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#Grand Rounds

Can Bacterial Vaginosis in the First Trimester Predict Preterm Birth?

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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

METHODS:

  • Nested case-control study in a prospective pregnancy cohort
    • Singelton pregnancies
    • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Vaginal microbiome in early pregnancy and subsequent risk of spontaneous preterm birth: a case–control study

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Related ObG Topics:

Bacterial Vaginosis – CDC Diagnosis and Treatment Recommendations
FDA Approves Secnidazole: Single-Dose Oral Treatment for BV
Do Hormonal Contraceptives Protect Against BV and Potential HIV Infection?

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