Vaginal microbiota of American Indian women and associations with measures of psychosocial stress

Abstract

Molecular-bacterial vaginosis (BV) is characterized by low levels of vaginal Lactobacillus species and is associated with higher risk of sexually transmitted infections (STI). Perceived psychosocial stress is associated with increased severity and persistence of infections, including STIs. American Indians have the highest rates of stress and high rates of STIs. The prevalence of molecular-BV among American Indian women is unknown. We sought to evaluate measures of psychosocial stress, such as historic loss (a multigenerational factor involving slavery, forced removal from one’s land, legally ratified race-based segregation, and contemporary discrimination) and their association with the vaginal microbiota and specific metabolites associated with BV, in 70 Northwestern Plains American Indian women. Demographics, perceived psychosocial stressors, sexual practices, and known BV risk factors were assessed using a modified version of the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project survey. Self-collected mid-vaginal swabs were profiled for bacterial composition by 16S rRNA gene amplicon sequencing and metabolites quantified by targeted liquid-chromatography mass spectrometry. Sixty-six percent of the participants were classified as having molecular-BV, with the rest being either dominated by L. crispatus (10%) or L. iners (24%). High levels of lifetime trauma were associated with higher odds of having molecular-BV (adjusted Odds Ratio (aOR): 2.5, 95% Credible Interval (CrI): 1.1–5.3). Measures of psychosocial stress, including historic loss and historic loss associated symptoms, were significantly associated with lifestyle and behavioral practices. Higher scores of lifetime trauma were associated with increased concentrations of spermine (aFC: 3.3, 95% CrI: 1.2–9.2). Historic loss associated symptoms and biogenic amines were the major correlates of molecular-BV. Historical loss associated symptoms and lifetime trauma are potentially important underlying factors associated with BV.

Resident microbes shape the vaginal epithelial glycan landscape

“…Among the specimens used in this work, women with BV were more likely to be Black, have less education, and a current or past history of sexually transmitted infection (see Table S1). Although not examined here, other studies have found correlates between BV and psychosocial stress 81,82 . We cannot formally rule out contributions by potentially confounding factors to the glycan landscape.…”

Resident microbes shape the vaginal epithelial glycan landscape

“…In these experiments, samples were selected on the basis of BV status (Nugent 0 to 3 for negative and 7 to 10 for positive) from a larger cohort without introducing any strategies to balance the groups for potential confounders. Although not examined here, other studies have found correlates between BV and psychosocial stress (89,90). One limitation is that we cannot formally rule out contributions by potentially confounding factors to the glycan landscape.…”

Structural Racism and Adverse Pregnancy Outcomes Through the Lens of the Maternal Microbiome

“…Weathering may affect the vaginal microbiome as chronic stress doubles the risk of BV incidence. 60,61 African American women are exposed to higher levels of psychological and physiologic stressors compared with White women, 15,[62][63][64] including from perceived racial discrimination, poverty, poor housing, and exposure to crime. Social stressors are also associated with altered gut microbiota in mouse models.…”