and provided self-collected vaginal swab specimens assayed for Chlamydia and gonorrhea.  T-tests and chi-square statistics compared baseline characteristics (sociodemographics, sexual risk behaviors, partner characteristics) among participants with no baseline pregnancy history relative to participants reporting: 1) a baseline history of ≥1 live birth; and 2) a baseline pregnancy history but no live birth.  Poisson models compared STI acquisition for each pregnancy outcome relative to no pregnancy history.   STI acquisition was defined as a positive STI test result during follow-up subsequent to a negative result or documented treatment.  Adjusted models controlled for baseline differences (p<0.1).

Results: Of 179 (95.2%) girls completing ≥1 follow-up assessment, 20 (11.2%) reported a live birth and 25 (14.0%) a terminated pregnancy/stillbirth.  Over half (55.0%, n=11) of girls reporting a live birth and 44.0% (n=11) with a terminated pregnancy/stillbirth acquired an STI, whereas 30.6% (n=41) with no pregnancy history did.  The adjusted relative risk of STI acquisition for girls reporting a live birth was 1.84 (95% CI: 1.08, 3.13).  Terminated pregnancy/stillbirth was not significantly associated with STI acquisition.

Conclusions: History of live birth independently predicted laboratory-confirmed STI acquisition over 6 months.  HIV/STI prevention may benefit by addressing the unique needs of detained African American girls with a live birth.