Roberts Christine L, Algert Charles S, Rickard Kristen L, Morris Jonathan M
Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia.
Syst Rev. 2015 Mar 21;4:31. doi: 10.1186/s13643-015-0018-2.
Recognition that ascending infection leads to preterm birth has led to a number of studies that have evaluated the treatment of vaginal infections in pregnancy to reduce preterm birth rates. However, the role of candidiasis is relatively unexplored. Our aim was to undertake a systematic review and meta-analysis to assess whether treatment of pregnant women with vulvovaginal candidiasis reduces preterm birth rates and other adverse birth outcomes.
We undertook a systematic review and meta-analysis of published randomised controlled trials (RCTs) in which pregnant women were treated for vulvovaginal candidiasis (compared to placebo or no treatment) and where preterm birth was reported as an outcome. Trials were identified by searching the Cochrane Central Register of Controlled Trials, Medline and Embase databases to January 2014. Trial eligibility and outcomes were pre-specified. Two reviewers independently assessed the studies against the agreed criteria and extracted relevant data using a standard data extraction form. Meta-analysis was used to calculate pooled rate ratios (RR) and 95% confidence intervals (CI) using a fixed-effects model.
There were two eligible RCTs both among women with asymptomatic candidiasis, with a total of 685 women randomised. Both trials compared treatment with usual care (no screening for, or treatment of, asymptomatic candidiasis). Data from one trial involved a post-hoc subgroup analysis (n = 586) of a larger trial of treatment of 4,429 women with asymptomatic infections in pregnancy and the other was a pilot study (n = 99). There was a significant reduction in spontaneous preterm births in treated compared with untreated women (meta-analysis RR = 0.36, 95% CI = 0.17 to 0.75). Other outcomes were reported by one or neither trial.
This systematic review found two trials comparing the treatment of asymptomatic vaginal candidiasis in pregnancy for the outcome of preterm birth. Although the effect estimate suggests that treatment of asymptomatic candidiasis may reduce the risk of preterm birth, the result needs to be interpreted with caution as the primary driver for the pooled estimate comes from a post-hoc (unplanned) subgroup analysis. A prospective trial with sufficient power to answer the clinical question 'does treatment of asymptomatic candidiasis in early pregnancy prevent preterm birth' is warranted.
PROSPERO CRD42014009241.
认识到上行感染会导致早产，引发了多项评估孕期阴道感染治疗以降低早产率的研究。然而，念珠菌病的作用相对未被充分探索。我们的目的是进行一项系统评价和荟萃分析，以评估治疗外阴阴道念珠菌病的孕妇是否能降低早产率及其他不良分娩结局。
我们对已发表的随机对照试验（RCT）进行了系统评价和荟萃分析，这些试验中孕妇接受了外阴阴道念珠菌病治疗（与安慰剂或不治疗相比），且将早产作为一项结局指标进行了报告。通过检索截至2014年1月的Cochrane对照试验中心注册库、Medline和Embase数据库来识别试验。预先确定试验的纳入标准和结局指标。两名评价者根据商定的标准独立评估研究，并使用标准数据提取表提取相关数据。采用固定效应模型进行荟萃分析以计算合并率比（RR）和95%置信区间（CI）。
有两项符合条件的RCT，均针对无症状念珠菌病女性，共有685名女性被随机分组。两项试验均将治疗与常规护理（不对无症状念珠菌病进行筛查或治疗）进行了比较。一项试验的数据涉及对一项更大规模的孕期4429名无症状感染女性治疗试验的事后亚组分析（n = 586），另一项是一项试点研究（n = 99）。与未治疗的女性相比，治疗组的自然早产率显著降低（荟萃分析RR = 0.36，95%CI = 0.17至0.75）。一项试验或两项试验均未报告其他结局。
该系统评价发现两项比较孕期无症状阴道念珠菌病治疗对早产结局影响的试验。尽管效应估计表明治疗无症状念珠菌病可能降低早产风险，但由于合并估计的主要驱动因素来自事后（非计划）亚组分析，结果需谨慎解读。有必要进行一项有足够效力回答“孕早期治疗无症状念珠菌病能否预防早产”这一临床问题的前瞻性试验。
PROSPERO CRD42014009241。
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