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Ansari A, You YA, Lee G, Kim SM, Park SW, Hur YM, Kim YJ. Dysbiotic Vaginal Microbiota Induces Preterm Birth Cascade via Pathogenic Molecules in the Vagina. Metabolites 2024; 14:45. [PMID: 38248848 PMCID: PMC10821287 DOI: 10.3390/metabo14010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Dysbiotic vaginal microbiota (DVM) disturb the vaginal environment, including pH, metabolite, protein, and cytokine profiles. This study investigated the impact of DVM on the vaginal environment in 40 Korean pregnant women and identified predictable biomarkers of birth outcomes. Cervicovaginal fluid (CVF) samples were collected in the third trimester using vaginal swabs, examined for pH, and stored at -80 °C for further analysis. The samples were grouped as full-term (FTB, n = 20) and preterm (PTB, n = 20) births. The microbiota was profiled in the V1-V9 regions. The levels of targeted metabolites, TLR-4, and cytokines were determined. The pH of CVF from PTB (>4.5) was significantly higher than that of the CVF from FTB (>3.5) (p < 0.05). Neonatal gestational age at delivery, birth weight, and Apgar score differed significantly between groups. The relative abundances of beneficial Lactobacillus spp., such as Lactobacillus gasseri, Lactobacillus jensenii, and Bifidobacterium, were higher in FTB, whereas those of pathogenic Enterococcus faecalis, Staphylococcus, Prevotella, Ureaplasma parvum, and Corynebacterium spp. were higher in PTB. Acetate, methanol, TLR-4, and TNF-α levels were negatively correlated with gestational age at delivery and birth weight. Moreover, ethanol, methanol, TLR-4, IL-6, IL-1β, and TNF-α levels were positively correlated with succinate, acetate, acetoacetate, formate, and ammonia. Overall, DVM induces preterm birth via pathogenic molecules in the vagina.
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Affiliation(s)
- AbuZar Ansari
- Department of Obstetrics and Gynecology and Ewha Medical Research Institute, Ewha Womans University, Seoul 07985, Republic of Korea; (Y.-A.Y.); (G.L.); (S.M.K.); (S.W.P.); (Y.M.H.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 07984, Republic of Korea
| | - Young-Ah You
- Department of Obstetrics and Gynecology and Ewha Medical Research Institute, Ewha Womans University, Seoul 07985, Republic of Korea; (Y.-A.Y.); (G.L.); (S.M.K.); (S.W.P.); (Y.M.H.)
| | - Gain Lee
- Department of Obstetrics and Gynecology and Ewha Medical Research Institute, Ewha Womans University, Seoul 07985, Republic of Korea; (Y.-A.Y.); (G.L.); (S.M.K.); (S.W.P.); (Y.M.H.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 07984, Republic of Korea
| | - Soo Min Kim
- Department of Obstetrics and Gynecology and Ewha Medical Research Institute, Ewha Womans University, Seoul 07985, Republic of Korea; (Y.-A.Y.); (G.L.); (S.M.K.); (S.W.P.); (Y.M.H.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 07984, Republic of Korea
| | - Sun Wha Park
- Department of Obstetrics and Gynecology and Ewha Medical Research Institute, Ewha Womans University, Seoul 07985, Republic of Korea; (Y.-A.Y.); (G.L.); (S.M.K.); (S.W.P.); (Y.M.H.)
| | - Young Min Hur
- Department of Obstetrics and Gynecology and Ewha Medical Research Institute, Ewha Womans University, Seoul 07985, Republic of Korea; (Y.-A.Y.); (G.L.); (S.M.K.); (S.W.P.); (Y.M.H.)
| | - Young Ju Kim
- Department of Obstetrics and Gynecology and Ewha Medical Research Institute, Ewha Womans University, Seoul 07985, Republic of Korea; (Y.-A.Y.); (G.L.); (S.M.K.); (S.W.P.); (Y.M.H.)
- Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 07984, Republic of Korea
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Mashatan N, Heidari R, Altafi M, Amini A, Ommati MM, Hashemzaei M. Probiotics in vaginal health. Pathog Dis 2023; 81:ftad012. [PMID: 37286796 DOI: 10.1093/femspd/ftad012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/28/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
Bacterial vaginosis, a type of vaginal inflammation, can be considered the main reason for abnormal discharges of the vagina and vaginal dysbiosis during reproductive years. Epidemiological investigations of females suffering from vaginitis demonstrated that at least 30% to 50% of all women had Bacterial vaginosis (BV). One of the fields of treatment is the use of probiotics, probiotics are commonly defined as viable microorganisms (yeasts or bacteria) that can positively affect the health of their hosts. They are used in foods, notably fermented milk products, and medicine-related products. The development of new probiotic strains is aimed at more active advantageous organisms. Lactobacillus species are the dominant bacteria in a normal vagina that can decrease the pH of the vagina by the production of lactic acid. A number of lactobacilli types can produce hydrogen peroxide as well. The presence of hydrogen peroxide-induced low pH can prevent the growth of several other microorganisms. The vaginal flora of BV cases can modify by replacing the Lactobacillus species with a high density of anaerobic bacteria (i.e. Mobiluncus sp. Bacteroides sp.), Mycoplasma hominis, and Gardnerella vaginalis. More vaginal infections are treated with medications, while there is a possibility of recurrence and chronic infection because of the adverse effects on the indigenous lactobacilli. Probiotics and prebiotics have shown capacities for optimizing, maintaining, and restoring the vaginal microflora. Therefore, biotherapeutics can offer alternative approaches to reduce infections of the vagina and thus promote consumers' health.
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Affiliation(s)
- Noushin Mashatan
- Graduated, School of Applied Sciences, University of Brighton, Brighton, UK
| | - Reza Heidari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
| | - Mana Altafi
- Department of Microbiology, Faculty of Biological Science and Technology, Shiraz Pardis Branch, Islamic Azad University, Shiraz, Iran
| | - Amir Amini
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
| | - Mohammad Mehdi Ommati
- Henan Key Laboratory of Environmental and Animal Products Safety, College of Animal Science and Technology, Luoyang, Henan, China
| | - Masoud Hashemzaei
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
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Maternal Baseline Risk Factors for Abnormal Vaginal Colonisation among High-Risk Pregnant Women and the Association with Adverse Pregnancy Outcomes: A Retrospective Cohort Study. J Clin Med 2022; 12:jcm12010040. [PMID: 36614842 PMCID: PMC9821127 DOI: 10.3390/jcm12010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Abnormal vaginal colonisation can lead to adverse pregnancy outcomes such as preterm birth through intra-amniotic inflammation. Despite the concern, little is known about its risk factors and impact in pregnant women at high-risk for spontaneous preterm birth. Thus, we conducted this single-centre retrospective cohort study including 1381 consecutive women who were admitted to the high-risk pregnancy unit. The results of vaginal culture at admission were categorised according to the colonising organism: bacteria (Gram-negative or -positive) and genital mycoplasmas. Maternal baseline socioeconomic, and clinical characteristics, as well as pregnancy, delivery, and neonatal outcomes were compared according to the category. Maternal risk factors for Gram-negative colonisation included advanced maternal age, increased pre-pregnancy BMI, a greater number of past spontaneous abortions, earlier gestational age at admission, and IVF. Gram-positive colonisation was likewise associated with earlier gestational age at admission. Genital mycoplasmal colonisation was associated with a greater number of past induced abortions, a lower level of education completed, and a lower rate of multifetal pregnancy and IVF. The neonates from mothers with Gram-negative colonisation had a greater risk of NICU admission, proven early onset neonatal sepsis, and mortality. However, not Gram-positive bacteria or genital mycoplasma was directly associated with adverse pregnancy outcomes.
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Lacroix G, Gouyer V, Rocher M, Gottrand F, Desseyn JL. A porous cervical mucus plug leads to preterm birth induced by experimental vaginal infection in mice. iScience 2022; 25:104526. [PMID: 35754724 PMCID: PMC9218384 DOI: 10.1016/j.isci.2022.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/14/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022] Open
Abstract
During gestation, the cervical mucus plug (CMP) acts to seal the cervical canal. Pilot studies in humans have suggested that a porous CMP may increase the risk of uterine infection and preterm birth. We examined the gel-forming content of the mouse vagina and the CMP. We experimentally infected pregnant mice by intravaginal administration of pathogens related to preterm birth in humans. We found that the epithelium in both the vagina and cervical canal of pregnant mice produced the two gel-forming mucins Muc5b and Muc5ac. The CMP was porous in Muc5b-deficient mice for which intravaginal administration of Escherichia coli O 55 led to the activation of an inflammatory response in the uterus and 100% preterm births. The pathogen was found in the mucus plug and uterus. This study shows that Muc5b is essential for the in vivo barrier function and the prevention of uterine infections during gestation. Muc5b and Muc5ac are the main gel-forming mucins of the mouse vagina and cervical canal During pregnancy, a cervical mucus plug (CMP) is formed and seals the cervical canal Muc5b-deficient CMP is highly porous Inflammation following vaginal infection causes preterm birth in Muc5b-deficient mice
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Affiliation(s)
- Guillaume Lacroix
- University Lille, Inserm, CHU Lille, U1286 - Infinite, 59000 Lille, France
| | - Valérie Gouyer
- University Lille, Inserm, CHU Lille, U1286 - Infinite, 59000 Lille, France
| | - Mylène Rocher
- University Lille, Inserm, CHU Lille, U1286 - Infinite, 59000 Lille, France
| | - Frédéric Gottrand
- University Lille, Inserm, CHU Lille, U1286 - Infinite, 59000 Lille, France
| | - Jean-Luc Desseyn
- University Lille, Inserm, CHU Lille, U1286 - Infinite, 59000 Lille, France
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Kazemian H, Zarandi MK, Zargoush Z, Ghafourian S, Sadeghifard N, Jalilian A, Shafieian M, Pakzad I. The prevalence of gonococcal and non-gonococcal infections in women referred to obstetrics and gynecology clinics. LE INFEZIONI IN MEDICINA 2022; 30:247-253. [PMID: 35693060 PMCID: PMC9177188 DOI: 10.53854/liim-3002-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Bacterial vaginosis is a condition caused by changes in the vaginal microbial ecosystem and increases the risk of preterm delivery, premature rupture of membranes, endometritis, and weight loss of the baby. This study aimed to evaluate the frequency of gonococcal and non-gonococcal genital infections in women referred to clinics in Ilam, Iran. Two swab samples were taken from each patient using a sterile swab, one swab was placed in a THB medium for the culture of Streptococcus agalactiae and the other in PBS buffer for PCR. PCR method was conducted for the identification of the other bacterial agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and also S. agalactiae. Sampling was performed on 169 women with symptomatic vaginosis. The frequency of S. agalactiae by culture and PCR methods was 4.7% (8 samples) and 13.6% (23 samples) respectively. Also, 6.5% (11 samples), 3.5% (6 samples), 4.1% (7 samples), 1.2% (2 samples), and 0% of the samples were positive for N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum and C. trachomatis by PCR method. Except for a significant association between S. agalactiae colonization and abortion, there was no significant correlation between the prevalence of these bacteria and the patient's age, age of marriage, number of deliveries, and number of abortions. Overall, the prevalence of gonococcal and non-gonococcal infection in women referred to clinics in Ilam is similar to the other parts of Iran.
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Affiliation(s)
- Hossein Kazemian
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Morteza Karami Zarandi
- Department of Microbiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zeinab Zargoush
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Sobhan Ghafourian
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Nourkhoda Sadeghifard
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Anahita Jalilian
- Department of Obstetrics and Gynecology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mahnaz Shafieian
- Department of Midwifery, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Iraj Pakzad
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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Kwon DY, Seo MR, Park H, Kim SY, Sung JH, Choi SJ, Oh SY, Roh CR. Differential impact of abnormal vaginal colonization on perinatal outcome and association with early-onset neonatal sepsis: preterm labor vs. preterm premature rupture of membrane. J Matern Fetal Neonatal Med 2021; 35:8338-8344. [PMID: 34498988 DOI: 10.1080/14767058.2021.1974384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to check whether the impact of abnormal vaginal colonization on perinatal outcomes would be different in patients with preterm labor (PTL) and premature membrane rupture (PPROM). We also sought to determine the concordance rate of microorganisms isolated from the maternal vagina and neonatal blood in cases of early-onset neonatal sepsis (EONS) in PTL and PPROM. METHODS This retrospective study included 996 singleton pregnancies who were admitted to the high risk care unit of our institution due to PTL (n = 519) or PPROM (n = 477) and underwent vaginal culture examination at admission between January 2005 and April 2019. Abnormal vaginal colonization was defined upon isolation of aerobic microorganisms. The maternal baseline characteristics, delivery, and neonatal outcomes were compared according to the presence or absence of abnormal vaginal flora, both in PTL and PPROM. RESULTS The rate of abnormal vaginal colonization in PTL and PPROM was 17.0 and 21.4%, respectively. Both in PTL and PPROM, the gestational age at admission was lower in the abnormal vaginal colonization group (PTL, 27.2 ± 3.5 vs. 28.2 ± 3.5 weeks, p = .024; PPROM, 26.1 ± 5.3 vs. 27.5 ± 4.5 weeks, p = .007). Multivariable analysis demonstrated that the group with abnormal bacteria in PPROM but not in PTL had a significantly higher rate of EONS than the group without abnormal bacteria after adjustment for confounders including gestational age at admission (PPROM, odds ratio, OR [95% confidence interval, CI]: 4.172 [1.426-12.206]; PTL, OR [95% CI]: 0.661 [0.079-5.505]). Concordance analysis showed that the maternal vaginal bacteria colonization by Escherichia coli (5.9 vs. 0.5%, p = .033) and Staphylococcus aureus (14.3 vs. 0.2%, p = .032) in PPROM was significantly correlated with the microorganisms from the neonatal blood culture EONS cases. In PTL, no specific microorganisms showed concordance between maternal vaginal bacteria and microorganisms causing EONS. CONCLUSION Our data showed that maternal vaginal colonization in PPROM, but not in PTL, is an independent risk factor for EONS.
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Affiliation(s)
- Do Youn Kwon
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi Rang Seo
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyea Park
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seo-Yeon Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Ansari A, Bose S, You Y, Park S, Kim Y. Molecular Mechanism of Microbiota Metabolites in Preterm Birth: Pathological and Therapeutic Insights. Int J Mol Sci 2021; 22:8145. [PMID: 34360908 PMCID: PMC8347546 DOI: 10.3390/ijms22158145] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
Preterm birth (PTB) refers to the birth of infants before 37 weeks of gestation and is a challenging issue worldwide. Evidence reveals that PTB is a multifactorial dysregulation mediated by a complex molecular mechanism. Thus, a better understanding of the complex molecular mechanisms underlying PTB is a prerequisite to explore effective therapeutic approaches. During early pregnancy, various physiological and metabolic changes occur as a result of endocrine and immune metabolism. The microbiota controls the physiological and metabolic mechanism of the host homeostasis, and dysbiosis of maternal microbial homeostasis dysregulates the mechanistic of fetal developmental processes and directly affects the birth outcome. Accumulating evidence indicates that metabolic dysregulation in the maternal or fetal membranes stimulates the inflammatory cytokines, which may positively progress the PTB. Although labour is regarded as an inflammatory process, it is still unclear how microbial dysbiosis could regulate the molecular mechanism of PTB. In this review based on recent research, we focused on both the pathological and therapeutic contribution of microbiota-generated metabolites to PTB and the possible molecular mechanisms.
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Affiliation(s)
- AbuZar Ansari
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
| | - Shambhunath Bose
- Department of Bioscience, Sri Sathya Sai University for Human Excellence, Navanihal, Okali Post, Kamalapur, Kalaburagi, Karnataka 585313, India;
| | - Youngah You
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
| | - Sunwha Park
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
| | - Youngju Kim
- Department of Obstetrics and Gynecology, Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul 07985, Korea; (A.A.); (Y.Y.); (S.P.)
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Identification of Indicators for Preterm Birth Using Retinoid Metabolites. Metabolites 2021; 11:metabo11070443. [PMID: 34357337 PMCID: PMC8304766 DOI: 10.3390/metabo11070443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
Metabolites reflect the biochemical dynamics for the maintenance of pregnancy and parturition. UPLC-Q/TOF-MS and LC-MS/MS metabolomics were performed to identify and validate the plasma metabolomic signatures of preterm birth (PTB). We recruited pregnant women between 16 and 40 weeks 5 days gestational age at Ewha Womans Mokdong Hospital for a nested case-control study. In untargeted UPLC-Q/TOF-MS, score plots of partial least-squares discriminant analysis clearly separated the PTB group from the term birth (TB, n = 10; PTB, n = 11). Fifteen metabolites were significantly different between the two groups, as indicated by a variable importance in projection >1 and p < 0.05. Metabolic pathways involving retinol, linoleic acid, d-arginine, and d-ornithine were associated with PTB. Verification by LC-MS/MS focused on retinol metabolism (TB, n = 39; PTB, n = 20). Retinol levels were significantly reduced in PTB compared to TB, while retinal palmitate, all-trans-retinal, and 13-cis-retinoic acid (13cis-RA) significantly increased (p < 0.05). Retinol-binding protein levels were also elevated in PTB. Additionally, all-trans-retinal (AUC 0.808, 95% CI: 0.683–0.933) and 13cis-RA (AUC 0.826, 95% CI: 0.723–0.930) showed improved predictions for PTB-related retinol metabolites. This study suggests that retinoid metabolism improves the accuracy of PTB predictions and plays an important role in maintaining pregnancy and inducing early parturition.
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Identification of Potential Biomarkers in the Cervicovaginal Fluid by Metabolic Profiling for Preterm Birth. Metabolites 2020; 10:metabo10090349. [PMID: 32867268 PMCID: PMC7570126 DOI: 10.3390/metabo10090349] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
During pregnancy, dysbiosis in the vaginal microbiota directly affects the metabolic profiles, which might impact preterm birth (PTB). In this study, we performed cervicovaginal fluid (CVF) metabolic profiling using nuclear magnetic resonance (NMR) spectroscopy and identified the metabolic markers for predicting PTB. In this nested case-control study, 43 South Korean pregnant women with PTB (n = 22), and term birth (TB; n = 21) were enrolled with their demographic profiles, and CVF samples were collected by vaginal swabs. The PTB group had two subgroups based on post-CVF sampling birth: PTB less than (PTB < 7 d) and more than 7 days (PTB ≥ 7 d). We observed significant differences in the gestational age at birth (GAB), cervical length (CL), and neonatal birth weight among the groups. The principal component analysis (PCA), and partial least square discriminant analysis (PLS-DA) scatter plot showed the separation between the PTB < 7 d group, and the TB group. Out of 28 identified metabolites, acetone, ethanol, ethylene glycol, formate, glycolate, isopropanol, methanol, and trimethylamine N-oxide (TMAO) were significantly increased in the PTB group compared with the TB group. The ROC curve analysis revealed that the acetone, ethylene glycol, formate, glycolate, isopropanol, methanol, and TMAO had the best predictive values for PTB. Additionally, the correlation analysis of these metabolites showed a strong negative correlation with GAB and CL. These metabolites could be beneficial markers for the clinical application of PTB prediction.
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Suff N, Karda R, Diaz JA, Ng J, Baruteau J, Perocheau D, Tangney M, Taylor PW, Peebles D, Buckley SMK, Waddington SN. Ascending Vaginal Infection Using Bioluminescent Bacteria Evokes Intrauterine Inflammation, Preterm Birth, and Neonatal Brain Injury in Pregnant Mice. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:2164-2176. [PMID: 30036519 PMCID: PMC6168615 DOI: 10.1016/j.ajpath.2018.06.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 12/11/2022]
Abstract
Preterm birth is a serious global health problem and the leading cause of infant death before 5 years of age. At least 40% of cases are associated with infection. The most common way for pathogens to access the uterine cavity is by ascending from the vagina. Bioluminescent pathogens have revolutionized the understanding of infectious diseases. We hypothesized that bioluminescent Escherichia coli can be used to track and monitor ascending vaginal infections. Two bioluminescent strains were studied: E. coli K12 MG1655-lux, a nonpathogenic laboratory strain, and E. coli K1 A192PP-lux2, a pathogenic strain capable of causing neonatal meningitis and sepsis in neonatal rats. On embryonic day 16, mice received intravaginal E. coli K12, E. coli K1, or phosphate-buffered saline followed by whole-body bioluminescent imaging. In both cases, intravaginal delivery of E. coli K12 or E. coli K1 led to bacterial ascension into the uterine cavity, but only E. coli K1 induced preterm parturition. Intravaginal administration of E. coli K1 significantly reduced the proportion of pups born alive compared with E. coli K12 and phosphate-buffered saline controls. However, in both groups of viable pups born after bacterial inoculation, there was evidence of comparable brain inflammation by postnatal day 6. This study ascribes specific mechanisms by which exposure to intrauterine bacteria leads to premature delivery and neurologic inflammation in neonates.
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Affiliation(s)
- Natalie Suff
- Gene Transfer Technology Group, University College London, London, United Kingdom; Preterm Birth Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
| | - Rajvinder Karda
- Gene Transfer Technology Group, University College London, London, United Kingdom
| | - Juan A Diaz
- Gene Transfer Technology Group, University College London, London, United Kingdom
| | - Joanne Ng
- Gene Transfer Technology Group, University College London, London, United Kingdom
| | - Julien Baruteau
- Gene Transfer Technology Group, University College London, London, United Kingdom; Department of Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Dany Perocheau
- Gene Transfer Technology Group, University College London, London, United Kingdom
| | - Mark Tangney
- SynBio Centre, University College Cork, Cork, Ireland
| | - Peter W Taylor
- School of Pharmacy, University College London, London, United Kingdom
| | - Donald Peebles
- Preterm Birth Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
| | - Suzanne M K Buckley
- Gene Transfer Technology Group, University College London, London, United Kingdom.
| | - Simon N Waddington
- Gene Transfer Technology Group, University College London, London, United Kingdom; MRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Relationships Between Perinatal Interventions, Maternal-Infant Microbiomes, and Neonatal Outcomes. Clin Perinatol 2018; 45:339-355. [PMID: 29747892 DOI: 10.1016/j.clp.2018.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The human microbiome acquires its vastness and diversity over a relatively short time period during development. Much is unknown, however, about the precise prenatal versus postnatal timing or its sources and determinants. Given early evidence of a role for influences during pregnancy and early neonatal and infant life on the microbiome and subsequent metabolic health, research investigating the development and shaping of the microbiome in the fetus and neonate is an important arena for study. This article reviews the relevant available literature and future questions on what shapes the microbiome during early development and mechanisms for doing so.
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Cools P. The role of Escherichia coli in reproductive health: state of the art. Res Microbiol 2017; 168:892-901. [PMID: 28242352 DOI: 10.1016/j.resmic.2017.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 01/27/2023]
Abstract
Escherichia coli is a well-known commensal of the normal intestinal microbiome that can also colonize the vaginal microbiome, usually without symptoms. However, E. coli can also be a highly virulent and frequently deadly pathogen. In this review, I will discuss the role E. coli has in reproductive health and disease.
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Affiliation(s)
- Piet Cools
- Laboratory Bacteriology Research, Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
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13
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Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities. Eur J Clin Microbiol Infect Dis 2016; 35:657-64. [PMID: 26810061 DOI: 10.1007/s10096-016-2584-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/13/2016] [Indexed: 12/31/2022]
Abstract
The purpose of this investigation was to evaluate the impact of the vaginal milieu on the presence of abnormal Pap smears and a positive human papilloma virus (HPV) test. A cross-sectional study was conducted between June 2014 and May 2015, evaluating the vaginal discharge by fresh wet mount microscopy and comparing these data with Pap smear findings. Wet mount slides were scored for bacterial vaginosis (BV), aerobic vaginitis (AV), presence of Candida and Trichomonas vaginalis. Cytologic evaluation was done on all Pap smears according to the Bethesda criteria. The cobas© HPV Test (Roche) was performed for HPV detection. A total of 622 cases were evaluated. The mean age of the patients was 41.6 ± 10.65 years (range 21-75). Eighty-three women (13.3 %) had a cytology result worse than low-grade squamous intraepithelial lesion (LSIL). When comparing this group with the one with normal or minor [atypical squamous cells of undetermined significance (ASC-US) or LSIL] Pap smear abnormalities, there were no differences in the presence of Candida (32.5 % vs. 33.2 %, p = 1.0), absence of lactobacilli (38.6 % vs. 32.5 %, p = 0.32) or BV (20.5 % vs. 13.2 %, p = 0.09). On the other hand, moderate or severe inflammation (msI) (41.0 % vs. 28.8 %, p = 0,04), moderate or severe AV (msAV) (16.9 % vs. 7.2 %, p = 0.009) and msAV/BV (37.3 % vs. 20.0 %, p = 0.001) were more common in women with such major cervical abnormalities. No significant association was found between deviations of the vaginal milieu and high-risk HPV infection. The presence of msI or msAV, but not BV, is independently associated with an increased risk of major cervical cytological abnormalities, but not with HPV infection.
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14
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Diagnosis of aerobic vaginitis by quantitative real-time PCR. Arch Gynecol Obstet 2016; 294:109-14. [DOI: 10.1007/s00404-015-4007-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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15
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Donders GGG, Donders F, Bellen G, Depuydt C, Eggermont N, Michiels T, Lule J, Byamughisa J. Screening for abnormal vaginal microflora by self-assessed vaginal pH does not enable detection of sexually transmitted infections in Ugandan women. Diagn Microbiol Infect Dis 2015; 85:227-30. [PMID: 27112831 DOI: 10.1016/j.diagmicrobio.2015.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/06/2015] [Accepted: 12/22/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Is self-assessed vaginal pH measurement to detect abnormal vaginal bacterial microflora (AVF) an adequate prescreening method for detection of genital sexually transmitted infections (STIs)? MATERIALS AND METHODS A total of 360 Ugandan women tested themselves with a gloved finger and a pH color strip. PCR for bacterial vaginosis (BV)-associated bacteria was tested by PCR for Mycoplasma hominis, Ureaplasma urealyticum, and/or Atopobium vaginae, while the STIs were diagnosed by positive PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and/or Trichomonas vaginalis. RESULTS A strong correlation was found between self-assessed pH values and BV-associated bacteria (P<0.0001), but not with STIs, not as single infections, nor in general. CONCLUSION Self-measured vaginal pH correlated well with markers of high-risk microflora types such as BV or aerobic vaginitis, but not with STIs. Hence, in a screening program addressing AVF in low-resource countries, extra specific tests are required to exclude STIs.
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Affiliation(s)
- Gilbert G G Donders
- Femicare vzw, Clinical Research for Women, Tienen, Belgium; Department of Obstetrics and Gynaecology, University Hospital Antwerpen, Antwerp, Belgium; Department of Obstetrics and Gynaecology, General Hospital H Hart, Tienen, Belgium.
| | | | - Gert Bellen
- Femicare vzw, Clinical Research for Women, Tienen, Belgium.
| | - Christophe Depuydt
- Department of Molecular Diagnostics, Algemeen Medisch Laboratorium (AML), Sonic HealthCare Benelux, Antwerp, Belgium.
| | | | | | - John Lule
- Department Obstetrics and Gynaecology, Mulago University Hospital, Kampala, Uganda.
| | - Jacobat Byamughisa
- Department Obstetrics and Gynaecology, Mulago University Hospital, Kampala, Uganda.
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16
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Baldwin EA, Walther-Antonio M, MacLean AM, Gohl DM, Beckman KB, Chen J, White B, Creedon DJ, Chia N. Persistent microbial dysbiosis in preterm premature rupture of membranes from onset until delivery. PeerJ 2015; 3:e1398. [PMID: 26644969 PMCID: PMC4671185 DOI: 10.7717/peerj.1398] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/20/2015] [Indexed: 01/28/2023] Open
Abstract
Background. Preterm Premature Rupture of Membranes (PPROM) is a major leading cause of preterm births. While the cause for PPROM remains unidentified, it is anticipated to be due to subclinical infection, since a large proportion of PPROM patients display signs of chorioamnionitis. Since subclinical infections can be facilitated by dysbiosis, our goal was to characterize the vaginal microbiome and amniotic fluid discharge upon PPROM, through latency antibiotic treatment, and until delivery, to detect the presence of pathogens, microbiota alteration, and microbial response to treatment. Methods. Enrolled subjects (15) underwent routine institutional antenatal care for PPROM, including the administration of latency antibiotics. Serial vaginal swabs were obtained from diagnosis of PPROM through delivery and the sequencing of the V3-V5 region of the 16S rRNA gene was performed for all collected samples. Results. The results show that Lactobacilli species were markedly decreased when compared to vaginal swabs collected from uncomplicated pregnancy subjects with a matched gestational time. Prevotella and Peptoniphilus were the most prevalent taxa in PPROM subjects at presentation. The vaginal microbiome of the PPROM subjects varied substantially intra- and inter-subjects. Several taxa were found to be significantly reduced during and after the antibiotic treatment: Weeksella, Lachnospira, Achromobacter, and Pediococcus. In contrast, Peptostreptococcus and Tissierellaceae ph2 displayed a significant increase after the antibiotic treatment. However, the relative abundance of Lactobacillus, Prevotella, and Peptoniphilus was not substantially impacted during the hospitalization of the PPROM subjects. The deficiency of Lactobacillus, and constancy of known pathogenic species, such as Prevotella and Peptoniphilus during and after antibiotics, highlights the persistent dysbiosis and warrants further investigation into mitigating approaches. Discussion. PPROM is responsible for one third of all preterm births. It is thought that subclinical infection is a crucial factor in the pathophysiology of PPROM because 25-40% of patients present signs of chorioamnionitis on amniocentesis. Here we sought to directly assess the bacterial content of the vagina and leaking amniotic fluid of subjects at presentation, throughout treatment and up until delivery, in order to search for common pathogens, microbiota changes, and microbial response to latency antibiotic treatment. We have found that the vaginal microbiome of PPROM subjects is highly variable and displays significant changes to treatment. However, the unchanging deficiency of Lactobacillus, and persistence of known pathogenic species, such as Prevotella and Peptoniphilus from presentation, through antibiotic treatment and up until delivery, highlights the persistent dysbiosis and warrants further investigation into mitigating approaches.
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Affiliation(s)
| | | | | | - Daryl M. Gohl
- Genomics Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Jun Chen
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Bryan White
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | | | - Nicholas Chia
- Department of Surgical Research, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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17
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Migale R, Herbert BR, Lee YS, Sykes L, Waddington SN, Peebles D, Hagberg H, Johnson MR, Bennett PR, MacIntyre DA. Specific Lipopolysaccharide Serotypes Induce Differential Maternal and Neonatal Inflammatory Responses in a Murine Model of Preterm Labor. THE AMERICAN JOURNAL OF PATHOLOGY 2015. [PMID: 26212908 DOI: 10.1016/j.ajpath.2015.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intrauterine inflammation is recognized as a key mediator of both normal and preterm birth but is also associated with neonatal neurological injury. Lipopolysaccharide (LPS) is often used to stimulate inflammatory pathways in animal models of infection/inflammation-induced preterm labor; however, inconsistencies in maternal and neonatal responses to LPS are frequently reported. We hypothesized that LPS serotype-specific responses may account for a portion of these inconsistencies. Four different Escherichia coli LPS serotypes (O111:B4, O55:B5, O127:B8, and O128:B12) were administered to CD1 mice via intrauterine injection at gestational day 16. Although control animals delivered at term 60 ± 15 hours postinjection (p.i.), those administered with O111:B4 delivered 7 ± 2 hours p.i., O55:B5 delivered 10 ± 3 hours p.i., O127:B8 delivered 16 ± 10 hours p.i., and O128:B12 delivered 17 ± 2 hours p.i. (means ± SD). A correlation between the onset of preterm labor and myometrial activation of the inflammatory transcription factor, activator protein 1, but not NF-κB was observed. Specific LPS serotypes induced differential activation of downstream contractile and inflammatory pathways in myometrium and neonatal pup brain. Our findings demonstrate functional disparity in inflammatory pathway activation in response to differing LPS serotypes. Selective use of LPS serotypes may represent a useful tool for targeting specific inflammatory response mechanisms in these models.
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Affiliation(s)
- Roberta Migale
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Bronwen R Herbert
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Yun S Lee
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Lynne Sykes
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Simon N Waddington
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom; Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witswatersrand, Johannesburg, South Africa
| | - Donald Peebles
- UCL Centre for Perinatal Brain Protection & Repair, Institute for Women's Health, University College London, London, United Kingdom
| | - Henrik Hagberg
- Department of Clinical Sciences, Perinatal Center, University of Gothenburg, Gothenburg, Sweden; Division of Imaging Sciences and Biomedical Engineering, Centre for the Developing Brain, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Mark R Johnson
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Phillip R Bennett
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - David A MacIntyre
- Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom.
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Touzon MS, Losada M, Eliseht MC, Menghi C, Gatta C, Santa Cruz G, Malamud de Ruda Vega H, Vay C, Tatti S, Famiglietti A, Perazzi B. [Evaluation of vaginal dysfunction in symptomatic and asymptomatic pregnant women by using the analysis of basic vaginal states (BVS) and its comparison with the conventional microbiological study]. Rev Argent Microbiol 2014; 46:182-7. [PMID: 25444125 DOI: 10.1016/s0325-7541(14)70070-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/22/2014] [Indexed: 11/15/2022] Open
Abstract
Infections of the lower genital tract associated to maternal and perinatal complications frequently occur during pregnancy. The aim of this study was to evaluate vaginal dysfunction through the analysis of basic vaginal states (BVS) using the methodology of balance of the vaginal content (BAVACO) and to compare it with the microbiological study of candidiasis, trichomoniasis and bacterial vaginosis (BV). Pregnant patients (1238) were examined from 2010 to 2012. In asymptomatic (A) (n: 1046) and symptomatic pregnant women (S) (n: 192) BVS I was 59.5% and 26% of the patients, respectively. BVS II was observed in 19.7% of A and in 17.2% of S. BVS III was only detected in A in 0.4%. BVS IV was observed in 14.4% of A and in 38% of S. BVS V was detected in 6% of A and in 18.8% of S. Yeasts were associated to BVS I and II in 55.5% and 23.2% of A, respectively; and in 32.4% and 31% of S, respectively. Trichomonas were associated to BVS I in 50% of A, to IV in 44.4% of S and to V in 33.3% of S. BAVACO susceptibility to detect yeasts was 80.4% and 85.5% in A and S, respectively; 40% and 75% in A and S, respectively, to detect trichomonas and 100% in A and S to detect BV. BAVACO specificity was 100% for all pathogens in A and S. The study of BVS proved useful as a guide to evaluate vaginal dysfunction, regardless of symptomatology. Therefore, this study is recommended as prenatal control.
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Affiliation(s)
- María S Touzon
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina.
| | - Mirta Losada
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - Martha Cora Eliseht
- Tracto Genital Inferior, Primera Cátedra de Obstetricia, Hospital de Clínicas, Universidad de Buenos Aires, Argentina
| | - Claudia Menghi
- Laboratorio de Parasitología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - Claudia Gatta
- Laboratorio de Parasitología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - Gabriela Santa Cruz
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - Hilda Malamud de Ruda Vega
- Tracto Genital Inferior, Primera Cátedra de Obstetricia, Hospital de Clínicas, Universidad de Buenos Aires, Argentina
| | - Carlos Vay
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - Silvio Tatti
- Tracto Genital Inferior, Primera Cátedra de Obstetricia, Hospital de Clínicas, Universidad de Buenos Aires, Argentina
| | - Angela Famiglietti
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
| | - Beatriz Perazzi
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina
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Walther-António MRS, Jeraldo P, Berg Miller ME, Yeoman CJ, Nelson KE, Wilson BA, White BA, Chia N, Creedon DJ. Pregnancy's stronghold on the vaginal microbiome. PLoS One 2014; 9:e98514. [PMID: 24896831 PMCID: PMC4045671 DOI: 10.1371/journal.pone.0098514] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/02/2014] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the vaginal microbiome throughout full-term uncomplicated pregnancy. Methods Vaginal swabs were obtained from twelve pregnant women at 8-week intervals throughout their uncomplicated pregnancies. Patients with symptoms of vaginal infection or with recent antibiotic use were excluded. Swabs were obtained from the posterior fornix and cervix at 8–12, 17–21, 27–31, and 36–38 weeks of gestation. The microbial community was profiled using hypervariable tag sequencing of the V3–V5 region of the 16S rRNA gene, producing approximately 8 million reads on the Illumina MiSeq. Results Samples were dominated by a single genus, Lactobacillus, and exhibited low species diversity. For a majority of the patients (n = 8), the vaginal microbiome was dominated by Lactobacillus crispatus throughout pregnancy. Two patients showed Lactobacillus iners dominance during the course of pregnancy, and two showed a shift between the first and second trimester from L. crispatus to L. iners dominance. In all of the samples only these two species were identified, and were found at an abundance of higher than 1% in this study. Comparative analyses also showed that the vaginal microbiome during pregnancy is characterized by a marked dominance of Lactobacillus species in both Caucasian and African-American subjects. In addition, our Caucasian subject population clustered by trimester and progressed towards a common attractor while African-American women clustered by subject instead and did not progress towards a common attractor. Conclusion Our analyses indicate normal pregnancy is characterized by a microbiome that has low diversity and high stability. While Lactobacillus species strongly dominate the vaginal environment during pregnancy across the two studied ethnicities, observed differences between the longitudinal dynamics of the analyzed populations may contribute to divergent risk for pregnancy complications. This helps establish a baseline for investigating the role of the microbiome in complications of pregnancy such as preterm labor and preterm delivery.
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Affiliation(s)
| | - Patricio Jeraldo
- Department of Surgical Research, Mayo Clinic, Rochester, Minnesota, United States of America
- Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Margret E. Berg Miller
- Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Carl J. Yeoman
- Department of Animal and Range Sciences, Montana State University, Bozeman, Montana, United States of America
| | - Karen E. Nelson
- Genomic Medicine Group, J. Craig Venter Institute, Rockville, Maryland, United States of America
| | - Brenda A. Wilson
- Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Bryan A. White
- Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Nicholas Chia
- Department of Surgical Research, Mayo Clinic, Rochester, Minnesota, United States of America
- Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
- Department of Physiology and Biomedical Engineering, Mayo College, Rochester, Minnesota, United States of America
| | - Douglas J. Creedon
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Honda H, Yokoyama T, Akimoto Y, Tanimoto H, Teramoto M, Teramoto H. The frequent shift to intermediate flora in preterm delivery cases after abnormal vaginal flora screening. Sci Rep 2014; 4:4799. [PMID: 24762852 PMCID: PMC5381188 DOI: 10.1038/srep04799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/09/2014] [Indexed: 11/28/2022] Open
Abstract
The effect of screening and treatment for abnormal vaginal flora on the reduction of preterm deliveries remains controversial. We evaluated whether this screening and treatment reduces the preterm delivery rate for general-population pregnant women. Pregnant women of the Intervention group (n = 574) underwent the screening test and the treatment of vaginal metronidazole during the early second trimester, and those of the Control group (n = 1,161) did not. We compared the preterm delivery rate between these two groups. We also compared the profiles of vaginal flora of the preterm delivery cases with those of the pregnant women with a normal course. There was no significant difference in the preterm delivery rate between these two groups. However, in the preterm delivery cases, a frequent shift to intermediate flora was observed not before but after the screening in the Intervention group. This shift may explain why most of the previous studies failed in regard to the prevention of preterm deliveries.
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Affiliation(s)
- Hiroshi Honda
- Department of Obstetrics and Gynecology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Takanori Yokoyama
- Department of Obstetrics and Gynecology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Yumiko Akimoto
- Department of Obstetrics and Gynecology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Hirotoshi Tanimoto
- Department of Obstetrics and Gynecology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Mitsue Teramoto
- Department of Obstetrics and Gynecology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Hideki Teramoto
- Department of Obstetrics and Gynecology, Hiroshima City Asa Hospital, Hiroshima, Japan
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Jahic M, Mulavdic M, Nurkic J, Jahic E, Nurkic M. Clinical characteristics of aerobic vaginitis and its association to vaginal candidiasis, trichomonas vaginitis and bacterial vaginosis. Med Arch 2013; 67:428-30. [PMID: 25568514 PMCID: PMC4272474 DOI: 10.5455/medarh.2013.67.428-430] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/15/2013] [Indexed: 12/04/2022] Open
Abstract
Aim of the work: Examine clinical characteristics of aerobic vaginitis and mixed infection for the purpose of better diagnostic accuracy and treatment efficiency. Materials and methods: Prospective research has been conducted at Clinic for Gynecology and Obstetrics, Department for Microbiology and Pathology at Polyclinic for laboratory diagnostic and Gynecology and Obstetrics Department at Health Center Sapna. Examination included 100 examinees with the signs of vaginitis. Examination consisted of: anamnesis, clinical, gynecological and microbiological examination of vaginal smear. Results: The average age of the examinees was 32,62±2,6. Examining vaginal smears of the examinees with signs of vaginitis in 96% (N-96) different microorganisms have been isolated, while in 4% (N-4) findings were normal. AV has been found in 51% (N-51) of the examinees, Candida albicans in 17% (N-17), BV in 15% (N-15), Trichomonas vaginalis in 13% (N-13). In 21% (N-21) AV was diagnosed alone while associated with other agents in 30% (N-30). Most common causes of AV are E. coli (N-55) and E. faecalis (N-52). AV and Candida albicanis have been found in (13/30, 43%), Trichomonas vaginalis in (9/30, 30%) and BV (8/30, 26%). Vaginal secretion is in 70,05% (N-36) yellow coloured, red vagina wall is recorded in 31,13% (N-16) and pruritus in 72,54% (N-37). Increased pH value of vagina found in 94,10% (N-48). The average pH value of vaginal environment was 5,15±0,54 and in associated presence of AV and VVC, TV and BV was 5,29±0,56 which is higher value considering presence of AV alone but that is not statistically significant difference (p>0,05). Amino-odor test was positive in 29,94% (N-15) of associated infections. Lactobacilli are absent, while leukocytes are increased in 100% (N-51) of the examinees with AV. Conclusion: AV is vaginal infection similar to other vaginal infections. It is important to be careful while diagnosing because the treatment of AV differentiates from treatment of other vaginitis.
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Affiliation(s)
- Mahira Jahic
- Gynecology Clinic, Dr Mahira Jahic" Tuzla, Bosnia and Herzegovina
| | - Mirsada Mulavdic
- Department of Microbiolology, Polyclinic for Laboratory Diagnostics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Jasmina Nurkic
- Department of Immunology, Polyclinic for Laboratory Diagnostics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Elmir Jahic
- Clinic for Cardiovascular Disease, Department of Interventional Cardiology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Midhat Nurkic
- Clinic for Cardiovascular Disease, Department of Interventional Cardiology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Myhre R, Brantsæter AL, Myking S, Eggesbø M, Meltzer HM, Haugen M, Jacobsson B. Intakes of garlic and dried fruits are associated with lower risk of spontaneous preterm delivery. J Nutr 2013; 143:1100-8. [PMID: 23700347 PMCID: PMC3681545 DOI: 10.3945/jn.112.173229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Several studies have found associations between microbial infections during pregnancy and preterm delivery (PTD). We investigated the influence of food with antimicrobial and prebiotic components on the risk of spontaneous PTD. A literature search identified microbes associated with spontaneous PTD. Subsequently, 2 main food types (alliums and dried fruits) were identified to contain antimicrobial components that affect the microbes associated with spontaneous PTD; they also contained dietary fibers recognized as prebiotics. We investigated intake in 18,888 women in the Norwegian Mother and Child Cohort (MoBa), of whom 950 (5%) underwent spontaneous PTD (<37 gestational weeks). Alliums (garlic, onion, leek, and spring onion) [OR: 0.82 (95% CI: 0.72, 0.94), P = 0.005] and dried fruits (raisins, apricots, prunes, figs, and dates) [OR: 0.82 (95% CI: 0.72, 0.94); P = 0.005] were associated with a decreased risk of spontaneous PTD. Intake of alliums was related to a more pronounced risk reduction in early spontaneous PTD (gestational weeks 28-31) [OR: 0.39 (95% CI: 0.19, 0.80)]. The strongest association in this group was with garlic [OR: 0.47 (95% CI: 0.25-0.89)], followed by cooked onions. Intake of dried fruits showed an association with preterm prelabor rupture of membranes (PPROM) [OR: 0.74 (95% CI: 0.65, 0.95)]; the strongest association in this group was with raisins [OR: 0.71 (95% CI: 0.56, 0.92)]. The strongest association with PPROM in the allium group was with garlic [OR: 0.74 (95% CI: 0.56, 0.97)]. In conclusion, intake of food with antimicrobial and prebiotic compounds may be of importance to reduce the risk of spontaneous PTD. In particular, garlic was associated with overall lower risk of spontaneous PTD. Dried fruits, especially raisins, were associated with reduced risk of PPROM.
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Affiliation(s)
- Ronny Myhre
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Anne Lise Brantsæter
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; and
| | - Solveig Myking
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Merete Eggesbø
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; and
| | - Margaretha Haugen
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; and
| | - Bo Jacobsson
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway,Perinatal Center, Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Göteborg, Sweden
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Association of bactericidal activity of genital tract secretions with Escherichia coli colonization in pregnancy. Am J Obstet Gynecol 2012; 207:297.e1-8. [PMID: 22867687 DOI: 10.1016/j.ajog.2012.07.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/26/2012] [Accepted: 07/20/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Genital tract secretions exhibit bactericidal activity against Escherichia coli. We hypothesized that this defense may be modulated during pregnancy. STUDY DESIGN Secretions were collected by vaginal swab from 70 pregnant women (35-37 weeks' gestation) and 35 nonpregnant controls. We mixed E coli with swab eluants or control buffer and colonies enumerated to measure bactericidal activity. Cytokines, chemokines, and antimicrobial peptides were quantified by multiplex or enzyme-linked immunosorbent assay. RESULTS Pregnant women had significantly greater bactericidal activity, higher concentrations of proinflammatory cytokines, and lower levels of beta defensins compared to controls. Seven (10%) pregnant and 8 (23%) nonpregnant women were vaginally colonized with E coli; colonization was inversely associated with bactericidal activity. CONCLUSION The soluble mucosal immune environment is altered in pregnancy. We speculate that the observed changes may protect against colonization and ascending infection and could provide a biomarker to identify pregnant women at risk for infectious complications including preterm birth.
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Pathogenesis to treatment: preventing preterm birth mediated by infection. Infect Dis Obstet Gynecol 2012; 5:106-14. [PMID: 18476162 PMCID: PMC2364559 DOI: 10.1155/s1064744997000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/1997] [Accepted: 10/21/1997] [Indexed: 11/26/2022] Open
Abstract
Prevention of preterm birth and subsequent newborn immaturity is a primary goal of obstetrical care worldwide. Accumulated evidence shows that 1) as many as 25–50% of preterm births are caused by common genital tract infections and subsequent maternal/fetal inflammatory responses; 2) microbial and maternal host factors (phospholipases, proteases, etc.) play roles in preterm labor and preterm premature rupture of membranes (pPROM); 3) integrated aspects of maternal and fetal host responses (inflammation, altered immune adaptations, endocrine and paracrine mechanisms) play increasingly understood roles in premature activation of parturition; and 4) identification and systemic treatment of common genitourinary infections, most importantly bacterial vaginosis (BV), reduce the risks of preterm delivery and PROM.
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Kessous R, Weintraub AY, Sergienko R, Lazer T, Press F, Wiznitzer A, Sheiner E. Bacteruria with group-B streptococcus: is it a risk factor for adverse pregnancy outcomes? J Matern Fetal Neonatal Med 2012; 25:1983-6. [DOI: 10.3109/14767058.2012.671872] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Moghaddam Banaem L, Mohamadi B, Asghari Jaafarabadi M, Aliyan Moghadam N. Maternal serum C-reactive protein in early pregnancy and occurrence of preterm premature rupture of membranes and preterm birth. J Obstet Gynaecol Res 2012; 38:780-6. [PMID: 22435496 DOI: 10.1111/j.1447-0756.2011.01804.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine the relationship between maternal serum C-reactive protein (CRP) levels in the first 20 weeks of pregnancy and later occurrence of preterm premature rupture of membranes and preterm birth. MATERIAL AND METHODS A prospective cohort study that measured maternal serum CRP levels in 778 pregnant women in the first half of pregnancy was performed in the city of Noor (north Iran), and included follow-up of patients up to time of delivery. Preterm premature rupture of membranes and preterm birth were defined as the occurrence of membranes rupture and birth, respectively before 37 weeks of gestation. RESULTS Of the 778 pregnancies studied, 19 (2.41%) preterm premature rupture of membranes and 58 (7.3%) preterm births were seen. Median CRP levels in preterm premature rupture of membranes and preterm birth cases were much higher than in term deliveries (7 and 6.8 respectively vs 2.4 mg/L; 66.67 and 64.76, respectively vs 24.38 nmol/L). CRP levels >4 mg/L had statistically significant relationships with preterm premature rupture of membranes (OR 5.91, 95% CI 2.07-16.89) and preterm birth (OR 8.95, 95% CI 4.60-17.43). With a cut-off level of 4 mg/L of CRP, sensitivity, specificity, and likelihood ratios (LR(+) and LR(-) ) for preterm birth were 81, 70, 2.70, 0.28%, respectively, and for preterm premature rupture of membranes they were 79, 67, 2.41 and 0.31%, respectively. CONCLUSION It seems that the inflammatory marker, CRP, can be used in the early stages of pregnancy to identify women at risk of experiencing preterm premature rupture of membranes and preterm birth.
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Affiliation(s)
- Lida Moghaddam Banaem
- Midwifery and Reproductive Health Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Lata I, Pradeep Y, Sujata, Jain A. Estimation of the Incidence of Bacterial Vaginosis and other Vaginal Infections and its Consequences on Maternal/Fetal Outcome in Pregnant Women Attending an Antenatal Clinic in a Tertiary Care Hospital in North India. Indian J Community Med 2011; 35:285-9. [PMID: 20922108 PMCID: PMC2940187 DOI: 10.4103/0970-0218.66855] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 03/27/2010] [Indexed: 11/04/2022] Open
Abstract
Aims: This study was undertaken to estimate the incidence of bacterial vaginosis (BV) and other vaginal infections during pregnancy and its association with urinary tract infections (UTI) and its consequences on pregnancy outcome, maternal and fetal morbidity and mortality. Settings and Design: Prospective cohort study. Materials and Methods: The present prospective cohort study was conducted on 200 women attending the antenatal clinic (ANC) of a tertiary hospital. All pertinent obstetric and neonatal data covering antenatal events during the course of pregnancy, delivery, puerperium and condition of each newborn at the time of birth were collected. BV was detected by both Gram stain and gold standard clinical criteria (Amsel’s composite criteria). Statistical analysis used: Data were analyzed using SPSS version 9. Fischer’s exact test, chi square tests and Student’s’ test has been used for analysis. The probability of 5% was considered as significant for continuous variables such as age, period of gestation and birth weight. Odds ratio (OR) and confidence interval (CI) with 95% probability were determined. Results: The incidence of bacterial vaginosis was 41 in 200 patients. Adverse outcomes such as preterm labor, PROM and fetal complications were found more in pregnant women who had bacterial vaginosis (N=41), bacterial vaginosis with UTI (N=14) as compared to those without bacterial vaginosis (N=118). Conclusions: The incidence of poor pregnancy outcome was higher in bacterial vaginosis with UTI. Prevention of BV and UTI is cost effective to minimize the pregnancy-related complications and preterm labor to decrease in perinatal and maternal mortality and morbidity. We recommend all antenatal patients should be screened for the presence of bacterial vaginosis, other infections and UTI.
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Affiliation(s)
- Indu Lata
- Department of Maternal and Reproductive Health, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
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28
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Abstract
Aerobic vaginitis (AV) is an alteration in vaginal bacterial flora that differs from bacterial vaginosis (BV). AV is characterised by an abnormal vaginal microflora accompanied by an increased localised inflammatory reaction and immune response, as opposed to the suppressed immune response that is characteristic of BV. Given the increased local production of interleukin (IL)-1, IL-6 and IL-8 associated with AV during pregnancy, not surprisingly AV is associated with an increased risk of preterm delivery, chorioamnionitis and funisitis of the fetus. There is no consensus on the optimal treatment for AV in pregnant or non-pregnant women, but a broader spectrum drug such as clindamycin is preferred above metronidazole to prevent infection-related preterm birth. The exact role of AV in pregnancy, the potential benefit of screening, and the use of newer local antibiotics, disinfectants, probiotics and immune modulators need further study.
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Affiliation(s)
- Ggg Donders
- Department of Obstetrics and Gynaecology, The Regional Hospital Heilig Hart Tienen and University Hospital Gasthuisberg Leuven, Belgium
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Galiñanes S, Coppolillo E, Cifarelli M, Cora Eliseht M, Pellisa E, Losada M, Gruccio S, Ruda Vega H, Vay C, Famiglietti A, Perazzi B. Vaginal Inflammatory Status in Pregnant Women with Normal and Pathogenic Microbiota in Lower Genital Tract. ISRN OBSTETRICS AND GYNECOLOGY 2011; 2011:835926. [PMID: 21766038 PMCID: PMC3135143 DOI: 10.5402/2011/835926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 03/18/2011] [Indexed: 11/23/2022]
Abstract
Objective. To assess the vaginal inflammatory status (VIS) in pregnant women, whether symptomatic or asymptomatic, by leukocyte quantification in relation to the microbiota during each pregnancy trimester (T). Materials and Methods. A thousand two hundred and forty eight vaginal exudates from pregnant women were prospectively examined. All the patients underwent a clinical and colposcopic examination and a microbiological study of vaginal exudates. Leukocyte quantification was determined by May-Grunwald Giemsa staining as LNR per field (400X). Results. Statistically significant differences (SSD) in LNR were observed in the VIS of asymptomatic patients (AP) compared with that of symptomatic ones (SP) with normal microbiota: 10–15 for the 1st T, <10, 20 to 25 and >25 for the 2nd T and >25 for the 3rd; with candidiasis:
<10 for the 1st T, <10, 15 to 20 and >25 for the 2nd T and <10 and >25 for the 3rd T. In women with trichomoniasis, SSD in the LNR were observed between SP with LNR ≥ 10 and AP with NLR < 10 in the three trimesters altogether. In women with BV, no SSD were observed in the LNR of any AP with respect to SP for the three T. Conclusion. The VIS is influenced by vaginal microbiota and depends on the state of pregnancy and also, on gestational age. The pronounced leukocyte increase in asymptomatic patients in the absence of lower genital tract infection during the third trimester of pregnancy should be highlighted.
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Affiliation(s)
- Sebastián Galiñanes
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Enrique Coppolillo
- Lower Genital Tract Clinic, Obstetrics Division, Department of Tocogynecology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Maximiliano Cifarelli
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Martha Cora Eliseht
- Lower Genital Tract Clinic, Obstetrics Division, Department of Tocogynecology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Ercilia Pellisa
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Mirta Losada
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Sebastián Gruccio
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Hilda Ruda Vega
- Lower Genital Tract Clinic, Obstetrics Division, Department of Tocogynecology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Carlos Vay
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Angela Famiglietti
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
| | - Beatriz Perazzi
- Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clínicas, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Córdoba 2351, 1120, City of Buenos Aires, Argentina
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Weintraub AY, Kessous R, Sergienko R, Salem Yaniv S, Press F, Wiznitzer A, Sheiner E. Is colonization with GBS in a previous pregnancy associated with adverse perinatal outcomes? Arch Gynecol Obstet 2010; 284:787-91. [DOI: 10.1007/s00404-010-1724-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 10/13/2010] [Indexed: 11/30/2022]
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Calabrese N, Calabrese A, Nibali L, Rosati A, Fiengo S, Di Renzo GC. Is there any association between periodontitis and preterm low birth weight? J Matern Fetal Neonatal Med 2010; 23:1288-93. [DOI: 10.3109/14767051003615467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Intrauterine infection and preterm labor. Infect Dis Obstet Gynecol 2010; 3:37-44. [PMID: 18475419 PMCID: PMC2364409 DOI: 10.1155/s1064744995000287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/1994] [Accepted: 10/19/1994] [Indexed: 11/17/2022] Open
Abstract
Preterm birth remains the leading cause of perinatal mortality and morbidity. Evidence suggests that intrauterine infection plays an important role in the pathogenesis of preterm labor. This article reviews the clinical data supporting this theory and the cellular and biochemical mechanisms by which intrauterine infection may initiate uterine contractions. The clinical and laboratory methods of diagnosing clinical chorioamnionitis and asymptomatic bacterial invasion of the intraamniotic cavity are also reviewed. Finally, the management of clinical chorioamnionitis and asymptomatic microbial invasion of the amniotic fluid and the use of adjunctive antibiotic therapy in the treatment of preterm labor are presented.
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Abstract
Preterm delivery occurs in less than 10% of pregnancies but accounts for more than 60% of all neonatal deaths. Approximately one third of preterm deliveries are associated with preterm prelabour amniorrhexis and in a high proportion of such cases the underlying cause may be ascending infection from the lower genital tract. The causes of neonatal death in pregnancies with amniorrhexis are prematurity, pulmonary hypoplasia and sepsis. In the management of pregnancies with preterm prelabour amniorrhexis it is essential to distinguish between those with and without intrauterine infection. If there is no infection at presentation it is unlikely that this will develop and in such cases there is no benefit from hospitalisation, bed rest, prophylactic tocolytics or antibiotics. The group with evidence of intrauterine infection go into spontaneous labour within a few days of amniorrhexis; in this group the main determinant for the appropriate management is the gestation at amniorrhexis.
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Grigsby PL, Novy MJ, Adams Waldorf KM, Sadowsky DW, Gravett MG. Choriodecidual inflammation: a harbinger of the preterm labor syndrome. Reprod Sci 2009; 17:85-94. [PMID: 19843879 DOI: 10.1177/1933719109348025] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Causal, cellular, and inflammatory links between choriodecidual infection with group B streptococcus (GBS) and preterm labor were assessed in a nonhuman primate model. Rhesus monkeys received varying doses of a clinical isolate of GBS, type III or saline, via an indwelling catheter placed between the chorion/decidua and myometrium in the lower pole of the uterus. Choriodecidual inoculation of GBS was followed by a graded response in amniotic fluid (AF) leukocytes, proinflammatory cytokines, prostaglandin E(2) and F(2alpha), and uterine activity (P < .05). The magnitude of the inflammatory response in AF was related, in part, to the initial inoculum size and whether AF cultures remained negative or became positive for GBS. Microbial invasion of AF was associated with advanced inflammation and preterm labor. We provide experimental evidence that choriodeciduitis is a transitional stage of intrauterine infection, which may be self-limited, remain dormant, or progress to intraamniotic infection. These data, coupled with clinical observations, suggest that choriodecidual inflammation is an antecedent event in the pathogenesis of premature cervical ripening (functional cervical insufficiency), premature rupture of the fetal membranes, or preterm labor.
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Affiliation(s)
- Peta L Grigsby
- Division of Reproductive Sciences, Oregon National Primate Research Center, Beaverton, Oregon 97006, USA.
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35
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Nunns D, Higgins SP, Mandal D. Genital tract infections in women attending for colposcopy. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619609028385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Donders GG, Van Calsteren K, Bellen G, Reybrouck R, Van den Bosch T, Riphagen I, Van Lierde S. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG 2009; 116:1315-24. [PMID: 19538417 DOI: 10.1111/j.1471-0528.2009.02237.x] [Citation(s) in RCA: 246] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Abnormal vaginal flora (AVF) before 14 gestational weeks is a risk factor for preterm birth (PTB). The presence of aerobic microorganisms and an inflammatory response in the vagina may also be important risk factors. AIM The primary aim of the study was to investigate the differential influences of AVF, full and partial bacterial vaginosis, and aerobic vaginitis in the first trimester on PTB rate. The secondary aim was to elucidate why treatment with metronidazole has not been found to be beneficial in previous studies. SETTING Unselected women with low-risk pregnancies attending the prenatal unit of the Heilig Hart General Hospital in Tienen, Belgium, were included in the study. MATERIALS AND METHODS At the first prenatal visit, 1026 women were invited to undergo sampling of the vaginal fluid for wet mount microscopy and culture, of whom 759 were fully evaluable. Abnormal vaginal flora (AVF; disappearance of lactobacilli), bacterial vaginosis (BV), aerobic vaginitis (AV), increased inflammation (more than ten leucocytes per epithelial cell) and vaginal colonisation with Candida (CV) were scored according to standardised definitions. Partial BV was defined as patchy streaks of BV flora or sporadic clue cells mixed with other flora, and full BV as a granular anaerobic-type flora or more than 20% clue cells. Vaginal fluid was cultured for aerobic bacteria, Mycoplasma hominis and Ureaplasma urealyticum. Outcome was recorded as miscarriage <or=13 weeks + 6 days [early miscarriage (EM), n = 8 (1.1%)], between 14 + 0 and 24 weeks + 6 days [late miscarriage (LM), n = 7 (0.9%)], delivery or miscarriage <or=34 weeks + 6 days n = 29 (3.8%)], <or=36 weeks + 6 days n = 70 (9.2%)]. PTB between 25 + 0 and 36 weeks + 6 days was further divided in severe PTB (SPTB, 25 + 0 to 34 weeks + 6 days) and mild PTB (MPTB, 35 + 0 to 36 weeks + 6 days). RESULTS Women without abnormalities of the vaginal flora in the first trimester had a 75% lower risk of delivery before 35 weeks compared with women with AVF [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.12-0.56]. The absence of lactobacilli (AVF) was associated with increased risks of PTB (OR 2.4; 95% CI 1.2-4.8), EPTB (OR 6.2; 95% CI 2.7-14) and miscarriage (OR 4.9; 95% CI 1.4-17). BV was associated with increased risks of PTB (OR 2.4; 95% CI 1.1-4.7), EPTB (OR 5.3; 95% CI 2.1-12.9) and miscarriage (OR 6.6; 95% CI 2.1-20.9) and coccoid AV was associated with increased risks of EPTB (OR 3.2; 95% CI 1.2-9.1) and miscarriage (OR 5.2; 95% CI 1.5-17). In women with BV, partial BV had a detrimental effect on the risk of PTB for all gestational ages, but full BV did not. Preterm deliveries later than 24 weeks+ 6 days were more frequent when M. hominis was present (EPTB OR 13.3; 95% CI 3.2-55). DISCUSSION Bacterial vaginosis, AV and AVF are associated with PTB, especially LM and severe PTB between 25 and 35 weeks. The absence of lactobacilli (AVF), partial BV and M. hominis, but not full BV, were associated with an increased risk of preterm delivery after 24 weeks+ 6 days. As metronidazole effectively treats full BV, but is ineffective against other forms of AVF, the present data may help to explain why its use to prevent PTB has not been successful in most studies.
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Affiliation(s)
- G G Donders
- Femicare vzw, Clinical Research for Women, Tienen, Belgium.
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Lohsoonthorn V, Kungsadalpipob K, Chanchareonsook P, Limpongsanurak S, Vanichjakvong O, Sutdhibhisal S, Wongkittikraiwan N, Sookprome C, Kamolpornwijit W, Jantarasaengaram S, Manotaya S, Siwawej V, Barlow WE, Fitzpatrick AL, Williams MA. Is maternal periodontal disease a risk factor for preterm delivery? Am J Epidemiol 2009; 169:731-9. [PMID: 19131565 DOI: 10.1093/aje/kwn399] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Several studies have suggested an association between maternal periodontal disease and preterm delivery, but this has not been a consistent finding. In 2006-2007, the authors examined the relation between maternal periodontal disease and preterm delivery among 467 pregnant Thai women who delivered a preterm singleton infant (<37 weeks' gestation) and 467 controls who delivered a singleton infant at term (> or =37 weeks' gestation). Periodontal examinations were performed within 48 hours after delivery. Participants' periodontal health status was classified into 4 categories according to the extent and severity of periodontal disease. Logistic regression was used to estimate odds ratios and 95% confidence intervals. Preterm delivery cases and controls were similar with regard to mean probing depth, mean clinical attachment loss, and mean percentage of sites exhibiting bleeding on probing. After controlling for known confounders, the authors found that severe clinical periodontal disease was not associated with an increased risk of preterm delivery (odds ratio = 1.20, 95% confidence interval: 0.67, 2.16). In addition, there was no evidence of a linear increase in risk of preterm delivery or its subtypes associated with increasing severity of periodontal disease (P(trend) > 0.05). The results of this case-control study do not provide convincing evidence that periodontal disease is associated with preterm delivery or its subtypes among Thai women.
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Affiliation(s)
- Vitool Lohsoonthorn
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Patumwan, Bangkok, Thailand.
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Abstract
PURPOSE There is growing evidence showing that a number of complex human diseases are caused or are at least influenced by periodontal diseases. Such diseases include cardiovascular diseases, respiratory diseases, diabetes mellitus and osteoporosis. The aim of study was to evaluate periodontal diseases as a risk factor for a preterm low birth weight. MATERIALS AND METHODS A total of 48 mothers, 20 of who had a preterm low birth weight delivery, were examined in the Clinics of Periodontology, Faculty of Dentistry, Cumhuriyet University. The periodontal exams consisted of a full mouth pocket depth, a Loe and Sillness Gingival index score measurements, and a panoramic radiograph analysis. Information on any other factors that may cause a preterm low birth weight was obtained from the family physician. RESULTS The study results indicated that periodontitis (OR: 3.6 95% CI: 1.06-12.18) together with bacterial vaginosis (OR: 11.57 95% CI: 1.26-105.7) were independent risk factors of a preterm low birth weight. According to the data obtained from this study, the paternal age, tobacco use and the mothers' height were not significant risk factors for a preterm low birth weight. CONCLUSION Within the limits of this study, it is concluded that a poor periodontal health status of the mother may be a potential risk factor for a preterm low birth weight.
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Affiliation(s)
- Ismail Marakoglu
- Selcuk University, Faculty of Dentistry, Department of Periodontology, 42080, Konya, Turkey.
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Tamrakar R, Yamada T, Furuta I, Cho K, Morikawa M, Yamada H, Sakuragi N, Minakami H. Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women. BMC Infect Dis 2007; 7:128. [PMID: 17986357 PMCID: PMC2212641 DOI: 10.1186/1471-2334-7-128] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 11/07/2007] [Indexed: 11/30/2022] Open
Abstract
Background Bacterial vaginosis (BV), the etiology of which is still uncertain, increases the risk of preterm birth. Recent PCR-based studies suggested that BV is associated with complex vaginal bacterial communities, including many newly recognized bacterial species in non-pregnant women. Methods To examine whether these bacteria are also involved in BV in pregnant Japanese women, vaginal fluid samples were taken from 132 women, classified as normal (n = 98), intermediate (n = 21), or BV (n = 13) using the Nugent gram stain criteria, and studied. DNA extracted from these samples was analyzed for bacterial sequences of any Lactobacillus, four Lactobacillus species, and four BV-related bacteria by PCR with primers for 16S ribosomal DNA including a universal Lactobacillus primer, Lactobacillus species-specific primers for L. crispatus, L. jensenii, L. gasseri, and L. iners, and BV-related bacterium-specific primers for BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium. Results The prevalences of L. crispatus, L. jensenii, and L. gasseri were significantly higher, while those of BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium were significantly lower in the normal group than in the BV group. Unlike other Lactobacillus species, the prevalence of L. iners did not differ between the three groups and women with L. iners were significantly more likely to have BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium. Linear regression analysis revealed associations of BVAB2 and Megasphaera with Nugent score, and multivariate regression analyses suggested a close relationship between Eggerthella-like bacterium and BV. Conclusion The BV-related bacteria, including BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium, are common in the vagina of pregnant Japanese women with BV. The presence of L. iners may be correlated with vaginal colonization by these BV-related bacteria.
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Affiliation(s)
- Renuka Tamrakar
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Kita-ku N14 W6, Sapporo, Japan.
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Abstract
Clinicians need information on the risk of Early Onset Group B Streptococcal disease (EOGBS) for counselling pregnant women and to decide who would benefit most from antibiotic treatment during labour. We carried out a systematic review of the research literature and conducted meta-analyses to obtain estimates for the natural history of EOGBS that are representative of the UK population. The mean rate of colonisation for the UK was 14% and we found weak evidence that the prevalence is increasing over time. Maternal GBS colonisation was more likely in women who delivered preterm compared with at term. Just over one-third of babies born to colonised mothers become colonised with GBS at birth (36%), and 3% of colonised babies develop EOGBS bacteraemia. In the UK, EOGBS constitutes one-third of all early onset bacteraemia due to pathogens, in contrast to one-half in the USA.
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Affiliation(s)
- Tim Colbourn
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guildford Street, WC1N 1EH, London, United Kingdom.
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41
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Lohsoonthorn V, Qiu C, Williams MA. Maternal serum C-reactive protein concentrations in early pregnancy and subsequent risk of preterm delivery. Clin Biochem 2007; 40:330-5. [PMID: 17289011 PMCID: PMC2074883 DOI: 10.1016/j.clinbiochem.2006.11.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 10/27/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the relation between maternal early pregnancy serum C-reactive protein (CRP) and preterm delivery (PTD). DESIGN AND METHODS Women were recruited before 20 weeks gestation and were followed up until delivery. Maternal serum CRP was measured by competitive immunoassay. Logistic regression procedures were used to calculate adjusted odds ratio (OR) and 95% confidence intervals (95%CI). RESULTS Elevations in CRP concentrations were associated with the risk of PTD overall. After adjusting for confounding, the OR for highest quartile (> or = 7.5 vs. < 2.0 mg/L) of CRP was 2.04 (95%CI: 1.13-3.69). Stratified analyses indicated that elevated CRP was associated with an increased risk of spontaneous preterm labour (OR=2.15, 95%CI: 0.85-5.42), medically indicated preterm delivery (OR=3.29, 95%CI: 0.98-11.02), and very preterm delivery (OR=20.6, 95%CI: 2.53-168.03), but not with preterm premature rupture of membranes (OR=1.48, 95%CI: 0.56-3.86). CONCLUSIONS Elevated CRP concentrations in early pregnancy are associated with an increased risk of PTD, particularly medically indicated PTD and very PTD.
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Affiliation(s)
- Vitool Lohsoonthorn
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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42
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Kumar S, Suri V, Sharma M. Bacterial vaginosis in preterm labor. Int J Gynaecol Obstet 2006; 95:40-1. [PMID: 16828770 DOI: 10.1016/j.ijgo.2006.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2006] [Revised: 05/16/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Affiliation(s)
- S Kumar
- Department of Obstetrics and Gynaecology, PGIMER Chandigarh, India
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43
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Abstract
Adverse pregnancy outcomes can follow direct placental, fetal, or neonatal infection, or preterm birth associated with vaginal, cervical, intrauterine, or even nonpelvic infections. These latter infections appear to be associated with the majority of very early preterm births, and may explain some of the long-term neurologic damage associated with preterm birth. Bacterial vaginosis and its associated intrauterine infections likely contribute far more to the overall burden of adverse pregnancy outcomes than the more classical perinatal infections such as rubella and syphilis.
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Affiliation(s)
- Robert L Goldenberg
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, 1500 6th Avenue South, Birmingham, AL 35233, USA.
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Crowther CA, Thomas N, Middleton P, Chua MC, Esposito M. Treating periodontal disease for preventing preterm birth in pregnant women. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005297] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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45
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Coppolillo EF, Perazzi BE, Famiglietti AMR, Cora Eliseht MG, Vay CA, Barata AD. Diagnosis of Bacterial Vaginosis During Pregnancy. J Low Genit Tract Dis 2003; 7:117-21. [PMID: 17051056 DOI: 10.1097/00128360-200304000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE.: To evaluate the sensitivity and specificity of the score and each one of the clinical criteria (pH, potassium hydroxide (KOH) test for amines, and clue cells) in relation to the Amsel's method. MATERIALS AND METHODS.: One hundred ninety vaginal exudates from pregnant women were studied from April to August 1997. The patients were examined in the Lower Genital Tract and Colposcopy Clinics of the Obstetrics Division at the University Hospital de Clínicas at the University of Buenos Aires, Argentina.The diagnosis of bacterial vaginosis (BV) was made by the presence of three or more of the following criteria: homogeneous vaginal discharge, pH >/= 4.5, positive KOH test for amines, and microscopic presence of clue cells. We also used the microscopic observation of coccobacilli forms in Gram stain (Nugent's method), diagnosing BV with a score >/= 7. RESULTS.: Nugent's method showed a sensitivity of 97% and specificity of 98%. The presence of clue cells showed a sensitivity of 92% and specificity of 97%. The sensitivity of the pH and KOH test for amines was 87% and 81%, whereas the respective specificity was 45% and 99%. CONCLUSIONS.: Because Nugent's method showed a very good specificity and sensitivity, it can be used as another method in the diagnosis of BV. The presence of clue cells diagnosed BV with better sensitivity and specificity than the other clinical criteria. In this way, we recommend the microscopic exam by Gram stain, using Nugent's method or the presence of clue cells, for diagnosing BV.
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Affiliation(s)
- Enrique F Coppolillo
- 1Department of Tocogynecology, Lower Genital Tract Clinic, Hospital de Clínicas, University Hospital of Buenos Aires, Buenos Aires, Argentina; 2Department of Clinical Biochemistry, Clinical Bacteriology Laboratory, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina; and 3Obstetrical Department, Hospital de Clínicas, University Hospital of Buenos Aires, Buenos Aires, Argentina
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46
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Galvão MP, Rösing CK, Ferreira MB. Effects of ligature-induced periodontitis in pregnant Wistar rats. PESQUISA ODONTOLOGICA BRASILEIRA = BRAZILIAN ORAL RESEARCH 2003; 17:51-5. [PMID: 12908060 DOI: 10.1590/s1517-74912003000100010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to evaluate the influence of ligature-induced periodontal disease in pregnant rats on their newborn's health parameters. Twenty-four female adult Wistar rats were divided into two groups: the control group (G1) and the group that was submitted to dental ligatures around second upper molars (G2). After the four week period of development of periodontitis, the female animals were mated with male adult Wistar rats. There were no differences in the body weight of females between the two groups during mating and pregnancy. No differences were observed among the groups in relation to the viable newborn index. However, there were differences in newborn birth weight, explained by the diverse size of the litters. In this study, ligature-induced periodontal disease did not promote changes during pregnancy that resulted in low birth weight in newborn Wistar rats.
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Schendel DE, Schuchat A, Thorsen P. Public health issues related to infection in pregnancy and cerebral palsy. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2002; 8:39-45. [PMID: 11921385 DOI: 10.1002/mrdd.10011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal inflammation typically associated with infection also suggest that an inflammatory response may be an important independent etiologic factor. If a substantial proportion of cerebral palsy is attributable to acute amnionitis infection and/or neonatal sepsis, cerebral palsy should have decreased in the United States after administration of intrapartum antibiotics became widespread in response to publication of public health consensus guidelines for Group B streptococcus in 1996. However, failure to detect declines could have a number of explanations and these explanations illustrate the many public health challenges related to intrauterine infection and cerebral palsy. Given the gaps in our current knowledge about intrauterine infection and cerebral palsy, public health recommendations for timely and specific prevention activities are limited at this time.
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Affiliation(s)
- Diana E Schendel
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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48
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Bruce FC, Kendrick JS, Kieke BA, Jagielski S, Joshi R, Tolsma DD. Is vaginal douching associated with preterm delivery? Epidemiology 2002; 13:328-33. [PMID: 11964935 DOI: 10.1097/00001648-200205000-00014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To examine the hypothesized association between vaginal douching and preterm delivery, we conducted a study among women in a managed care organization in Atlanta, GA. METHODS We drew a stratified random sample of 262 preterm (20-36 weeks' gestation) and 804 term deliveries that occurred between January 1996 and April 1997. Data were collected from telephone interviews and medical records. We used proportional hazards regression to compute gestation-specific conditional probabilities of delivery. The risk of preterm delivery associated with douching was examined, adjusted for potential confounders. RESULTS Douching during pregnancy increased the overall risk of preterm delivery (hazard ratio = 1.9, 95% confidence interval = 1.0-3.7). CONCLUSIONS Further research to clarify the relation between douching and preterm delivery should pay particular attention to the role of vaginal infections.
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Affiliation(s)
- F Carol Bruce
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA 30341, USA.
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49
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Davenport ES, Williams CECS, Sterne JAC, Murad S, Sivapathasundram V, Curtis MA. Maternal periodontal disease and preterm low birthweight: case-control study. J Dent Res 2002; 81:313-8. [PMID: 12097443 DOI: 10.1177/154405910208100505] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Periodontal disease has been suggested to be an important risk factor for preterm low birthweight (PLBW). Here we report a case-control study of 236 cases (infants < 37 wks and weighing < 2499 g) and a daily random sample of 507 controls (> or = 38 wks and weighing > or = 2500 g). Clinical periodontal indices were measured on the labor wards. Associated risk factors for periodontal disease and PLBW were ascertained by means of a structured questionnaire and maternity notes. The risk for PLBW decreased with increasing pocket depth (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.68 to 1.00). After adjustment for maternal age, ethnicity, maternal education, smoking, alcohol consumption, infections, and hypertension during pregnancy, this decreased further (OR 0.78, 95% CI 0.64 to 0.99). We found no evidence for an association between PLBW and periodontal disease. Our results do not support a specific drive to improve periodontal health of pregnant women as a means of improving pregnancy outcomes.
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Affiliation(s)
- E S Davenport
- Department of Oral Growth and Development, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Turner Street, London E1 2AD, UK.
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50
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Pastore LM, Thorp JM, Royce RA, Savitz DA, Jackson TP. Risk score for antenatal bacterial vaginosis: BV PIN points. J Perinatol 2002; 22:125-32. [PMID: 11896517 DOI: 10.1038/sj.jp.7210654] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Develop a clinical risk score to screen for antenatal bacterial vaginosis (BV), irrespective of symptoms. STUDY DESIGN Cohort study of 913 pregnant women with last menstrual periods between January 30, 1995 and February 22, 1997. BV was evaluated by Nugent-scored vaginal smears (scores of 7 to 10 considered positive) between 24 and 29 weeks' gestation. Forty-four potential risk factors were assessed. RESULTS 17.8% of women had BV, of whom 22% were screened for BV by the usual care provider. Logistic regression-adjusted analyses found six predictors: vaginal pH>4.5 (OR=11.6, 95% confidence interval [CI] [7.8, 17.2]); black race (OR=1.9, 95% CI [1.3, 2.8]); condom use during pregnancy (OR=1.6, 95% CI [1.0, 2.5]); antenatal BV (OR=1.7, 95% CI [1.0, 2.8]); absence of sperm on smear (OR=1.7, 95% CI [1.0, 2.9]); and no history of sexually transmitted diseases (OR=1.6, 95% CI [1.0, 2.5]). Risk score weights were 5 for an elevated vaginal pH and 1 otherwise. The sensitivity and specificity of screening women with scores > or =4 were both 77%; this would involve screening 33% of patients. CONCLUSION Approximately 80% of our BV cases were asymptomatic, emphasizing the need for objective risk assessment. Using six factors, clinicians can identify pregnant women at risk for BV.
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Affiliation(s)
- Lisa M Pastore
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC 27517-9212, USA
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