Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 129, Issue 1, Pages 43-51Publisher
WILEY
DOI: 10.1111/1471-0528.16843
Keywords
Fecundability; pregnancy; vaginal cleanliness; vaginal microenvironment
Categories
Funding
- National Key Research and Development Programme of China [2016YFC1000307]
- National Natural Science Foundation of China [81872634]
- CAMS Innovation Fund for Medical Sciences (CIFMS) [2018-I2M1-004]
- National Human Genetic Resources Sharing Service Platform [2005DKA21300]
- National Population and Reproductive Health Science Data Centre, People's Republic of China [2005DKA32408]
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This study found a negative association between a poor vaginal microenvironment and women's fecundability, emphasizing the importance of assessing vaginal health during pre-pregnancy check-ups. Women with a poor vaginal microenvironment were associated with a reduction in fecundability.
Objective To evaluate the association between the vaginal microenvironment and fecundability among women. Design Register-based nationwide cohort study. Setting Chinese National Free Pre-conception Check-up Project from 2015 to 2018. Population Our study included a total of 3 388 554 eligible women who were attempting to become pregnant. Method We assessed the vaginal microenvironment at baseline by considering four indices: vaginal pH, clue cell examination, whiff test and vaginal cleanliness grading. If any of these indicators was abnormal, the vaginal microenvironment was defined as poor. Propensity score matching was used to control for potential confounders and reduce bias. Logistic models were used to estimate the fecundability odds ratios (FORs) after adjustment for covariates. Main outcome measures Achievement of a pregnancy within 1 year. Results Of the total study population, 379 718 women (11.2%) had a poor vaginal microenvironment and their pregnancy rate after 1 year was significantly lower than the group with a normal microenvironment (71.8% versus 76.1%, P < 0.001). After adjusting for potential confounders, the women with a poor vaginal microenvironment were associated with a 9% reduction in fecundability compared with the normal microenvironment group (FOR 0.91, 95% CI 0.90-0.92). The adverse effects of a poor vaginal microenvironment were stronger among multipara (FOR 0.89, 95% CI 0.87-0.90) or women with irregular menstruation (FOR 0.86, 95% CI 0.84-0.89). Conclusion There was a negative association between a poor vaginal microenvironment and the fecundability of women. These findings highlight the significance of assessing the vaginal microenvironment during pre-pregnancy health examinations. Tweetable abstract Women with a poor vaginal microenvironment were associated with a reduction in fecundability.
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