Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, USA.
Am J Obstet Gynecol. 2011 Sep;205(3):177-90. doi: 10.1016/j.ajog.2011.03.047. Epub 2011 Apr 2.
The purpose of this study was to determine whether the administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation reduces the risk of preterm birth and late miscarriage. We conducted a systematic review and metaanalysis of randomized controlled trials of the early administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation. Five trials that comprised 2346 women were included. Clindamycin that was administered at <22 weeks of gestation was associated with a significantly reduced risk of preterm birth at <37 weeks of gestation and late miscarriage. There were no overall differences in the risk of preterm birth at <33 weeks of gestation, low birthweight, very low birthweight, admission to neonatal intensive care unit, stillbirth, peripartum infection, and adverse effects. Clindamycin in early pregnancy in women with abnormal vaginal flora reduces the risk of spontaneous preterm birth at <37 weeks of gestation and late miscarriage. There is evidence to justify further randomized controlled trials of clindamycin for the prevention of preterm birth. However, a deeper understanding of the vaginal microbiome, mucosal immunity, and the biology of BV will be needed to inform the design of such trials.
本研究旨在确定在<22 周妊娠时存在阴道菌群异常的女性中应用克林霉素能否降低早产和晚期流产的风险。我们对<22 周妊娠时阴道菌群异常的女性早期应用克林霉素的随机对照试验进行了系统评价和荟萃分析。共纳入 5 项包含 2346 名女性的试验。<22 周妊娠时应用克林霉素与<37 周妊娠时早产风险显著降低以及晚期流产相关。<33 周妊娠时早产、低出生体重儿、极低出生体重儿、新生儿重症监护病房入住、死胎、围产期感染以及不良反应的风险无总体差异。在阴道菌群异常的女性中，妊娠早期应用克林霉素可降低自发性<37 周妊娠早产和晚期流产的风险。有证据表明，有必要进一步开展克林霉素预防早产的随机对照试验。但是，为了指导此类试验的设计，需要更深入地了解阴道微生物组、黏膜免疫和 BV 的生物学特性。
