First trimester bacterial vaginosis, individual microorganism levels, and risk of second trimester pregnancy loss among urban women

Abstract

Objective-To examine the role of first trimester bacterial vaginosis (BV) and level of BVassociated microorganisms diagnosed using the Nugent's Gram stain criteria and the risk of second trimester pregnancy loss among urban women. Design-Prospective cohort study.Setting-Pregnant women seeking prenatal care in the first trimester.Patients-Women presenting for their first prenatal care visit who had completed 12 weeks gestation or less and resided within Philadelphia PA. Main Outcome Measures-Pregnancy Loss.Results-1948 women enrolled at a mean gestational age of 10 weeks (range 7.4 to 12.6 weeks). Women with the highest level of BV-related vaginal flora alteration compared to women with normal vaginal flora had over a twofold increased risk of second trimester pregnancy loss after adjustment for confounders (adjusted HR: 2.49, 95% CI: 1.13 to 5.48). Low Lactobacillus spp, and the absence of Lactobacillus spp. were also significantly related to the risk of second trimester pregnancy loss (aHR: 1.32, 95% CI: 1.10-1.64 and aHR: 2.30, 95% CI: 1.09 -4.85; respectively). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Overall BV positivity was not related to second trimester pregnancy loss. NIH Public AccessComparing the highest to lowest tertile of BV positivity in early pregnancy conferred a two-fold increased risk of second trimester pregnancy loss and low amounts or the absence of Lactobacillus spp. in the first trimester also significantly increased the risk of second trimester pregnancy loss.

Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective

“…Transmission of STIs is also associated with BV, since BV increases viral replication and vaginal shedding of HIV-1 (7,(12)(13)(14) and herpes simplex virus type 2 (HSV-2) (15). During pregnancy, BV has been linked to late fetal loss, and 10%-30% of pregnant women with BV give birth prematurely, although there is a lack of consistent evidence that treatment of BV reduces the risk of preterm delivery (16)(17)(18)(19)(20)(21)(22)(23). Further complicating research and clinical practice is the fact that women with BV are only slightly more likely than women without BV to report vaginal symptoms (24).…”

Human Three-Dimensional Endometrial Epithelial Cell Model To Study Host Interactions with Vaginal Bacteria and Neisseria gonorrhoeae

“…Colonization of the endometrium by these microbes is associated with complications of gynecologic and reproductive health, including endometritis, pelvic inflammatory disease (PID) (1,2), preterm delivery, and spontaneous abortions (3), resulting in a significant public health impact. Historically, the endometrium of healthy women has been considered to be a sterile environment.…”

The Natural Antimicrobial Peptide Subtilosin Acts Synergistically with Glycerol Monolaurate, Lauric Arginate, and ε-Poly- l -Lysine against Bacterial Vaginosis-Associated Pathogens but Not Human Lactobacilli

“…Estimates predict that 10 to 30% of North American women are affected by BV, although many of these cases remain asymptomatic (2). This poses a significant risk for women of reproductive age, as the uncontrolled proliferation of organisms linked to BV has been associated with the development of pelvic inflammatory disease (14) and a variety of pregnancy-related complications, including intra-amniotic infections leading to fetal brain damage (13,24), preterm births with an elevated risk of infant death (26), low infant birth weight (17), and spontaneous abortion (10,23). BV, and particularly its causative agent G. vaginalis, is also associated with an elevated probability of contracting HIV and increased proliferation of the virus in multiple cell lines (15-17, 31, 38; for a recent review, see 41).…”