Analysis of Vaginal Microbiota Variations in the Third Trimester of Pregnancy and Their Correlation with Preterm Birth: A Case-Control Study

Abstract

This study conducted a detailed analysis of the vaginal microbiota in pregnant women to explore its correlation with preterm birth (PTB) outcomes. The primary objective was to identify microbial variations associated with increased PTB risk. Secondary objectives included investigating how changes in microbial composition relate to the local immune environment and PTB. Utilizing a retrospective case–control design, the study involved pregnant women with liveborn infants between 2019 and 2023. In total, 89 women who delivered preterm and 106 term deliveries were included. Data collection focused on third-trimester vaginal cultures. Statistically significant differences were observed between the preterm and full-term groups in several areas. The median white blood cell count (10.2 × 103/mm3 vs. 7.6 × 103/mm3, p = 0.009) and neutrophil count (7.2 × 103/mm3 vs. 5.1 × 103/mm3, p < 0.001) were higher in the preterm group. Vaginal pH was also elevated in preterm births (5.6 vs. 4.4, p < 0.001), with a higher prevalence of bacterial vaginosis (29.2% vs. 12.3%, p = 0.001) as indicated by the Nugent Score. The study noted a significant association of PTB with the presence of Candida spp. (OR = 1.84, p = 0.018), Gardnerella vaginalis (OR = 2.29, p = 0.003), Mycoplasma hominis (OR = 1.97, p = 0.007), and Ureaplasma urealyticum (OR = 2.43, p = 0.001). Conversely, a reduction in Lactobacillus spp. correlated with a decreased PTB risk (OR = 0.46, p = 0.001). The study provides compelling evidence that specific vaginal microbiota components, particularly certain pathogenic bacteria and an altered Lactobacillus profile, are significantly associated with PTB risk. These findings highlight the potential of targeting microbial factors in strategies aimed at reducing PTB rates. Further research is necessary to fully understand the complex interplay between microbial dynamics, host immunity, and PTB outcomes.

Is the Early Screening of Lower Genital Tract Infections Useful in Preventing Adverse Obstetrical Outcomes in Twin Pregnancy?

“…The idea that lower genital tract infections may be associated with preterm birth is supported by the findings that specific alterations in the vaginal microbiome, particularly certain pathogenic bacteria and a decrease in the richness and diversity of the vaginal microbial community, are significantly associated with preterm birth [29][30][31].…”

“…It is known that lower genital tract infections (LGTIs) are related to preterm labor and birth in singleton pregnancies [4,5,[23][24][25][26][27][28]. Moreover, recent studies have demonstrated that specific alterations in the vaginal microbiome, particularly certain pathogenic bacteria and a decrease in the richness and diversity of the vaginal microbial community, are significantly associated with preterm birth [29][30][31]. Twin pregnancy has also been associated with decreased microbiome diversity, thus suggesting a potential predisposing mechanism to…”

Impact of Exogenous Factors and Anesthetic Risk in Premature Birth during the Pandemic Period

“…A public health issue includes old addictions such as alcohol [ 3 , 4 , 5 , 6 ], smoking [ 7 , 8 ], and newer prohibited substances [ 9 ], as well as many medications (benzodiazepines, herbal medicines, and atypical antidepressants) [ 10 ]. The parturient’s anesthetic risk in premature birth [ 11 , 12 , 13 , 14 , 15 ] may be higher than in the case of a full-term birth due to the immaturity of the child’s nervous system and other factors related to prematurity [ 16 ], such as the pregnant woman’s health condition, exogenous factors, mental status, and socio-economic and emotional conditions. However, anesthesia is often necessary to control pain [ 15 , 17 ] and allow doctors to surgically intervene in specific obstetric indications and anesthetic risks [ 18 , 19 , 20 ] of the patient that may arise during premature birth.…”