Journal
BMC MEDICINE
Volume 16, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12916-017-0999-x
Keywords
Vaginal microbiota; Preterm birth; Preterm prelabour rupture of membranes; Antibiotics; Erythromycin; Neonatal sepsis; Pregnancy
Categories
Funding
- Medical Research Council [MR/L009226/1]
- Comprehensive Biomedical Research Centre at Imperial College London of the National Institute for Health Research [P45272]
- Imperial National Health Service Trust
- Genesis Research Trust [P51389]
- Biotechnology and Biological Sciences Research Council [BB/L020858/1] Funding Source: researchfish
- Medical Research Council [MR/L009226/1] Funding Source: researchfish
- National Institute for Health Research [13/121/07] Funding Source: researchfish
- BBSRC [BB/L020858/1] Funding Source: UKRI
- MRC [MR/L009226/1] Funding Source: UKRI
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Background: Preterm prelabour rupture of the fetal membranes (PPROM) precedes 30% of preterm births and is a risk factor for early onset neonatal sepsis. As PPROM is strongly associated with ascending vaginal infection, prophylactic antibiotics are widely used. The evolution of vaginal microbiota compositions associated with PPROM and the impact of antibiotics on bacterial compositions are unknown. Methods: We prospectively assessed vaginal microbiota prior to and following PPROM using MiSeq-based sequencing of 16S rRNA gene amplicons and examined the impact of erythromycin prophylaxis on bacterial load and community structures. Results: In contrast to pregnancies delivering at term, vaginal dysbiosis characterised by Lactobacillus spp. depletion was present prior to the rupture of fetal membranes in approximately a third of cases (0% vs. 27%, P = 0.026) and persisted following membrane rupture (31%, P = 0.005). Vaginal dysbiosis was exacerbated by erythromycin treatment (47%, P = 0.00009) particularly in women initially colonised by Lactobacillus spp. Lactobacillus depletion and increased relative abundance of Sneathia spp. were associated with subsequent funisitis and early onset neonatal sepsis. Conclusions: Our data show that vaginal microbiota composition is a risk factor for subsequent PPROM and is associated with adverse short-term maternal and neonatal outcomes. This highlights vaginal microbiota as a potentially modifiable antenatal risk factor for PPROM and suggests that routine use of erythromycin for PPROM be re-examined.
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