Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS E-02, Atlanta, GA, 30333, USA.
Matern Child Health J. 2011 Oct;15(7):1020-8. doi: 10.1007/s10995-010-0661-0.
Randomized trials of bacterial vaginosis (BV) treatment among pregnant women to reduce preterm birth have had mixed results. Among non-pregnant women, BV recurs frequently after treatment. Randomized trials of early BV treatment for pregnant women in which recurrence was retreated have shown promise in reducing preterm birth. Syracuse's Healthy Start (SHS) program began in 1997; in 1998 prenatal care providers for pregnant women living in high infant mortality zip codes were encouraged to screen for abnormal vaginal flora at the first prenatal visit. Vaginal swabs were sent to a referral hospital laboratory for Gram staining and interpretation. SHS encouraged providers to treat and rescreen women with bacterial vaginosis or abnormal flora (BV). We abstracted prenatal and hospital charts of live births between January 2000 and March 2002 for maternal conditions and treatments. We merged abstracted data with local electronic data. We evaluated the effect of BV screening before 22 weeks gestation, treatment, and rescreening using a retrospective cohort study design. Among 838 women first screened before 22 weeks, 346 (41%) had normal flora and 492 (59%) women had BV at a mean of 13 weeks gestation; 202 (24%) did not have treatment documented and 290 (35%) received treatment at a mean of 15 weeks gestation; 267 (92%) of those treated were re-screened. Among pregnant women with early BV, 42 (21%) untreated women and 28 (10%) treated women delivered preterm (Odds Ratio [OR] 0.4, 95% confidence interval [CI] 0.2-0.7)). After adjustment for age, race, prior preterm birth and other possible confounders, treatment remained associated with a reduced risk of preterm birth compared to no treatment (aOR = 0.5, 95% CI 0.3-0.9); the aOR for women with normal flora was not significantly different.
Screening, treatment, and rescreening for BV/abnormal flora between the first prenatal visit and 22 weeks gestation showed promise in reducing preterm births and deserves further study.
随机临床试验表明，细菌性阴道病（BV）治疗可降低早产风险，但结果不一。非孕妇在BV 治疗后经常复发。对孕妇进行早期 BV 治疗并在复发时再次治疗的随机临床试验显示，可降低早产风险。
评估在孕 22 周前筛查、治疗和再筛查 BV/异常菌群是否可降低早产率。
回顾性队列研究。
纽约州锡拉丘兹市。
2000 年 1 月至 2002 年 3 月间活产的孕妇。
对居住在高婴儿死亡率邮政编码地区的孕妇，在首次产前检查时进行异常阴道菌群筛查。阴道拭子送到转诊医院进行革兰氏染色和判读。SHS 鼓励医生对患有细菌性阴道病或异常菌群的孕妇进行治疗和再次筛查。
早产发生率。
在 838 名在孕 22 周前首次筛查的孕妇中，346 名（41%）有正常菌群，492 名（59%）有 BV，平均孕周为 13 周；202 名（24%）未记录治疗，290 名（35%）在平均孕周 15 周时接受治疗；267 名（92%）接受治疗的孕妇进行了再筛查。在患有早期 BV 的孕妇中，42 名（21%）未治疗的孕妇和 28 名（10%）接受治疗的孕妇早产（比值比 [OR] 0.4，95%置信区间 [CI] 0.2-0.7））。调整年龄、种族、既往早产和其他可能的混杂因素后，与未治疗相比，治疗与降低早产风险相关（调整后比值比[aOR]0.5，95%CI 0.3-0.9）；正常菌群组的 aOR 无显著差异。
在首次产前检查至孕 22 周期间筛查、治疗和再筛查 BV/异常菌群可降低早产率，值得进一步研究。
