MAJOR ARTICLE Urogenital Schistosomiasis in Pregnancy • JID 2021:223 (15 April) • 1433 The Journal of Infectious Diseases Received 18 October 2019; editorial decision 7 December 2019; accepted 11 December 2019; published online December 13, 2019. Correspondence: Claire D. Bourke, PhD, Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Blizard Building, London, E1 2AT, UK (c.bourke@qmul.ac.uk). The Journal of Infectious Diseases ® 2021;223:1433–44 © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.  This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: 10.1093/infdis/jiz664 Determinants of Urogenital Schistosomiasis Among Pregnant Women and its Association With Pregnancy Outcomes, Neonatal Deaths, and Child Growth Wellington Murenjekwa, 1 Rachel Makasi, 1 Robert Ntozini, 1, Bernard Chasekwa, 1 Kuda Mutasa, 1 Lawrence H. Moulton, 2 James M. Tielsch, 3 Jean H. Humphrey, 1,2 Laura E. Smith, 1,4 Andrew J. Prendergast, 1,5 and Claire D. Bourke 1,5, ; for the SHINE Trial Team 1 Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe, 2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, 3 Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA, 4 Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA, and 5 Blizard Institute, Queen Mary University of London, London, UK Background. Schistosoma haematobium is a parasitic helminth that causes urogenital pathology. Te impact of urogenital schis- tosomiasis during pregnancy on birth outcomes and child growth is poorly understood. Methods. Risk factors for urogenital schistosomiasis were characterized among 4437 pregnant women enrolled in a cluster- randomized community-based trial in rural Zimbabwe. Infection was defned via urine microscopy (≥1 S. haematobium egg) and urinalysis (hematuria). Associations between infection and pregnancy outcomes were assessed in case-control analyses using con- ditional logistic regression. Te association of maternal infection with birthweight and length-for-age Z scores (LAZ) at 1 and 18 months of age were assessed using generalized estimating equations. Results. Urogenital schistosomiasis (egg positive and/or hematuria positive) was detected in 26.8% of pregnant women. Risk factors signifcantly 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 signifcantly associated with adverse pregnancy out- comes (miscarriage, stillbirth, preterm, and small-for-gestational age), birthweight, neonatal death, or LAZ. Conclusions. Including pregnant women in antihelminthic treatment programs would beneft 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 benefts for pregnancy outcomes or child growth. Clinical Trials Registration. NCT01824940. Keywords. schistosomiasis; pregnancy; women; Zimbabwe; adverse birth outcomes; birthweight; stunting; Schistosoma haematobium; child health; parasites. Urogenital schistosomiasis is a highly prevalent disease in sub-Saharan Africa caused by Schistosoma haematobium para- sites. Infection is transmitted by freshwater-dwelling larval schistosomes, which penetrate the skin, migrate, and mature into long-lived adult worms residing in urogenital blood ves- sels. Adult worm pairs continuously produce eggs, which pass from blood to urine for excretion. Ongoing egg deposition drives chronic tissue damage, which can progress to renal and urogenital dysfunction if untreated [1]. Microscopic detection of S. haematobium eggs in urine is diagnostic of urogenital schistosomiasis, which can also be identified indirectly via he- maturia [2–5]. Adult worms can be cleared by the antihelminthic drug praziquantel; however, treatment does not clear immature parasites nor prevent reinfection [1]. Repeated exposure to new infections, which is common in endemic communities reliant on unprotected water sources, can drive high-intensity infec- tions associated with more severe pathology [1]. International guidelines advocate for improved water, sanitation, and hygiene (WASH) provision and practice uptake as a means of control- ling schistosomiasis [6]. Schistosome prevalence and infection intensity peak in school-age children, the predominant target of epidemiolog- ical evaluation and mass drug administration programs (MDA) [7, 8]. Much less is known about the risk factors for urogen- ital schistosomiasis among pregnant women. An estimated 40 million reproductive-age women are currently infected and 10 million African women per year have schistosomiasis during pregnancy [9]. Female genital schistosomiasis, which afects ap- proximately 16 million women [10], includes active infections and genital pathology that persists posttreatment [11]. Te World Health Organization (WHO) recommends inclusion Downloaded from https://academic.oup.com/jid/article/223/8/1433/5674952 by guest on 11 December 2023