Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 128, Issue 13, Pages 2061-2072Publisher
WILEY
DOI: 10.1111/1471-0528.16816
Keywords
Lactobacillus; preterm premature rupture of membranes; spontaneous preterm birth; vaginal microbiome
Categories
Funding
- Wellbeing of Women
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The study suggests that increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.
Objective To assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)/preterm prelabour rupture of membranes (PPROM). Design Nested case-control study. Setting UK tertiary referral hospital. Sample High-risk women with previous sPTB/PPROM <34(+0) weeks' gestation who had a recurrence (n = 22) or delivered at >= 37(+0) weeks without PPROM (n = 87). Methods Vaginal swabs collected between 15 and 22 weeks' gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR. Main outcome measure Recurrent early sPTB/PPROM. Results Of the 109 high-risk women, 28 had anaerobic vaginal dysbiosis, with the remainder dominated by lactobacilli (Lactobacillus iners 36/109, Lactobacillus crispatus 23/109, or other 22/109). VMB type and diversity were not associated with recurrence. Women with a recurrence, compared to those without, had a higher median vaginal bacterial load (8.64 versus 7.89 log(10) cells/mcl, adjusted odds ratio [aOR] 1.90, 95% CI 1.01-3.56, P = 0.047) and estimated Lactobacillus concentration (8.59 versus 7.48 log(10) cells/mcl, aOR 2.35, (95% CI 1.20-4.61, P = 0.013). A higher recurrence risk was associated with higher median bacterial loads for each VMB type after stratification, although statistical significance was reached only for L. iners domination (aOR 3.44, 95% CI 1.06-11.15, P = 0.040). Women with anaerobic dysbiosis or L. iners domination had a higher median vaginal bacterial load than women with a VMB dominated by L. crispatus or other lactobacilli (8.54, 7.96, 7.63, and 7.53 log(10) cells/mcl, respectively). Conclusions Vaginal bacterial load is associated with early sPTB/PPROM recurrence. Domination by lactobacilli other than L. iners may protect women from developing high bacterial loads. Future PTB studies should quantify vaginal bacteria and yeasts. Tweetable abstract Increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.
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