4.6 Review

Adverse pregnancy and birth outcomes associated with Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum: a systematic review and meta-analysis

期刊

BMJ OPEN
卷 12, 期 8, 页码 -

出版社

BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2022-062990

关键词

GYNAECOLOGY; MICROBIOLOGY; OBSTETRICS; EPIDEMIOLOGY; Epidemiology

资金

  1. Swiss National Science Foundation [197831, 160909]
  2. Australian National Health amp
  3. Medical Research Council (NHMRC) Early Career Fellowship Grant (2018-2021)
  4. Australian Award/UNSW UIPA scholarship
  5. Women And Newborns Trial of Antenatal Interventions and Management (WANTAIM) trial - DFID/MRC/Wellcome Trust Joint Global Health Trials, Australian NHMRC Grant [ISRCTN37134032]
  6. Swiss National Science Foundation
  7. r4d programme [IZ07Z0-160909]

向作者/读者索取更多资源

This systematic review investigates the role of genital mycoplasmas in adverse pregnancy and birth outcomes. The findings suggest that Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum may be associated with preterm birth, low birth weight, premature rupture of membranes, spontaneous abortion, and perinatal or neonatal death.
Objectives Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum (genital mycoplasmas) commonly colonise the urogenital tract in pregnant women. This systematic review aims to investigate their role in adverse pregnancy and birth outcomes, alone or in combination with bacterial vaginosis (BV).Methods We searched Embase, Medline and CINAHL databases from January 1971 to February 2021. Eligible studies tested for any of the three genital mycoplasmas during pregnancy and reported on the primary outcome, preterm birth (PTB) and/or secondary outcomes low birth weight (LBW), premature rupture of membranes (PROM), spontaneous abortion (SA) and/or perinatal or neonatal death (PND). Two reviewers independently screened titles and abstracts, read potentially eligible full texts and extracted data. Two reviewers independently assessed risks of bias using published checklists. Random effects meta-analysis was used to estimate summary ORs (with 95% CIs and prediction intervals). Multivariable and stratified analyses were synthesised descriptively.Methods We searched Embase, Medline and CINAHL databases from January 1971 to February 2021. Eligible studies tested for any of the three genital mycoplasmas during pregnancy and reported on the primary outcome, preterm birth (PTB) and/or secondary outcomes low birth weight (LBW), premature rupture of membranes (PROM), spontaneous abortion (SA) and/or perinatal or neonatal death (PND). Two reviewers independently screened titles and abstracts, read potentially eligible full texts and extracted data. Two reviewers independently assessed risks of bias using published checklists. Random effects meta-analysis was used to estimate summary ORs (with 95% CIs and prediction intervals). Multivariable and stratified analyses were synthesised descriptively.Results Of 53/1194 included studies, 36 were from high-income countries. In meta-analysis of unadjusted ORs, M. hominis was associated with PTB (OR 1.87, 95% CI 1.49 to 2.34), PROM, LBW and PND but not SA. U. urealyticum was associated with PTB (OR 1.96, 95% CI 1.14 to 1.39), PROM, and SA. U. parvum was associated with PTB (1.79, 95% CI 1.28 to 2.52) and PROM. Seven of 53 studies reported any multivariable analysis. In two studies, analyses stratified by BV status showed that M. hominis and U. parvum were more strongly associated with PTB in the presence than in the absence of BV. The most frequent source of bias was a failure to control for confounding.Conclusions The currently available literature does not allow conclusions about the role of mycoplasmas in adverse pregnancy and birth outcomes, alone or with coexisting BV. Future studies that consider genital mycoplasmas in the context of the vaginal microbiome are needed.PROSPERO registration number CRD42016050962.

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