Abstract
The features of the vaginal microbiota (VM) community can reflect health status, and they could become new biomarkers for disease diagnosis. During pregnancy, domination of bacteria of the genus Lactobacillus in the VM community is regarded as a keystone because they stabilize the VM by producing antimicrobial compounds and competing adhesion. An altered VM composition provides a marker for adverse pregnancy outcomes. This nested case–control study aimed to characterize the VM in women with a tubal pregnancy (TP) presenting with pain and/or uterine bleeding in early pregnancy. Chinese women with a symptomatic early pregnancy of unknown location were the study cohort. 16S rDNA gene-sequencing of V3–V4 variable regions was done to assess the diversity, structures, taxonomic biomarkers, and classification of the VM community. The primary outcome was the location of the early pregnancy. The VM community in women with a TP showed higher diversity (PD-whole-tree, median: 8.26 vs. 7.08, P = 0.047; Shannon Diversity Index, median: 1.43 vs 0.99, P = 0.03) and showed different structures to those in women with an intrauterine pregnancy (IUP) (R = 0.23, P < 0.01). Bacteria of the genus Lactobacillus were significantly enriched in the IUP group, whereas bacteria of the genera Gardnerella and Prevotella were significantly enriched in the TP group. Lactobacillus abundance could be used to classify the pregnancy location (AUC = 0.81). Non-Lactobacillus-dominated microbiota (≤ 0.85% Lactobacillus) was significantly associated with a TP (adjusted odds ratio: 4.42, 95% confidence interval: 1.33 to 14.71, P = 0.02). In conclusion, among women with a symptomatic early pregnancy, a higher diversity and lower abundance of Lactobacillus in the VM is associated with a TP.
Highlights
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus
The cohort was comprised of 292 women with symptomatic early pregnancy of unknown location (PUL), 46 of whom were diagnosed subsequently with a tubal pregnancy (TP), and the remainder of whom diagnosed with an intrauterine pregnancy (IUP)
A greater diversity and lower abundance of Lactobacillus in the vaginal microbiota (VM) was associated with a TP
Summary
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. An ectopic pregnancy most often occurs within a fallopian tube. Retrospective case–control studies have shown that the prevalence of fallopian tube damage increases after continuous exposure to PID (13% after one exposure, 35% after two exposures, and 75% after three exposures), which may lead to an increase in the incidence of TP (Bjartling et al, 2007; Bakken, 2008). One nested case–control study with a sample size of 2026 found that pain as the presenting symptom (odds ratio (OR): 1.16, 95% confidence interval (CI): 0.92–1.48) and bleeding as the presenting symptom (OR: 1.34, 95%CI:1.04–1.78) were risk factors for an ectopic pregnancy (Barnhart et al, 2006). Finding inflammation-related biomarkers associated with TP risk in symptomatic women in early pregnancy is important
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