Turner Abigail N, Carr Reese Patricia, Chen Pai Lien, Kwok Cynthia, Jackson Rebecca D, Klebanoff Mark A, Fichorova Raina N, Chipato Tsungai, Morrison Charles S
Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, OH.
School of Medicine and Health Sciences, George Washington University, Washington, DC.
Am J Obstet Gynecol. 2016 Sep;215(3):332.e1-332.e10. doi: 10.1016/j.ajog.2016.02.045. Epub 2016 Mar 2.
Bacterial vaginosis, a highly prevalent vaginal condition, is correlated with many adverse reproductive outcomes. In some studies, low vitamin D status (measured as serum 25-hydroxyvitamin D, 25[OH]D) has been associated with increased prevalence of bacterial vaginosis.
We examined the cross-sectional association between vitamin D status and prevalence of bacterial vaginosis, separately for pregnant and nonpregnant women. Using prospectively collected data, we also characterized the effect of time-varying vitamin D status on incident bacterial vaginosis.
We quantified 25(OH)D in stored sera collected quarterly from 571 Zimbabwean women participating in the Hormonal Contraception and Risk of HIV Acquisition Study. The analysis was restricted to women not using hormonal contraception. We characterized associations between vitamin D insufficiency (defined as 25[OH]D ≤ 30 ng/mL vs > 30 ng/mL) and prevalence of bacterial vaginosis among nonpregnant women at the enrollment visit and among pregnant women at the first follow-up visit that pregnancy was detected. Among women who were negative for bacterial vaginosis at enrollment (n = 380), we also assessed the effect of time-varying vitamin D status on incident bacterial vaginosis. We used the Liaison 25(OH)D total assay to measure 25(OH)D. Bacterial vaginosis was diagnosed via Nugent score.
At enrollment, the prevalence of bacterial vaginosis was 31% and overall median 25(OH)D was 29.80 ng/mL (interquartile range, 24.70-34.30 ng/mL): 29.75 ng/mL (interquartile range, 25.15-33.95 ng/mL) among women with bacterial vaginosis, and 29.90 ng/mL (interquartile range, 24.70-34.50 ng/mL) among women without bacterial vaginosis. Among pregnant women, the prevalence of bacterial vaginosis was 27% and overall median 25(OH)D was 29.90 ng/mL (interquartile range, 24.10-34.00 ng/mL): 30.80 ng/mL (interquartile range, 26.10-36.90 ng/mL) among women with bacterial vaginosis, and 29.10 ng/mL (interquartile range, 23.80-33.45 ng/mL) among women without bacterial vaginosis. Vitamin D levels ≤ 30 ng/mL were not associated with a prevalence of bacterial vaginosis in nonpregnant women (adjusted prevalence ratio, 1.04; 95% confidence interval, 0.81-1.34) or pregnant women (adjusted prevalence ratio, 0.88, 95% confidence interval, 0.51-1.54). Vitamin D levels ≤ 30 ng/mL were similarly not associated with incident bacterial vaginosis (adjusted hazard ratio, 0.98, 95% confidence interval, 0.73-1.31). Our findings were robust to alternative specifications of vitamin D status including using a cut point for vitamin D deficiency of < 20 ng/mL vs ≥ 20 ng/mL and modeling 25(OH)D as a continuous variable.
Among reproductive-age Zimbabwean women, insufficient vitamin D was not associated with increased bacterial vaginosis prevalence or incidence. Given established associations between bacterial vaginosis and poor reproductive outcomes, identification of factors leading to high bacterial vaginosis prevalence is urgently needed.
细菌性阴道病是一种非常普遍的阴道疾病，与许多不良生殖结局相关。在一些研究中，维生素D水平低（以血清25-羟基维生素D，即25[OH]D衡量）与细菌性阴道病患病率增加有关。
我们分别研究了孕妇和非孕妇中维生素D水平与细菌性阴道病患病率之间的横断面关联。利用前瞻性收集的数据，我们还描述了随时间变化的维生素D水平对细菌性阴道病发病的影响。
我们对参与激素避孕与感染HIV风险研究的571名津巴布韦女性每季度采集的储存血清中的25(OH)D进行了定量分析。分析仅限于未使用激素避孕的女性。我们描述了维生素D不足（定义为25[OH]D≤30 ng/mL与>30 ng/mL）与入组时非孕妇以及首次随访检测到怀孕时孕妇细菌性阴道病患病率之间的关联。在入组时细菌性阴道病检测为阴性的女性（n = 380）中，我们还评估了随时间变化的维生素D水平对细菌性阴道病发病的影响。我们使用Liaison 25(OH)D总检测法测量25(OH)D。通过Nugent评分诊断细菌性阴道病。
入组时，细菌性阴道病患病率为31%，总体25(OH)D中位数为29.80 ng/mL（四分位间距，24.70 - 34.30 ng/mL）：细菌性阴道病女性中为29.75 ng/mL（四分位间距，25.15 - 33.95 ng/mL），无细菌性阴道病女性中为29.90 ng/mL（四分位间距，24.70 - 34.50 ng/mL）。在孕妇中，细菌性阴道病患病率为27%，总体25(OH)D中位数为29.90 ng/mL（四分位间距，24.10 - 34.00 ng/mL）：细菌性阴道病女性中为30.80 ng/mL（四分位间距，26.10 - 36.90 ng/mL），无细菌性阴道病女性中为29.10 ng/mL（四分位间距，23.80 - 33.45 ng/mL）。维生素D水平≤30 ng/mL与非孕妇（校正患病率比，1.04；95%置信区间，0.81 - 1.34）或孕妇（校正患病率比，0.88，95%置信区间，0.51 - 1.54）的细菌性阴道病患病率无关。维生素D水平≤30 ng/mL与细菌性阴道病发病同样无关（校正风险比，0.98，95%置信区间，0.73 - 1.31）。我们的研究结果对于维生素D状态的其他设定是稳健的，包括使用维生素D缺乏的切点<20 ng/mL与≥20 ng/mL以及将25(OH)D作为连续变量进行建模。
在育龄津巴布韦女性中，维生素D不足与细菌性阴道病患病率或发病率增加无关。鉴于细菌性阴道病与不良生殖结局之间已确立的关联，迫切需要确定导致细菌性阴道病高患病率的因素。
