Donders Gilbert G G, Ruban Kateryna, Bellen Gert, Petricevic Ljubomir
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J Perinat Med. 2017 Jul 26;45(5):505-515. doi: 10.1515/jpm-2016-0111.
Mycoplasmata have been linked to pregnancy complications and neonatal risk. While formerly a limited number of species could be discovered by cultures, molecular biology nowadays discovers both lower quantities and more diverse species, making us realize that mycoplasmata are ubiquitous in the vaginal milieu and do not always pose a danger for pregnant women. As the meaning of mycoplasmata in pregnancy is not clear to many clinicians, we summarized the current knowledge about the meaning of different kinds of mycoplasmata in pregnancy and discuss the potential benefits and disadvantages of treatment. Currently, there is no general rule to screen and treat for mycoplasmata in pregnancy. New techniques seem to indicate that Ureaplasma parvum (Up), which now can be distinguished from U. urealyticum (Uu), may pose an increased risk for preterm birth and bronchopulmonary disease in the preterm neonate. Mycoplasma hominis (Mh) is related to early miscarriages and midtrimester abortions, especially in the presence of abnormal vaginal flora. Mycoplasma genitalium (Mg) is now recognized as a sexually transmitted infection (STI) that is involved in the causation of cervicitis, pelvic inflammatory disease (PID) in non-pregnant, and preterm birth and miscarriages in pregnant women, irrespective of the presence of concurrent other STIs, like Chlamydia or gonorrhoea. Proper studies to test for efficacy and improved pregnancy outcome are scarce and inconclusive. Azythromycin is the standard treatment now, although, for Mg, this may not be sufficient. The role of clarithromycin in clinical practice still has to be established. There is a stringent need for new studies based on molecular diagnostic techniques and randomized treatment protocols with promising and safe antimicrobials.
支原体与妊娠并发症及新生儿风险有关。以前通过培养只能发现有限数量的物种，而如今分子生物学发现了数量更少且种类更多样的物种，这使我们认识到支原体在阴道环境中普遍存在，且并非总是对孕妇构成危险。由于许多临床医生对支原体在妊娠中的意义并不清楚，我们总结了目前关于不同种类支原体在妊娠中的意义的知识，并讨论了治疗的潜在利弊。目前，对于妊娠期间支原体的筛查和治疗尚无通用规则。新技术似乎表明，现在可与解脲脲原体（Uu）区分开来的微小脲原体（Up）可能会增加早产新生儿患支气管肺疾病的风险。人型支原体（Mh）与早期流产和孕中期流产有关，尤其是在阴道菌群异常的情况下。生殖支原体（Mg）现在被认为是一种性传播感染（STI），它可导致宫颈炎、非妊娠女性的盆腔炎（PID）以及孕妇的早产和流产，无论是否同时存在其他性传播感染，如衣原体或淋病。关于检测疗效和改善妊娠结局的恰当研究很少且尚无定论。阿奇霉素是目前的标准治疗药物，不过对于Mg感染，这可能并不足够。克拉霉素在临床实践中的作用仍有待确定。迫切需要基于分子诊断技术和使用有前景且安全的抗菌药物的随机治疗方案开展新的研究。
