Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

Abstract

BackgroundPreterm prelabour rupture of the fetal membranes (PPROM) precedes 30% of preterm births and is a risk factor for early onset neonatal sepsis. As PPROM is strongly associated with ascending vaginal infection, prophylactic antibiotics are widely used. The evolution of vaginal microbiota compositions associated with PPROM and the impact of antibiotics on bacterial compositions are unknown.MethodsWe prospectively assessed vaginal microbiota prior to and following PPROM using MiSeq-based sequencing of 16S rRNA gene amplicons and examined the impact of erythromycin prophylaxis on bacterial load and community structures.ResultsIn contrast to pregnancies delivering at term, vaginal dysbiosis characterised by Lactobacillus spp. depletion was present prior to the rupture of fetal membranes in approximately a third of cases (0% vs. 27%, P = 0.026) and persisted following membrane rupture (31%, P = 0.005). Vaginal dysbiosis was exacerbated by erythromycin treatment (47%, P = 0.00009) particularly in women initially colonised by Lactobacillus spp. Lactobacillus depletion and increased relative abundance of Sneathia spp. were associated with subsequent funisitis and early onset neonatal sepsis.ConclusionsOur data show that vaginal microbiota composition is a risk factor for subsequent PPROM and is associated with adverse short-term maternal and neonatal outcomes. This highlights vaginal microbiota as a potentially modifiable antenatal risk factor for PPROM and suggests that routine use of erythromycin for PPROM be re-examined.Electronic supplementary materialThe online version of this article 10.1186/s12916-017-0999-x) contains supplementary material, which is available to authorized users.

Prospective observational study of vaginal microbiota pre‐ and post‐rescue cervical cerclage

“…Ehsanipoor and colleagues propose that this bimodal distribution is due to the underlying aetiology of cervical dilation and that there may be two subsets of women, those destined for favourable outcomes following cerclage and those likely to deliver early because of subclinical infection . We, and others, have demonstrated associations between the bacterial community structure of the vaginal microbiome, and the risk and outcome of spontaneous preterm labour and PPROM . We have also shown that cervical cerclage is effective in preventing PTB in women with mechanical damage to their cervix caused by ablative treatment for cervical intraepithelial neoplasia .…”

“…We, and others, have demonstrated associations between the bacterial community structure of the vaginal microbiome, and the risk and outcome of spontaneous preterm labour and PPROM . We have also shown that cervical cerclage is effective in preventing PTB in women with mechanical damage to their cervix caused by ablative treatment for cervical intraepithelial neoplasia . We therefore hypothesised that women presenting with silent cervical dilation represent at least two aetiological groups.…”

“…There is increasing evidence that a vaginal microbiome dominated by Lactobacillus species such as Lactobacillus crispatus is associated with healthy reproductive outcomes, whereas Lactobacillus spp. depletion or atypical vaginal colonisation has been associated with subsequent PTB and PPROM . Management of women presenting with cervical dilation and exposed fetal membranes in the second trimester is challenging.…”

“…depletion or atypical vaginal colonisation has been associated with subsequent PTB 6,8 and PPROM. 7 Management of women presenting with cervical dilation and exposed fetal membranes in the second trimester is challenging. If left untreated, most will deliver within 2-3 weeks, even if asymptomatic at presentation, [10][11][12] resulting in miscarriage or extremely early preterm birth.…”

A Mediterranean Diet with an Enhanced Consumption of Extra Virgin Olive Oil and Pistachios Improves Pregnancy Outcomes in Women Without Gestational Diabetes Mellitus: A Sub-Analysis of the St. Carlos Gestational Diabetes Mellitus Prevention Study

“…There were no differences between groups in the rates of hypertensive disorders and smoking habits. However, these lower rates of small-for-gestational-age new-borns found could be related to the lower rates of urinary tract infections, which have been associated with higher risk of small-for-gestational-age new-borns [30,31] and prematurity [32]. The MedDiet enhanced with EVOO and nuts could have had a direct influence on the lower incidence of urinary tract infections.…”