Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case-control study


Goodfellow, L ORCID: 0000-0002-8111-5007, Verwijs, MC, Care, A ORCID: 0000-0003-2131-0406, Sharp, A ORCID: 0000-0003-3396-7464, Ivandic, J, Poljak, B, Roberts, D, Bronowski, C ORCID: 0000-0001-8089-4021, Gill, AC, Darby, AC ORCID: 0000-0002-3786-6209 et al (show 4 more authors) (2021) Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case-control study. BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 128 (13). pp. 2061-2072.

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Abstract

<h4>Objective</h4>To assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)/preterm prelabour rupture of membranes (PPROM).<h4>Design</h4>Nested case-control study.<h4>Setting</h4>UK tertiary referral hospital.<h4>Sample</h4>High-risk women with previous sPTB/PPROM <34<sup>+0</sup>  weeks' gestation who had a recurrence (n = 22) or delivered at ≥37<sup>+0</sup>  weeks without PPROM (n = 87).<h4>Methods</h4>Vaginal swabs collected between 15 and 22 weeks' gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR.<h4>Main outcome measure</h4>Recurrent early sPTB/PPROM.<h4>Results</h4>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<sub>10</sub> 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<sub>10</sub> 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<sub>10</sub> cells/mcl, respectively).<h4>Conclusions</h4>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.<h4>Tweetable abstract</h4>Increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.

Item Type: Article
Uncontrolled Keywords: Lactobacillus, preterm premature rupture of membranes, spontaneous preterm birth, vaginal microbiome
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 30 Jun 2021 14:39
Last Modified: 18 Jan 2023 21:37
DOI: 10.1111/1471-0528.16816
Open Access URL: https://www.medrxiv.org/content/10.1101/2021.01.14...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3128299
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