Objective To determine the prevalence of genital mycoplasma infection and the risk of spontaneous preterm birth (sPTB) in asymptomatic pregnant women. Design Prospective cohort. Setting Public and private health services in Ribeirão Preto-SP, Brazil. Population 1.349 asymptomatic women with a singleton pregnancy at 20-25 weeks of gestation (WG) recruited between 2010 and 2011. Methods Baseline data was assessed using a questionnaire, in addition to cervicovaginal fluid and blood samples, to analyze lower reproductive tract infections (RTIs) and immune mediators, respectively. The association between variables and the risk of sPTB was evaluated using logistic regression analysis to estimate the odds ratios (ORs). Main outcome measures Genital mycoplasma infection and prematurity. Results The prevalence of the sPTB and genital mycoplasma was 6.8% and 18%, respectively. The infection was not a risk factor for sPTB (aOR 0.66; 95% CI 0.32-1.35), even when associated with bacterial vaginosis (BV). However, it was associated with a low socioeconomic status (p=0.0470), cigarette use (p=0.0009), number of sexual partners (p=0.0019), and BV (p<.0001). Regarding the risk factors associated with sPTB, previous history of PTB (aOR 12.06; 95% CI 6.21-23.43) and a cervical length ≤ 2.5 cm (aOR 3.97; 95% CI 1.67-9.47) were significant. Conclusions The risk of sPTB was independently associated with the history of PTB and the cervical length but not with the genital mycoplasma infection. Funding: This work was founded by CNPq, FAPESP and CAPES. Keywords: Preterm birth, pregnancy, genital mycoplasma, bacterial vaginosis, risk factor

Objective To assess the risk of spontaneous preterm birth (sPTB) associated with genital mycoplasma infection in asymptomatic women.Design Prospective cohort.Setting Public and private health services in Ribeirão Preto, SP, Brazil.Population A cohort of 1349 asymptomatic women with a singleton pregnancy at 20-25 weeks of gestation.Methods Participants completed a sociodemographic and clinical history questionnaire during the prenatal visit and provided cervicovaginal samples for the evaluation of Mycoplasma hominis (Mh), Ureaplasma spp. and bacterial vaginosis (BV). For gestational outcome, information about the delivery was assessed and sPTB was defined as a birth that occurred before 37 weeks of gestation. The association between variables and the risk of sPTB was evaluated using logistic regression analysis to estimate the odds ratios (ORs). Main outcome measures Genital mycoplasma infection and prematurity.Results The prevalence of sPTB and genital mycoplasma was 6.8 and 18%, respectively. The infection was not a risk factor for sPTB (aOR 0.66, 95% CI 0.32-1.35), even when Mh and Ureaplasma spp. were found together (P = 0.83). Pregnant women with genital mycoplasma infections had greater BV (P < 0.0001), but this vaginal microbiota condition was not associated with sPTB (P = 0.35). Regarding the risk factors associated with sPTB, a previous history of sPTB (aOR 12.06,) and a cervical length of ≤2.5 cm (aOR 3.97, 95% CI 1.67-9.47) were significant.Conclusions Genital mycoplasma infection was not a risk factor for sPTB, even in the presence of other abnormal vaginal microbiota.

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Introduction: Chlamydia trachomatis (CT) is a sexually transmitted bacterium that is highly prevalent in young patients. Chlamydial infections during the gestational period have been associated with adverse obstetric outcomes, such as spontaneous preterm birth (sPTB). However, results in the literature are inconclusive. Objective: To evaluate the association between CT infection and sPTB. Methods: This was a case-control study nested in the cohort of the prospective Brazilian Ribeirão Preto and São Luís birth cohort study. Pregnant patients were recruited in private and public health clinics in São Luís and Ribeirão Preto, Brazil. At the gestational age of 20-25 weeks, cervicovaginal fluid samples were collected for the diagnosis of CT using a polymerase chain reaction. Plasma levels of Transforming Growth Factor-α (TGF- α), Interferon-γ (IFN- γ), Interleukin-10 (IL-10), IL-13, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, Tumor Necrosis Factor-α (TNF- α), and TNF-β were measured using a multiplex assay. Results: Of the 561 pregnant patients evaluated, 121 had sPTB and 440 had a full-term delivery (control group). According to our results, CT infection was not associated with sPTB (odds ratio, 1.13; 95% confidence interval, 0.50–2.56); however, it was more frequent among younger patients (p=0.0078), unmarried patients (p=0.0144), and those with multiple sexual partners (p=0.0299). There were no significant differences in the immune mediators between patients with sPTB or full-term deliveries, or between patients with or without a CT infection. Conclusion: In conclusion, CT infection was not associated with sPTB in our study. However, its correlation with younger pregnant patients suggests that these patients require careful clinical management.

Introdução: Cerca de 10,6% das gestações apresentam um desfecho de parto pré-termo (PPT), sendo ele a principal causa de mortalidade e morbidade infantil. O fator predominantemente associado a este desfecho adverso é a infecção materna, com destaque à infecção por micoplasmas genitais, como Mycoplasma hominis (Mh) e Ureaplasma spp. Por serem bactérias que constituem naturalmente a microbiota genital a associação entre esses microrganismos e o PPT ainda é controversa. Objetivo: Avaliar, em gestantes de uma coorte prospectiva, a prevalência das infecções por Mh e Uu e a associação desta infecção no desfecho gestacional de PPT. Métodos: Esta coorte constitui parte do projeto BRISA e foi acompanhada em Ribeirão Preto-SP, durante 2010/2011. Foram recrutadas gestantes com 20-25 semanas que realizaram entrevistas para coleta características de base, coleta de sangue para análise de mediadores imunológicos e coleta de amostras cervicovaginais para o diagnóstico de infecção pelo kit Mycoplasma IST 2 (bioMérieux) e escore de Nugent. A associação entre a infecção por Mh/Uu e características sociodemográficas, histórico clínico, disbiose vaginal e desfecho de PPT espontâneo (PPTe) foi investigada através da análise exploratória por Teste Qui-quadrado, seguida por análise de regressão logística univariada e multivariada. Resultados: Foram incluídas 1.349 gestantes e a prevalência de PPT foi de 9,2% (n=124), sendo que 71,8% (n=89) deles foram classificados como espontâneos (PPTe). Para a análise final do estudo foram incluídos apenas os PPTe e os parto termo (PT) (n=1.225), totalizando 1.314 gestantes analisadas. A prevalência de infecção por micoplasma genital foi de 18% (n=236), não sendo encontrada associação entre a infecção e o desfecho de PPTe (ORa 0,66; IC 95% 0,32 -1,35). No entanto, as gestantes com histórico de PPT anterior (ORa 1,16, IC 95% 0,55 -2,44) e comprimento de colo ≤ 2,5 cm (ORa 3,97, IC 95% 1,67 -9,47) apresentaram um risco significativamente maior de terem PPTe. Em relação à infecção, a presença de vaginose bacteriana (VB) foi a variável que mais conferiu risco à este desfecho (OR 5,1; IC 95% 3,28). Conclusão: O risco de PPTe esteve independentemente associado à um histórico de PPT em gestações anteriores e um comprimento de colo ≤ 2cm, mas não à infecção por micoplasma genital.