Bacterial vaginosis in pregnancy – a storm in the cup of tea

Jayaram, Pradeep; Mohan, Manoj; Konje, Justin C.

doi:10.1016/j.ejogrb.2020.08.009

Cited by 14 publications

(31 citation statements)

References 68 publications

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“…Vaginal microbiota are commonly classified into five or six community state types (CSTs; Jayaram et al, 2020;Ravel et al, 2011;Sabo et al, 2019). The first four are optimal CSTs, found in 73% of women and characterised by the dominant presence of one of four common lactobacillus spp.…”

Section: The Vaginamentioning

confidence: 99%

“…BV in early pregnancy has been classified as a risk factor for preterm birth (Integrative Human Microbiome Research Network Consortium, 2019;Lamont, 2015;Leitich et al, 2003), although the precise causal pathway is unclear. BV is also associated with an increased risk of premature rupture of fetal membranes and chorioamnionitis (Jayaram et al, 2020). Furthermore, BV facilitates the acquisition of sexually transmitted infections such as gonorrhoea, chlamydia and HIV (Petrova et al, 2015).…”

Section: Bacterial Vaginosis During Pregnancymentioning

confidence: 99%

“…Furthermore, BV facilitates the acquisition of sexually transmitted infections such as gonorrhoea, chlamydia and HIV (Petrova et al, 2015). There is some speculation that the thick, multispecies biofilm typical of BV may play a part in bacterial transmission from vagina to fetal membranes (Jayaram et al, 2020;Lim et al, 2010). Until a more precise aetiology of BV is known, management in pregnancy remains an important issue (Livengood, 2009;Shimaoka et al, 2019).…”

Section: Bacterial Vaginosis During Pregnancymentioning

confidence: 99%

“…The routine screening for BV and treatment of asymptomatic women with an incidental BV diagnosis are not currently supported in pregnancy (Perkins, 2019; US Preventive Services Task Force [USPSTF], 2020). Some practitioners may choose to screen pregnant women with a history of previous preterm birth <35 weeks and treat accordingly (Jayaram et al, 2020;Yudin & Money, 2017). However, the evidence is inconclusive on the benefits of treating asymptomatic women who test positive within this group (Lamont, 2015;USPSTF, 2020).…”

Section: Clinical Considerationsmentioning

confidence: 99%

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The microbiota of the vulva and vagina: Ways of washing to optimise the protective function of the vulvo-vaginal microbiota during pregnancy

Banga¹

2021

nzcomjnl

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Background: The microbiota of the vulva and vagina has a crucial protective function, which is important for all women and has particular significance in pregnancy. Yet this microbiota is part of a delicately balanced ecosystem, susceptible to extrinsic factors which include the simple matter of how women wash themselves. Clinical observation and anecdotal evidence indicate that women in Aotearoa New Zealand have washing practices that may compromise the naturally acidic vulvo-vaginal environment crucial to optimising the protective function of the microbiota. Aims: The aims of this review are: to determine if there is dissonance between how women are washing their vulva and vagina and recommended washing practices; and to raise awareness of the emerging significance of the vulvo-vaginal microbiota to women’s health, particularly in pregnancy. Method: A literature review was undertaken to discover what is reported (in the published literature) about the ways women wash themselves, products used, and their effect on the vulvo-vaginal microbiota. The evidence behind the “wash with water” recommendation was investigated. Findings: There is a lack of primary research on ways of vaginal washing used by women in Aotearoa New Zealand. Globally, women are routinely using a variety of products that include soap, anti-bacterial wipes, gels and baby wipes, and invasive vaginal washing practices such as douching, flannel scrubs and internal soap cleansing. All washing products, including gentle soap but excluding lactic-acid based gels, alter pH levels when used on either the vulva or the vagina. Washing practices that alter vaginal pH levels can cause a microbial shift into a sub-optimal state that compromises the protective function of the vulvo-vaginal microbiota and is more susceptible to bacterial vaginosis and group B streptococcus vaginal colonisation. The frequency and duration within suboptimal states may be predictors of risk. Conclusion: There is dissonance between the ways women wash their vulva and vagina, and evidence-based advice to just wash with water. The back-to-basics message “just wash with water” promotes a way of washing that optimises the protective function of the vulvo-vaginal microbiota, while also protecting the integrity of vulval skin, and supporting physiological self-cleaning of the vagina.

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Section: The Vaginamentioning

confidence: 99%

Section: Bacterial Vaginosis During Pregnancymentioning

confidence: 99%

Section: Bacterial Vaginosis During Pregnancymentioning

confidence: 99%

Section: Clinical Considerationsmentioning

confidence: 99%

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The microbiota of the vulva and vagina: Ways of washing to optimise the protective function of the vulvo-vaginal microbiota during pregnancy

Banga¹

2021

nzcomjnl

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“…Bacterial vaginosis (BV) as well as aerobic vaginitis (AV) are defined as disequilibrium in the vaginal microflora. Bacterial vaginosis can be asymptomatic or diagnosed on examination for other indications [4].…”

Section: Introductionmentioning

confidence: 99%

Contribution of vaginal infection to preterm premature rupture of membrane and adverse pregnancy outcome

elshabrawy

Mohammed

Ali

et al. 2021

Microbes and Infectious Diseases

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Background: Preterm premature rupture of membranes (PPROM) is the cause of approximately one third of preterm deliveries. Objectives: assess the relation of vaginal infections and their antimicrobial profile with PPROM and pregnancy outcome. Methodology: Case control study of 320 females with PPROM (case) and 320 females with normal pregnancy (control) at 28-37 weeks of gestation. Vaginal examination, vaginal pH assessment and Whiff test were done. Vaginal swabs were collected and examined microscopically for diagnosis of different vaginal infections. Swabs were cultivated, identification and antimicrobial susceptibility of revealed bacteria were done. Maternal and neonatal outcomes were assessed. Results: Bacterial vaginosis and aerobic vaginitis were identified in 29.1% and 17.3% of all participants respectively. There was statistically significant difference regarding prevalence of different vaginal infections in case and control groups (p<0.001). Aerobic vaginitis and bacterial vaginosis were risk factors for PPROM. Streptococcus agalactiae was the most prevalent organism. Erythromycin and ampicillin were the least effective antibiotics against Gram positive and Gram-negative isolates respectively. There was significant increase of all maternal and fetal adverse outcomes in cases with aerobic vaginitis. Conclusion: Different vaginal infections carry risk of PPROM and adverse maternal and neonatal outcomes. The variation in prevalence of bacterial isolates in different studies and localities notify the lack of standardized treatment for infected mothers. Accurate diagnosis of vaginal infection, precise medical treatment during pregnancy is essential for maintenance of maternal and neonatal health.

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Prevalence of bacterial vaginosis among pregnant women attending antenatal care in low‐ and middle‐income countries between 2000 and 2020: A systematic review and meta‐analysis

Park,

Rosca,

Cools

et al. 2024

Repro Female Child Health

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BackgroundBacterial vaginosis increases risk of preterm birth and low birthweight, adverse pregnancy outcomes that disproportionately affect low‐ and middle‐income countries (LMICs).ObjectivesWe aimed to estimate the prevalence of bacterial vaginosis among pregnant women attending antenatal care in LMICs between 2000 and 2020.Search StrategyWe conducted a systematic review of PubMed, Embase and five regional databases.Selection CriteriaWe included studies conducted in LMICs and published between 2000 and 2020 in which bacterial vaginosis prevalence was reported among pregnant women attending antenatal care.Data Collection and AnalysisWe corrected point estimates and applied random‐effects models to generate pool prevalence estimates. We carried out subgroup analyses by study year, country‐income level, HIV prevalence, sample size, diagnostic method, trimester of pregnancy, presence of symptoms at diagnosis and risk of bias.Main ResultsOf 1132 publications, 74 studies met inclusion criteria, contributing 80 data points from 46 661 pregnant women. Overall pooled mean prevalence across LMICs was 15.7%. Regional prevalence ranged from 25.1% in sub‐Saharan Africa to 7.4% in Central and Southern Asia. Prevalence was 33.4% in studies where HIV prevalence was ≥10%, and 6.6% in which HIV prevalence was <10%. The prevalence of bacterial vaginosis among pregnant women who were symptomatic was 24.2% versus 11.8% among those without associated symptoms.ConclusionsBacterial vaginosis prevalence is high. World Health Organization guidelines recommend screening and treatment for symptomatic pregnant women. This recommendation should be extended to include all pregnant women who have HIV infection. Research is needed to characterise biological mechanisms of bacterial vaginosis that lead to preterm birth and low birthweight, and to investigate antenatal interventions that may better interrupt these pathways.

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Bacterial vaginosis in pregnancy – a storm in the cup of tea

Cited by 14 publications

References 68 publications

The microbiota of the vulva and vagina: Ways of washing to optimise the protective function of the vulvo-vaginal microbiota during pregnancy

The microbiota of the vulva and vagina: Ways of washing to optimise the protective function of the vulvo-vaginal microbiota during pregnancy

Contribution of vaginal infection to preterm premature rupture of membrane and adverse pregnancy outcome

Prevalence of bacterial vaginosis among pregnant women attending antenatal care in low‐ and middle‐income countries between 2000 and 2020: A systematic review and meta‐analysis

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