Association between Obesity and Cervical Microflora Dominated by Lactobacillus iners in Korean Women

Oh, Hyun-Joo; Seo, Sang Soo; Kong, Jeong-Taek; Lee, Jae Kwan; Kim, Mi Kyung

doi:10.1128/jcm.01387-15

Cited by 37 publications

(35 citation statements)

References 39 publications

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“…35,36 Although these studies suggest that there may be an increased prevalence of BV in overweight/obese women, participant BV status was not reported. 33,34 One study conducted among US women reported a positive correlation between high BMI and BV; however, after multivariable modeling, this study showed BMI was not associated independently with BV. 37 This study had several caveats that included that less than one-third of the women who were examined were black, and that it did not examine the relationship between BMI and women with an "intermediate" microbiota (Nugent score,4e6).…”

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confidence: 57%

“…Most recently, it has been reported that the vaginal microbiota of overweight and obese Korean women exhibited a larger proportion of L iners and Prevotella compared with lean women. 33,34 This is of interest because both of these taxa previously have been associated with BV. 35,36 Although these studies suggest that there may be an increased prevalence of BV in overweight/obese women, participant BV status was not reported.…”

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confidence: 99%

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Association between obesity and bacterial vaginosis as assessed by Nugent score

Brookheart

Lewis

Peipert

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Bacterial vaginosis is 1 of the most common vaginal conditions in the United States. Recent studies have suggested that obese women have an abnormal microbiota reminiscent of bacterial vaginosis; however, few studies have investigated the prevalence of bacterial vaginosis in overweight and obese populations. Moreover, despite the increased prevalence of obesity and bacterial vaginosis in black women, it is not known whether racial disparities exist in the relationship between obesity and bacterial vaginosis. OBJECTIVE: The objective of this study was to examine the relationship between body mass index and bacterial vaginosis as determined by Nugent score and to determine the influence of race in this context. STUDY DESIGN: We performed a cross-sectional study using patient data and vaginal smears from 5918 participants of the Contraceptive CHOICE Project. Gram-stained vaginal smears were scored with the Nugent method and categorized as bacterial vaginosisenegative (Nugent score, 0e3), bacterial vaginosiseintermediate (Nugent score, 4e6), or bacterial vaginosisepositive (Nugent score, 7e10). Body mass index was determined with Centers for Disease Control and Prevention guidelines, and obese individuals were categorized as class I, II, or III obese based on National Institutes of Health and World Health Organization body mass index parameters. Linear regression was used to model mean differences in Nugent scores; Poisson regression with robust error variance was used to model prevalence of bacterial vaginosis. RESULTS: In our cohort, 50.7% of participants were black; 41.5% were white, and 5.1% were of Hispanic ethnicity; the average age of 25.3 years old. Overall, 28.1% of participants were bacterial vaginosisepositive. Bacterial vaginosis was prevalent in 21.3% of lean, 30.4% of overweight, and 34.5% of obese women (P<.001). The distribution of bacterial vaginosiseintermediate individuals was similar across all body mass index categories. Compared with the scores of lean women, Nugent scores were highest among overweight and obese class I women (adjusted mean difference: overweight women, 0.33 [95% confidence interval, 0.14e0.51] and obese women, 0.51 [95% confidence interval, 0.29e0.72]). Consistent with this, overweight and obese women had a higher frequency of bacterial vaginosis compared with lean women, even after adjustment for variables that included race. Among white women, the prevalence of bacterial vaginosis was higher for overweight and class I and class II/III obese white women compared with lean white women, which is a phenomenon not observed among black women and suggests an effect modification. CONCLUSION: Overweight and obese women have higher Nugent scores and a greater occurrence of bacterial vaginosis compared with lean women. Black women have a greater prevalence of bacterial vaginosis independent of their body mass index compared with white women.

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confidence: 57%

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confidence: 99%

Association between obesity and bacterial vaginosis as assessed by Nugent score

Brookheart

Lewis

Peipert

et al. 2019

American Journal of Obstetrics and Gynecology

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“…Studies have also linked obesity to early‐onset GBS infection in neonates . Differences have been identified in the vaginal and gut microbiome between women who are obese and women of normal weight, with emerging evidence of a causal association between the gut microbiome and obesity . As such, the factors that are driving the population rise in obesity may also serve to drive increases in GBS colonisation, and in turn early‐onset disease.…”

Section: Discussionmentioning

confidence: 99%

Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross‐sectional study

Rao

Hiles

Bassett³

et al. 2019

BJOG

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Objective To describe the epidemiology of maternal group B streptococcus (GBS) colonisation by racial group.Design Cross-sectional study.Setting Antenatal clinics in London North West University Healthcare NHS Trust. Population Pregnant women.Methods Group B streptococcus (GBS) colonisation status was recorded during a screening programme for the prevention of invasive early-onset GBS infection. Information regarding age, address, ethnicity, parity, mode of delivery, body mass index (BMI), and diabetes was routinely collected. Data were analysed by multivariable analysis. Main outcome measures Association between GBS colonisation and putative risk factors.Results Overall, 29.1% (1836/6309) of the women were colonized with GBS. Multivariable analysis showed significantly higher colonisation among women of black African origin (39.5%; OR = 1.57) compared with white British women (27.4%), and lowest colonisation in women of South Asian origin (23.3%; OR = 0.8). Higher parity (≥2) was associated with higher colonisation (35.3%), with the odds of colonisation over 40% higher than for nulliparous women. Increasing BMI was associated with an incremental rise in colonisation from 23 to 35%. Colonisation was not associated with age, season or mode of testing.Conclusion This study identified high maternal GBS colonisation rates in a racially and socially diverse population. The highest rates were seen in women of black African origin and also with higher parity and BMI. Further research is needed to understand the relationship between these factors and rectovaginal colonisation.Tweetable abstract Study of group B streptococcus colonisation in pregnant women in London shows highest rates in black African women and those with high BMI and parity.

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“…However, this study was limited to the analysis of interrelationships between cervical Lactobacillus species only with non-Lactobacillus members of the microbiota not considered. Therefore the generalisability of these ndings are unclear [50]. Our ndings suggest an increased prevalence of Lactobacillus-depleted vaginal microbiome in obese women, with a greater mean proportion of Lactobacillus crispatus in non-obese compared to obese women (Figure 2d).…”

Section: Discussionmentioning

confidence: 76%

The Association Between Obesity and Weight Loss after Bariatric Surgery on the Vaginal Microbiota

Raglan

MacIntyre

Mitra

et al. 2020

Preprint

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Background: Obesity and vaginal microbiome (VMB) dysbiosis are each risk factors for adverse reproductive and oncological health outcomes in women. Here we investigated the relationship between obesity, vaginal bacterial composition, local inflammation and bariatric surgery.Methods: Vaginal bacterial composition assessed by high-throughput sequencing of bacterial 16S rRNA genes and local cytokine levels measured using a multiplexed Magnetic Luminex Screening Assay were compared between 67 obese and 42 non-obese women. We further assessed temporal changes in the microbiota and cytokines in a subset of 27 women who underwent bariatric surgery. Results: The bacterial component of the vaginal microbiota in obese women was characterised by a lower prevalence of a Lactobacillus-dominant VMB and higher prevalence of a high diversity (Lactobacillus spp., and Gardnerella- spp. depleted) VMB, compared with non-obese subjects (p<0.001). Obese women had higher relative abundance of Dialister species (p<0.001), Anaerococcus vaginalis (p=0.021) and Prevotella timonensis (p=0.020) and decreased relative abundance of Lactobacillus crispatus (p=0.014). Local vaginal IL-1β, IL-4, IL-6, IL-8, IFNγ, MIP-1α, and TNFα levels were all higher among obese women, however only IL-1β and IL-8 correlated with VMB species diversity. In a subset of obese women undergoing bariatric surgery, there were no significant overall differences in VMB following surgery, however 75% of these women remained obese at six months. Prior to surgery there was no relationship between body mass index (BMI) and VMB structure, however post-surgery women with a Lactobacillus-dominant VMB had a significantly lower BMI than those with a high diversity VMB.Conclusions: Obese women have a significantly different vaginal microbiota composition with increased levels of local inflammation compared to non-obese women. Bariatric surgery does not change the VMB, however, those with the greatest weight loss six-months post-surgery are most likely to have a Lactobacillus-dominant VMB.

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Association between Obesity and Cervical Microflora Dominated by Lactobacillus iners in Korean Women

Cited by 37 publications

References 39 publications

Association between obesity and bacterial vaginosis as assessed by Nugent score

Association between obesity and bacterial vaginosis as assessed by Nugent score

Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross‐sectional study

The Association Between Obesity and Weight Loss after Bariatric Surgery on the Vaginal Microbiota

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