细菌性阴道病与早产：一项基于社区的前瞻性队列研究。
Bacterial vaginosis and preterm birth: a prospective community-based cohort study.
作者信息
Oakeshott Pippa, Kerry Sally, Hay Sima, Hay Philip
机构信息
General Practice, Community Health Sciences, St George's Hospital Medical School, London SW17 0RE, UK.
出版信息
Br J Gen Pract. 2004 Feb;54(499):119-22.
BACKGROUND
Preterm birth before 37 weeks' gestation is associated with 70% of perinatal morbidity and nearly half of long-term neurological morbidity. Hospital-based studies have shown that bacterial vaginosis is associated with preterm birth.
AIM
To estimate the relative risk of preterm birth in women with and without bacterial vaginosis, detected by self-administered vaginal swab at < 10 weeks' gestation.
DESIGN
Prospective cohort study.
SETTING
Thirty-two general practices and five family planning clinics in South London.
PARTICIPANTS
A total of 1216 women with bacterial vaginosis status established before 10 weeks' gestation, by analysis of Gram stained vaginal smears by two independent observers.
METHOD
All women who did not miscarry or have a termination of pregnancy before 16 weeks' gestation were sent a brief confidential questionnaire at 16 weeks and at term asking about pregnancy outcome. Data on non-responders were obtained by searches of hospital and general practice records and by telephone calls to patients.
RESULTS
Ascertainment was 87% (937/1072). The mean age of the women was 31 years. Thirteen per cent (122/925) had bacterial vaginosis and 5% (44/897) had a spontaneous preterm birth. The relative risk (RR) of preterm birth in women with bacterial vaginosis was 0.9 (95% confidence interval [CI] = 0.4 to 2.2). However, bacterial vaginosis was associated with late miscarriage at 13-23 weeks (R = 4.0, 95%CI = 1.3 to 12.1). Preterm birth was not associated with previous preterm birth, black ethnicity, age < 20 years, low social class, single marital status, or chlamydial infection. However, it was more common in women who reported smoking in pregnancy (RR = 2.9, 95% CI = 1.5 to 5.5). Of 867 responders, 552 (64%) said that providing a vaginal swab was at least as easy as providing a urine specimen.
CONCLUSIONS
In this low-risk community-based cohort, bacterial vaginosis was not a strong risk factor for preterm birth.
背景
妊娠37周前的早产与70%的围产期发病率以及近一半的长期神经疾病发病率相关。基于医院的研究表明，细菌性阴道病与早产有关。
目的
评估在妊娠10周前通过自行采集阴道拭子检测出有或无细菌性阴道病的女性发生早产的相对风险。
设计
前瞻性队列研究。
地点
伦敦南部的32家全科诊所和5家计划生育诊所。
参与者
通过两名独立观察者对革兰氏染色阴道涂片进行分析，共有1216名女性在妊娠10周前确定了细菌性阴道病状态。
方法
所有在妊娠16周前未流产或终止妊娠的女性在16周和足月时收到一份简短的保密问卷，询问妊娠结局。通过查阅医院和全科诊所记录以及给患者打电话获取未回复者的数据。
结果
确定率为87%（937/1072）。女性的平均年龄为31岁。13%（122/925）患有细菌性阴道病，5%（44/897）发生自发性早产。患有细菌性阴道病的女性早产的相对风险（RR）为0.9（95%置信区间[CI]=0.4至2.2）。然而，细菌性阴道病与13至23周的晚期流产有关（RR=4.0，95%CI=1.3至12.1）。早产与既往早产、黑人种族、年龄<20岁、社会阶层低、单身婚姻状况或衣原体感染无关。然而，在孕期吸烟的女性中更常见（RR=2.9，95%CI=1.5至5.5）。在867名回复者中，552名（64%）表示提供阴道拭子至少与提供尿液样本一样容易。
结论
在这个低风险的社区队列中，细菌性阴道病不是早产的强风险因素。
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