Bacterial Vaginosis In Early Pregnancy Research Articles

Screening Pregnant Women for Bacterial Vaginosis Using a Point-of-Care Test: A Prospective Validation Study.

Bacterial vaginosis in early pregnancy is associated with an increased risk of preterm birth. The introduction of a simple screen-and-treat program into antenatal care was shown to significantly reduce the rate of preterm birth. The gold standard for diagnosing bacterial vaginosis is Gram staining, which is, however, time-consuming and requires laboratory facilities. The objective of this prospective study was to validate a point-of-care sialidase activity detection test (OSOM® BVBLUE® Test) for asymptomatic pregnant women and evaluate its accuracy as a screening tool. We enrolled 200 pregnant participants, 100 with Gram staining-confirmed bacterial vaginosis and 100 healthy controls. Compared to Gram staining, the point-of-care test showed a sensitivity of 81%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 98.1%. In conclusion, we found that the OSOM® BVBLUE® Test was an accurate method for diagnosing bacterial vaginosis in asymptomatic pregnant women. This point-of-care test can therefore be considered a reliable and easy-to-use screening tool for bacterial vaginosis during pregnancy.

Screening and treatment of asymptomatic bacterial vaginosis in early pregnancy

Screening and treatment of asymptomatic bacterial vaginosis in early pregnancy

Vaginal Ureaplasma parvum serovars and spontaneous preterm birth

Ureaplasma species (spp) are the bacteria most often isolated from the amniotic cavity of women with preterm labor or preterm premature rupture of membranes; thus, the link between intrauterine Ureaplasma spp infection and adverse pregnancy outcome clearly is established. However, because vaginal Ureaplasma spp colonization is very common in pregnant women, the reason that these microorganisms cause ascending infections in some cases but remain asymptomatic in most pregnancies is not clear. Previous studies suggested an association between vaginal colonization with Ureaplasma parvum as opposed to U urealyticum and preterm delivery. However, because of the high frequency of vaginal Ureaplasma spp colonization during pregnancy, additional risk factors are needed to select a group of women who might benefit from treatment. To further identify pregnant women who are at increased risk for preterm delivery, the aim of the present study was to investigate U parvum serovar-specific pathogenicity in a large clinical cohort. We serotyped 1316 samples that were positive for U parvum using a high-resolution melt polymerase chain reaction assay, and results were correlated with pregnancy outcome. Within U parvum positive samples, serovar 3 was the most common isolate (43.3%), followed by serovar 6 (31.4%) and serovar 1 (25.2%). There was a significantly increased risk for spontaneous preterm birth at very low (<32 weeks gestation; P<.005) and extremely low (<28 weeks gestation; P<.005) gestational age in the group with vaginal U parvum serovar 3 colonization compared with the control group of pregnant women who tested negative for vaginal Ureaplasma spp colonization. This association was found for neither serovar 1 nor serovar 6. The combination of vaginal U parvum serovar 3 colonization and diagnosis of bacterial vaginosis in early pregnancy or a history of preterm birth further increased the risk for adverse pregnancy outcome. Colonization with U parvum serovar 3, but not serovar 1 or serovar 6, in early pregnancy is associated with preterm delivery at very and extremely low gestational age. The combination of U parvum serovar 3 colonization and a history of preterm birth or bacterial vaginosis further increases the risk for spontaneous preterm birth at low gestational age and may define a target group for therapeutic intervention studies.

Influence of vitamin D deficiency on reproductive health of women

The review provides an analysis of literature data on the effect of vitamin D deficiency on the reproductive health of women of childbearing age. The peculiarities of transformation of the inactive form, which enters the human body with food and sunlight exposure of the skin, into the active form of D hormone – calcitriol (1,25 (OH) 2D) are considered. It is shown that the activation of the processes of differentiation and proliferation of chondrocytes and osteoblasts, provision of phosphoric calcium homeostasis, processes of mineralization and bone growth remains the leading property of vitamin D. Active forms of vitamin D have a decisive role in other biological processes, including the regulation and differentiation of cell growth, the activity of metabolic processes, in particular the development of insulin resistance, obesity, the ability to change neuromuscular conductivity, influence immunity, inflammation, hormonal activity of woman's reproductive system. The role of vitamin D in the processes of programming fetal and neonatal development, the further risk of developmental diseases in childhood and adulthood, due to the presence of VDR and 1a-hydroxylase in tissues such as ovaries, uterus, placenta, and also in the pituitary. It has been shown that vitamin D deficiency causes a number of adverse complications of pregnancy: hypertension and especially preeclampsia, an increase in the frequency of cesarean sections and spontaneous premature births, bacterial vaginosis in early pregnancy, gestational diabetes mellitus. The data given on the possible role of vitamin D deficiency in the formation of polycystic ovary syndrome, its effect on puberty of girls, violation of the last is a predictor of the formation of a polycystic phenotype in the reproductive age. The conclusion is made about the expediency of determining the level of vitamin D and its supplementation at the pregravidar stage, which will ensure timely prevention of preeclampsia, weakness of labor activity, surgical delivery, and will also contribute to the birth of a healthy child.

Treatment of Bacterial Vaginosis in Early Pregnancy and its Effect on Spontaneous Preterm Delivery and Preterm Premature Rupture of Membranes

Background: This study was conducted to investigate whether screening and treatment of bacterial vaginosis (BV) in early pregnancy reduces the risk of spontaneous preterm delivery or preterm premature rupture of membranes (PPROMs). Material and methods: Women were screened for BV during their first visit to the maternal health care unit. After the vaginal samples were air dried, they were sent to the gynecological department and were analyzed using Hay/ Ison modified classification. Eligible women were those who lived in Skaraborg County and delivered at Skaraborgs Hospital in Skovde, Sweden. The women were divided into two groups, namely, screened women (with BV or with lactobacilli flora) and unscreened women. Women with BV were offered treatment with vaginal clindamycin. Results: During 2007-2015, 22,084 deliveries occurred at Skaraborgs Hospital; a total of 6,899 women were screened for BV, out of which 746 (10.8%) had BV flora. Survival analysis showed that women with BV had spontaneous preterm delivery significantly earlier than those with normal lactobacilli flora, even after treatment with vaginal clindamycin (log rank p=0.01). During the same period, 15,189 deliveries occurred at Skaraborgs Hospital; they were not screened for BV. The survival analysis showed that the unscreened women delivered slightly earlier than the screened women (t-test p<0.05), with mean delivery days of 239.4-241.7. Conclusion: Even though patients with BV had been treated with clindamycin, they still suffered from an increased risk of spontaneous preterm delivery as compared to women with normal lactobacilli flora. The difference between the screened women and the unscreened women could be attributed to the positive effect of the treatment of BV with clindamycin if it can be assumed that there is the same amount of untreated BV in the unscreened group.

Vaginose bactérienne et accouchement prématuré

Bacterial vaginosis (BV) is an imbalance of vaginal flora. There is a statistical association between BV in early pregnancy and the occurrence of obstetric complications including preterm delivery. If screening and treatment of asymptomatic BV in patients at low risk are not recommended, the management of patients at high risk of prematurity is controversial. Using molecular tool, a rational and objective approach to the imbalance of vaginal flora, would reassess the relationship between VB and obstetric complications.

Maternal vitamin A and β-carotene supplementation and risk of bacterial vaginosis: a randomized controlled trial in rural Bangladesh

Bacterial vaginosis (BV) in pregnancy is linked to preterm birth, but its risk factors are not well understood. Micronutrient deficiencies may be associated with an increased risk of this condition. We assessed the effect of weekly vitamin A or β-carotene supplementation during pregnancy until 3 mo postpartum on BV risk in rural northeastern Bangladesh. In this cluster-randomized, placebo-controlled trial, 33 clusters (n = 33) were randomly assigned to 3 groups. Women (n = 1812) were examined for BV by using self-administered swabs and the Nugent scoring method in early pregnancy, at 32 wk of gestation, and at 3 mo postpartum. The prevalence of BV in early pregnancy, before supplementation, was 7.6% (95% CI: 6.3%, 9.1%) overall. Neither the prevalence nor the incidence of BV in the third trimester differed by supplement group. However, the prevalence (OR: 0.71; 95% CI: 0.52, 0.98) and incidence (RR: 0.58; 95% CI: 0.41, 0.81) of BV at 3 mo postpartum was lower among women in the vitamin A group (9.1% and 6.7%, respectively) than in the placebo group (12.4% and 11.8%, respectively), but not in the β-carotene group. Both vitamin A and β-carotene reduced the prevalence and incidence of BV at both time points (ie, third trimester and 3 mo postpartum) by 30-40% compared with placebo (all P < 0.05). Weekly vitamin A supplementation reduced the risk of maternal BV in this rural Bangladeshi population. Enhancement of vitamin A status before and during pregnancy may reduce the risk of BV in areas with vitamin A deficiency. This trial is registered at clinicaltrials.gov as NCT00198822.

Changes in the Vaginal Microenvironment with Metronidazole Treatment for Bacterial Vaginosis in Early Pregnancy

Bacterial vaginosis (BV) is associated with preterm delivery, but there is little evidence that treatment improves pregnancy outcomes. We examined whether oral or vaginal metronidazole treatment for BV in early pregnancy was more effective in restoring the normal vaginal environment. This was a randomized controlled trial comparing oral and intravaginal metronidazole for treatment of BV in early pregnancy (<20 weeks). Vaginal samples collected at baseline and 4 weeks after treatment were evaluated using gram stain, culture, colorimetric detection of sialidase, and immunoassay for measurement of proinflammatory cytokines interleukins-1beta, -6, -8 (IL-1beta, IL-6, IL-8) and secretory leukocyte protease inhibitor (SLPI). We compared the effect of treatment between groups (using chi-square and t test) and within individuals (McNemar's test). Of 126 subjects, 108 (86%) completed follow-up (55 oral, 53 intravaginal). Of the study population, 34% achieved therapeutic cure, and this was not different between treatment groups. BV-associated bacteria were significantly reduced in both groups, but few subjects regained colonization with protective lactobacilli. Among women who achieved therapeutic cure, the level of IL-1beta dropped significantly (p < 0.001) and SLPI increased (p = 0.003). More women in the vaginal treatment group had undetectable sialidase after treatment (p = 0.013). Treatment with oral or intravaginal metronidazole in early pregnancy reduced colonization with BV-associated bacteria but was not effective in achieving therapeutic cure or in restoring healthy vaginal lactobacilli.

Maternal Vitamin D Deficiency Is Associated with Bacterial Vaginosis in the First Trimester of Pregnancy

Bacterial vaginosis (BV) is a highly prevalent vaginal infection that is associated with adverse pregnancy outcomes. Vitamin D exerts an influence on the immune system and may play a role in BV. The objective of this study was to examine the association between maternal vitamin D status and the prevalence of BV in early pregnancy. Women (n = 469) enrolled in a pregnancy cohort study at <16 wk underwent a pelvic examination and provided a blood sample for determination of serum 25-hydroxyvitamin D [25(OH)D]. BV was diagnosed using Gram-stained vaginal smears interpreted using the method of Nugent. Approximately 41% of women had BV (Nugent score 7-10) and 52% had a serum 25(OH)D concentration <37.5 nmol/L. The mean unadjusted serum 25(OH)D concentration was lower among BV cases (29.5 nmol/L; 95% CI: 27.1, 32.0) compared with women with normal vaginal flora (40.1 nmol/L; 95% CI: 37.0, 43.5; P < 0.001). BV prevalence decreased as vitamin D status improved (P < 0.001). Approximately 57% of the women with a serum 25(OH)D concentration <20 nmol/L had BV compared with 23% of women with a serum 25(OH)D concentration >80 nmol/L. There was a dose-response association between 25(OH)D and the prevalence of BV. The prevalence declined as 25(OH)D increased to 80 nmol/L, then reached a plateau. Compared with a serum 25(OH)D concentration of 75 nmol/L, there were 1.65-fold (95% CI: 1.01, 2.69) and 1.26-fold (1.01, 1.57) increases in the prevalence of BV associated with a serum 25(OH)D concentration of 20 and 50 nmol/L, respectively, after adjustment for race and sexually transmitted diseases. Vitamin D deficiency is associated with BV and may contribute to the strong racial disparity in the prevalence of BV.

Probiotics for preventing preterm labour

Preterm birth causes 60% to 80% of neonatal deaths. Survivors can experience life-long complications. The risk of preterm labour in the presence of maternal infection is thought to be 30% to 50%. Probiotics are defined as live micro-organisms which, when administered in an adequate amount, confer a health benefit on the host. They have been shown to displace and kill pathogens and modulate the immune response by interfering with the inflammatory cascade that leads to preterm labour and delivery. During pregnancy, local treatment restoring normal vaginal flora and acidity without systemic effects could be preferable to other treatment in preventing preterm labour. To evaluate the effectiveness and the safety of probiotics for preventing preterm labour and birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2006). All randomised controlled trials assessing the prevention of preterm birth in pregnant women and women planning pregnancy through the use of probiotics to treat or prevent urogenital infections. We extracted data using the prepared form and analysed with the Review Manager software. We assessed four trials for inclusion in the review. One trial started in February 2005 and is still ongoing. We excluded one trial because there were no data to be extracted from the article. Of the two trials included in the review, one enrolled women after 34 weeks of pregnancy using oral fermented milk as probiotic, while the other study utilised commercially available yogurt to be used vaginally by women diagnosed with bacterial vaginosis in early pregnancy. Reduction in genital infection was the only prespecified clinical outcome for which the data were available; pooled results showed an 81% reduction in the risk of genital infection with the use of probiotics (risk ratio 0.19; 95% confidence interval 0.08 to 0.48). Although the use of probiotics appears to treat vaginal infections in pregnancy, there are currently insufficient data from trials to assess impact on preterm birth and its complications.

Bacterial vaginosis in early pregnancy is associated with low birth weight and small for gestational age, but not with spontaneous preterm birth: A population-based study on Danish women

Objective. To analyze the association between bacterial vaginosis (BV) in early pregnancy and preterm birth, low birth weight (LBW) and small for gestational age (SGA) in a Danish population.Methods. A geographically defined population-based prospective study of Danish-speaking pregnant women over18 years of age enrolled before week 24 and followed until delivery. BV was diagnosed by Amsel's clinical criteria at enrolment.Results. At enrolment, 13.7% had BV. BV was not associated with an increased risk of spontaneous preterm birth (crude OR 0.8 (0.5–1.5)). Nulliparity was found to affect birth weight to such a degree that this variable was used for stratification. In nulliparous women BV was associated with LBW (adj. OR 4.3 (1.5–12)) and SGA (adj. OR 1.6 (0.7–3.1)) compared to nulliparous without BV. No such associations were seen for multiparous women with BV.Conclusions. BV was not associated with spontaneous preterm birth, but was associated with both LBW and SGA in nulliparous women.

Subclinical iron deficiency is a strong predictor of bacterial vaginosis in early pregnancy.

BackgroundBacterial vaginosis (BV) is the single most common vaginal infection in women of childbearing age and associated with a sizeable infectious disease burden among both non-pregnant and pregnant women, including a significantly elevated risk of adverse pregnancy outcome. Overall, little progress has been made in identifying causal factors involved in BV acquisition and persistence. We sought to evaluate maternal iron status in early pregnancy as a putative risk factor for BV, considering that micronutrients, and iron deficiency in particular, affect the host response against bacterial colonization, even in the setting of mild micronutrient deficiencies.MethodsIn a nested case-control study, we compared maternal iron status at entry to prenatal care (mean gestational age 9.2 ± 2.6 weeks) between eighty women with healthy vaginal microflora and eighteen women with vaginosis-like microflora. Vaginal microflora status was assessed by assigning a modified Nugent score to a Gram-stained vaginal smear. Maternal iron status was assayed by an array of conventional erythrocyte and serum indicators for iron status assessment, but also by more sensitive and more specific indicators of iron deficiency, including soluble transferrin receptors (sTfR) as an accurate measure of cellular and tissue iron deficiency and the iron deficiency log10[sTfR/ferritin] index as the presently most accurate measure of body storage iron available.ResultsWe found no statistically significant correlation between vaginal microflora status and routinely assessed iron parameters. In contrast, a highly significant difference between the healthy and vaginosis-like microflora groups of women was shown in mean values of sTfR concentrations (1.15 ± 0.30 mg/L versus 1.37 ± 0.38 mg/L, p = 0.008) and in mean iron deficiency log10[sTfR/ferritin] index values (1.57 ± 0.30 versus 1.08 ± 0.56, p = 0.003), indicating a strong association between iron deficiency and vaginosis-like microflora. An sTfR concentration >1.45 mg/L was associated with a 3-fold increased risk (95%CI: 1.4–6.7) of vaginosis-like microflora and after controlling for maternal age, gestational length, body mass, parity, and smoking habits with an adjusted odds ratio of 4.5 (95%CI: 1.4–14.2).ConclusionWe conclude that subclinical iron deficiency, presumably resulting from inadequate preconceptional iron supplies, is strongly and independently associated with vaginosis-like microflora during early pregnancy.

Vaginal markers of preterm birth

The etiology of spontaneous preterm labor (SPTL) and preterm birth (PTB) is multifactorial, but there is overwhelming evidence that infection is an important factor in up to 40% of cases. SPTL is either a physiological process occurring too early in pregnancy or a pathological process following an abnormal signal. The earlier in pregnancy at which labor occurs, the more likely this is to be the result of a pathological signal such as infection. The knowledge that infection may be the cause of SPTL is unhelpful once SPTL has begun. By that time, the inflammatory process which is an integral part of the parturition process may already have caused irreversible changes in the myometrial and cervical tissues which render attempts to reverse the process at best unhelpful and at worse damaging. It is much more logical to identify in early pregnancy those women at risk of SPTL and PTB due to the detection of abnormal genital tract flora. This might result in intervention such as antibiotics, which might reduce the incidence of SPTL and PTB. A number of studies using different methodologies and diagnostic techniques have shown a statistically significant association between abnormal genital tract flora [in the form of bacterial vaginosis (BV) or the detection of BV-related organisms] and adverse outcome of pregnancy whether late miscarriage, preterm pre-labor rupture of the membranes or PTB (1). The earlier in pregnancy at which abnormal genital tract flora was detected, the greater was the risk of PTB. A positive screening test at 26–32 weeks was associated with a statistically significant 1.4–1.9-fold increased risk of PTB but will have failed to detect those cases of late miscarriage and very early PTB associated with abnormal genital tract flora. In contrast, a positive screen in the second trimester was associated with a 2.6–6.9-fold increased risk of late miscarriage or PTB. In a longitudinal study, women with BV in early pregnancy had a 21% risk of an adverse outcome compared with only 11% of those who were detected as having the condition later in pregnancy. A number of studies have examined the use of antibiotics for the prevention of SPTL and PTB due to infection though they have used different antibiotics in different dosages, regimes, and routes of administration to women with varying degrees of risk and, not surprisingly, different outcomes (1). Bearing in mind the significance of early detection, it is not surprising that those intervention studies in which antibiotics were used early in pregnancy (<20 weeks) in low-risk women (2,3) were able to show significant benefit when compared to those studies in which antibiotics were administered at later gestational age (>20 weeks) (4). In a subgroup analysis of one of the studies in which antibiotics were used early in pregnancy (3), some women who were initially found to have abnormal genital tract flora, on review were found to have returned to normal flora (revertants). Because they subsequently had normal flora, they were not included in the intervention study but at follow-up were found to have a high incidence of adverse outcomes, similar to those women with full-blown BV who had been randomly allocated to placebo (5). This suggests that whatever damaging effects abnormal genital tract flora exerts, this occurs early in pregnancy and may be permanent even if the genital tract flora subsequently returns to normal. In summary: The earlier in pregnancy at which SPTL ensues, the more likely this is to be due to a pathological signal such as infection. The earlier in pregnancy, at which abnormal genital tract flora is detected, the greater is the risk of adverse outcome. Abnormal genital tract flora detected in early pregnancy even if subsequently found to have reverted to normal is associated with an increased risk of adverse outcome. It follows that if antibiotics are to be effective in reducing the incidence of SPTL and PTB, these have to be used in early pregnancy before the tissue damage associated with local and systemic inflammatory response has progressed to an irreversible stage. I am grateful to Pauline Mills for typing the manuscript.

Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth

Background. Bacterial vaginosis (BV) is an important risk factor for preterm birth. BV is detected in 10–30% of pregnant women and is often asymptomatic. Treatment of BV during pregnancy seems to reduce the risk of preterm delivery among high-risk women. We performed a cost-effectiveness analysis of screening and treatment for BV in early pregnancy among asymptomatic women at low risk for preterm delivery. Methods. A decision tree was built with two arms. For the screening (and treatment) arm the probabilities were derived from our earlier randomized trial on screening and treatment for BV, consisting of BV-positive women treated with intravaginal clindamycin cream or placebo and also of BV-negative pregnant women. The probabilities of outcomes among these women were collected from antenatal clinic records and hospital records, and for the no-screening arm mainly from the Finnish Perinatal Statistics. The outcomes considered were preterm delivery, mode of delivery, peripartum infections and postpartum complications. The unit costs associated with these outcomes were mainly based on disease-related groups (DRGs). No-screening was compared with two screening programs (one with clindamycin, the other with metronidazole treatment) and subjected to sensitivity analyses. Results. There was no significant difference between screening and no-screening strategies in the costs and in the rate of preterm deliveries but the screening strategy produced significantly fewer peripartum infections and postpartum complications. Sensitivity analyses suggested that the screening strategy may become cost-saving if the rate of preterm deliveries exceeds 3%. Conclusion. Screening and treatment for BV in early pregnancy may not reduce costs compared to no-screening in a population at low risk for preterm birth but would produce, at the same cost, more health benefits in terms of fewer peripartum infections and postpartum complications. However, it may be cost-saving if the rate of preterm deliveries is higher than 3%.

Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth.

Bacterial vaginosis (BV) is an important risk factor for preterm birth. BV is detected in 10-30% of pregnant women and is often asymptomatic. Treatment of BV during pregnancy seems to reduce the risk of preterm delivery among high-risk women. We performed a cost-effectiveness analysis of screening and treatment for BV in early pregnancy among asymptomatic women at low risk for preterm delivery. A decision tree was built with two arms. For the screening (and treatment) arm the probabilities were derived from our earlier randomized trial on screening and treatment for BV, consisting of BV-positive women treated with intravaginal clindamycin cream or placebo and also of BV-negative pregnant women. The probabilities of outcomes among these women were collected from antenatal clinic records and hospital records, and for the no-screening arm mainly from the Finnish Perinatal Statistics. The outcomes considered were preterm delivery, mode of delivery, peripartum infections and postpartum complications. The unit costs associated with these outcomes were mainly based on disease-related groups (DRGs). No-screening was compared with two screening programs (one with clindamycin, the other with metronidazole treatment) and subjected to sensitivity analyses. There was no significant difference between screening and no-screening strategies in the costs and in the rate of preterm deliveries but the screening strategy produced significantly fewer peripartum infections and postpartum complications. Sensitivity analyses suggested that the screening strategy may become cost-saving if the rate of preterm deliveries exceeds 3%. Screening and treatment for BV in early pregnancy may not reduce costs compared to no-screening in a population at low risk for preterm birth but would produce, at the same cost, more health benefits in terms of fewer peripartum infections and postpartum complications. However, it may be cost-saving if the rate of preterm deliveries is higher than 3%.

Oral clindamycin for asymptomatic bacterial vaginosis in early pregnancy reduces premature births

Oral clindamycin for asymptomatic bacterial vaginosis in early pregnancy reduces premature births

Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis.

Bacterial vaginosis (BV) has been reported to be associated with spontaneous preterm delivery and infectious morbidity after birth in non-Swedish populations. Our intention was to investigate the situation in a Swedish population. In this cohort study, 924 patients were enrolled consecutively. A Papanicolaou (Pap) smear, which included a posterior fornix sample, was obtained at the first visit (median: 12 weeks and 1 day) at the two antenatal care units in central Göteborg 1990-91. Clue cells in the Pap smear were considered to be consistent with BV. The principal outcome variables were spontaneous preterm birth (< 37 weeks) and postpartum endometritis. A relative risk (RR) was calculated with a 95% confidence interval. The prevalence of BV was 15.6%. An association was seen between BV in early pregnancy and postpartum endometritis [RR 3.26 (1.38-7.71)]. A non-significant association was found between BV and spontaneous preterm birth [RR 2.10 (0.90-4.94)]. A multiple logistic regression analysis was performed adjusting for primi-/multiparity and antibiotics during pregnancy and the odds ratio was 2.16 (0.87-3.64). The prevalence of BV was 15.6% in this Swedish pregnant population. The risk for postpartum endometritis was tripled among women with BV in early pregnancy. The risk for spontaneous preterm birth among women with BV was doubled but non-significant, although the samples were obtained early in pregnancy.

Socioeconomic and environmental risk factors of bacterial vaginosis in early pregnancy.

The main aim of this prospective study was to determine the socioeconomic, demographic and environmental factors that may be associated with the occurrence of bacterial vaginosis at early pregnancy in an indigent population from Central Poland. A group of 196 pregnant women was selected randomly from the patients of 10 district maternity units in the Lodz region, Central Poland. Only singleton pregnancies between 8 and 16 week of gestation were qualified for inclusion in the survey. A standard questionnaire covering medical, socioeconomic, demographic, constitutional and environmental items was administered to every subject and was verified with medical records. Cervico-vaginal swabs were collected from the women under study and tested for bacterial vaginosis (BV) according to Spiegel's criteria. Based on the results of Gram stain, BV was diagnosed in 51 women (28.5%), grade I microflora among 66 (36.9%) and grade II among 62 women (34.6%). In the univariate analysis, only single marital status proved to be an important risk factor associated with BV during pregnancy, this was confirmed in the multivariate analysis. Pregnant women who present risk factors for abnormal cervico-vaginal microflora should be covered by comprehensive prenatal surveillance, which enables early detection and treatment of this pathology. Research that identifies the causal pathways and mechanisms through which social disadvantage leads to a higher risk of preterm birth may help to reduce current socioeconomic and demographic disparities and improve pregnancy outcome.

Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis

Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis

Bacterial vaginosis in early pregnancy and adverse pregnancy outcome.

To assess the prevalence of bacterial vaginosis (BV) in asymptomatic pregnant women and its association with preterm birth (PTB) and premature rupture of membranes (PROM). In a cohort study 1,006 pregnant women between 16-28 weeks' gestation were screened for BV (Nugent's criteria) and for lower genital tract infection. Women were followed to confirm pregnancy outcome. Data were analyzed using STATA software. Univariate and multivariate methods were used to investigate the association between bacterial vaginosis and adverse pregnancy outcome. Prevalence of BV was 11.53%. Baseline characteristics were similar for both groups, 6.8% women were lost to follow-up. Incidence of PTB was higher in BV positive women compared to BV negative women (p = 0.001). On multiple logistic regression (MLR), BV was associated with an increased risk of PTB (p = 0.001) and PROM (p = 0.001), other correlates being previous PTB (p = 0.003) and the presence of enteropharyangeal organisms in vagina (p = 0.03). BV accounted for 82.53% of the attributable risk for PTB. Presence of BV in early pregnancy is associated with an increased risk of PTB and PROM. Multicentric interventional study is recommended.