Abstract
Infection-related preterm birth is a leading cause of infant mortality and morbidity; knowledge of bacterial populations invading the amniotic cavity and the routes of invasion is required to make progress in the prevention of preterm birth. Significant advances have been made in understanding bacterial communities in the vagina, but much less studied are intra-uterine bacterial populations during pregnancy. A systematic review of data published on the intra-uterine microbiome was performed; molecular information and summaries of species found in healthy individuals and in women with diagnosed infections served to construct a database and to analyse results to date. Thirteen studies fulfilled the review's inclusion criteria. The data of various investigations were collated, organized, and re-analyzed to achieve a more comprehensive understanding of microbial populations in the intra-amniotic space. The most common intra-amniotic bacterial taxa were species that can colonies the vagina in health and disease; there were others associated with the habitats of the mouth, gastrointestinal tract, and respiratory tract. The results suggest a central role for the ascending route of infections during pregnancy, and point to a possible secondary contribution via haematogenous invasion of the intra-amniotic space. The complete census of the intra-uterine microbiome awaits completion.
Highlights
Infection-related preterm birth is a leading cause of infant mortality and morbidity; knowledge of bacterial populations invading the amniotic cavity and the routes of invasion is required to make progress in the prevention of preterm birth
Its focus is on the dramatic advance of the knowledge of the bacterial communities present in the genital microbiota of pregnant women made in the last 18 years by non-cultivation, highthroughput techniques of analysis, and the potential contributions systematic investigations of the female genital microbiome can make to preventing Preterm birth (PTB)
There is a strong association between the presence of some bacteria in the intra-amniotic cavity and PTB
Summary
Bacterial aetiological agents of intra-amniotic infections and preterm birth in pregnant women. Investigations of the intra-uterine flora of women giving birth prematurely based on non-cultivation taxon-specific PCR analyses, as well as more recent studies employing non-cultivation broad-range PCR methods have demonstrated the presence of microflora in the intra-amniotic cavity even in the absence of any signs of infection (DiGiulio, 2012). The results of standard microbiological studies suggest that intrauterine infection accounts for as much as 25–45% of spontaneous PTB (Zhou et al, 2010); but employing molecular techniques, bacterial footprints have been detected in as many as 60% of women delivering preterm (Gardella et al, 2004). This study reviews and organizes systematically data published on the identity and frequency of detection of bacterial taxa found in the intra-amniotic space of women who delivered preterm. Its focus is on the dramatic advance of the knowledge of the bacterial communities present in the genital microbiota of pregnant women made in the last 18 years by non-cultivation, highthroughput techniques of analysis, and the potential contributions systematic investigations of the female genital microbiome can make to preventing PTB
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