12: Impact of high-risk cervicovaginal microbial communities and perceived stress on recurrent spontaneous preterm birth

Abstract

While select cervicovaginal (CV) microbiota and psychosocial factors have been associated with spontaneous preterm birth (sPTB), their impact on the risk of recurrence remains unclear. It is also unknown whether psychosocial factors, such as maternal stress, amplify underlying biologic risk. This study sought to determine the effect of high-risk CV microbial communities and perceived stress on the risk of recurrent sPTB. This was a secondary analysis of a prospective pregnancy cohort, Motherhood and Microbiome. The Cohen’s Perceived Stress Scale (PSS-14) was administered and cervical swabs were obtained between 16-20 weeks. PSS-14 scores ≥30 reflected high perceived stress. We analyzed CV microbiota using 16S rRNA sequencing and classified microbial communities into community state types (CST). CST IV is a high-risk CV microbial community characterized by anaerobes and a lack of Lactobacillus. The final cohort included women with prior sPTB who had recurrent sPTB or term birth. Multivariable logistic regression modeled adjusted associations between CST IV and sPTB as well as high PSS-14 and sPTB. Among the 201 women, 33 (16.4%) had CST IV and 45 (22.5%) had recurrent sPTB. While proportions of recurrent sPTB v. term birth among women with CST IV were not different (48.8% v. 30.2%; p=0.082), models adjusted for African American race and marital status revealed a significant association between CST IV and recurrent sPTB (aOR 2.99; CI 1.13-7.96). High PSS-14 was a confounder on this association. After adjusting for high PSS-14, the odds of recurrent sPTB with CST IV were higher (aOR 3.83; CI 1.30-11.33). Among women with a prior sPTB, high-risk CV microbial communities confer increased risk of recurrent sPTB. Adjustment for perceived stress amplified associations between CST IV and recurrent sPTB. Identification of modifiable social or behavioral factors may unveil novel non-pharmacologic interventions to decrease recurrent sPTB among women with underlying biologic risk. (R01NR01478; ME)View Large Image Figure ViewerDownload Hi-res image Download (PPT)