Vaginal microbiome as a tool for prediction of chorioamnionitis in preterm labor: a pilot study

Daichi Urushiyama,Eriko Ohnishi,Masahira Hattori,Chihiro Kiyoshima,Shingo Miyamoto,Shinichiro Nagamitsu,Kenichiro Hata,Takashi Setoue,Toyofumi Hirakawa,Wataru Suda,Fusanori Yotsumoto,Masamitsu Kurakazu,Kohei Miyata,Kazuki Nabeshima

doi:10.1038/s41598-021-98587-4

Abstract

Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Vaginal discharge samples were collected from 83 pregnant women admitted for preterm labor. Based on Blanc’s classification, the participants were divided into CAM (stage ≥ II; n = 46) and non-CAM (stage ≤ I; n = 37) groups. The 16S rDNA amplicons (V1–V2) from vaginal samples were sequenced and analyzed. Using a random forest algorithm, the bacterial species associated with CAM were identified, and a predictive CAM (PCAM) scoring method was developed. The α diversity was significantly higher in the CAM than in the non-CAM group (P < 0.001). The area under the curve was 0.849 (95% confidence interval 0.765–0.934) using the PCAM score. Among patients at < 35 weeks of gestation, the PCAM group (n = 22) had a significantly shorter extended gestational period than the non-PCAM group (n = 25; P = 0.022). Multivariate analysis revealed a significant difference in the frequency of developmental disorders in 3-year-old infants (PCAM, 28%, non-PCAM, 4%; P = 0.022). Analyzing vaginal microbiota can evaluate the risk of IAI. Future studies should establish appropriate interventions for IAI high-risk patients to improve perinatal prognosis.

Highlights

Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis
Increases in dysbiosis and certain bacteria in the vaginal flora have been reported in cases of preterm birth and/or bacterial vaginosis, there are still many uncertainties regarding the diagnostic performance of different microbial markers determined using conventional methods, such as culture, polymerase chain reaction, general bacterial composition analysis using principal coordinate analysis (PCoA), and community state types (CST)[39,40,41]
We evaluated the status of IAI by the histological examination of the placenta, rather than by preterm birth along with various confounding factors, and revealed the association between histological CAM and the vaginal microbiota

Summary

Introduction

Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Increases in dysbiosis and certain bacteria in the vaginal flora have been reported in cases of preterm birth and/or bacterial vaginosis, there are still many uncertainties regarding the diagnostic performance of different microbial markers determined using conventional methods, such as culture, polymerase chain reaction, general bacterial composition analysis using principal coordinate analysis (PCoA), and community state types (CST)[39,40,41]. By narrowing the CAM-associated bacteria based on 16S rDNA amplicon sequencing data by general analysis and machine learning and creating an original scoring method, IAI with poor prognosis could be predicted

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