Bacterial vaginosis (BV) is characterized by a shift in vaginal flora, with a decrease in the prevalence of Lactobacillus and an increase in the prevalence and concentration of anaerobic bacteria, Gardnerella vaginalis, and Mycoplasma hominis. BV, which is consistently associated with preterm delivery, 1,2 is also associated with first-and second-trimester miscarriage, 3,4 amniotic fluid infection, 5,6 histologic chorioamnionitis, 7 and postpartum endometritis. 8 The consistent associations between BV and these markers of upper genital tract infection provide strong indirect evidence that abnormal vaginal flora can ascend to cause bacterial upper genital tract infection and preterm birth. However, most pregnant women with BV have normal pregnancy outcomes.The presence and concentrations of microbial hydrolytic enzymes in women with BV vary. Sialidases (or neuraminidases) are glycosylases that are produced in vitro by several BV-associated bacteria. 9 Prolidase (or proline aminopeptidase) is another hydrolytic enzyme produced by BV-associated bacteria, including G vaginalis and Mobiluncus spp. 10 The only characterized immunogenic virulence factor found in BV thus far is the G vaginalis hemolytic toxin (Gvh). 11,12 The production and concentration of immunoglobulin A (IgA) in response to Gvh in women with BV also vary. Low levels of anti-Gvh IgA in women with BV who are not pregnant are correlated with high levels of vaginal sialidase activity 13 and with cleavage of IgA in vaginal fluid. 14 It remains to be established whether different profiles of these biochemical markers correspond to different levels of risk for poor pregnancy outcome. In the present study, we examined the hypothesis that an increased concentration of sialidase and prolidase and a decreased con- Udine, Italy, Seattle, Wash, and Pittsburgh, Pa OBJECTIVE: The purpose of this study was to determine whether the microbial hydrolytic enzymes, sialidase and prolidase, and immunoglobulin A against the Gardnerella vaginalis cytolysin (anti-Gvh IgA) increase the risk for early preterm birth (≤34 weeks of gestation) among women with bacterial vaginosis or intermediate flora.
STUDY DESIGN:Two hundred eighteen afebrile women in preterm labor with intact membranes had a vaginal Gram stain performed, and sialidase, prolidase, and anti-Gvh IgA concentrations were determined. RESULTS: Women with bacterial vaginosis or intermediate flora had significantly higher sialidase and prolidase concentrations than women with normal flora. Among women with bacterial vaginosis or intermediate flora, the women with sialidase had a higher rate of early preterm birth (P = .05). Sialidase had a sensitivity of 43% and specificity of 77% for early preterm birth. Prolidase and anti-Gvh IgA did not predict early preterm birth. CONCLUSION: Women in preterm labor with bacterial vaginosis or intermediate flora and detectable sialidase are at increased risk of early preterm birth. (Am J Obstet Gynecol 2002;187:877-81.)