Can Bacterial Vaginosis in the First Trimester Predict Preterm Birth?
BACKGROUND AND PURPOSE:
Bacterial vaginosis (BV) can now be identified using molecular techniques
In asymptomatic non-pregnant North American women of reproductive age, there are 5 vaginal bacterial community state types (CSTs)
4 of which are dominated by Lactobacillus species (CST I, II, III and V) and seen more frequently in Asian and White women
1 (CST IV) that is more diverse, includes species associated with BV (Gardnerella and Mobiluncus) and is more commonly seen in Black and Hispanic populations
The relationship between the vaginal microbiome and preterm birth remains controversial
Tabatabaei et al. (BJOG, 2018) compared the vaginal microbiome between preterm and term deliveries
Nested case-control study in a prospective pregnancy cohort
Women with either
Cases: Spontaneous preterm birth (<37 weeks) or
Controls: Term deliveries (≥37 weeks)
Vaginal microbiome was assessed by sequencing the V4 region of the 16S ribosomal RNA (rRNA) gene in swabs collected in early pregnancy
Relative abundance of bacterial operational taxonomic units, oligotypes, and vaginal CSTs were compared between groups
Estimated coefﬁcient used for statistical analysis
Expected change in log relative abundance between women who developed early and late spontaneous preterm birth and those who had a term delivery
94 cases of spontaneous preterm birth
17 early (<34 weeks)
77 late (34–36 weeks)
356 term deliveries (controls)
Decreased risk of early but not late preterm birth was associated with
Lactobacillus gasseri/ Lactobacillus johnsonii (coefficient −5.36, 95% CI −8.07 to −2.65)
Lactobacillus crispatus / Lactobacillus acidophilus (coefficient −4.58, 95% CI −6.20 to −2.96)
Lactobacillus iners / Ralstonia solanacearum (coefficient −3.98, 95% CI −6.48 to −1.47)
Bifidobacterium longum/ Bifidobacterium breve (coefficient −8.84, 95% CI −12.96 to −4.73)
Six vaginal CSTs were identified: four dominated by Lactobacillus; one with presence of bacterial vaginosis‐associated bacteria (Gardnerella vaginalis, Atopobium vaginae and Veillonellaceae bacterium) (CST IV); and one with nondominance of Lactobacillus (CST VI)
CST IV was associated with increased risk of early (coefficient 4.22, 95% CI 1.24–24.85) but not late (coefficient 1.63, 95% CI 0.68–5.04) preterm birth, compared with CST VI
There was a lack of association between the clinical Nugent score and vaginal microbiome composition
Lactobacillus gasseri/L. johnsonii, L. crispatus/L. acidophilus, L. iners/R. solanacearum and longum/B. breve may be associated with decreased risk of early preterm birth
Molecular sequencing appears to be a more accurate reflection of the vaginal microbiome than the Nugent score
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