Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.
March of Dimes European Preterm Birth Research Centre, Imperial College London, London, UK; Centre for Digestive and Gut Health, Imperial College London, London, UK; School of Biosciences, Cardiff University, Cardiff, UK.
Transl Res. 2019 May;207:30-43. doi: 10.1016/j.trsl.2018.12.005. Epub 2018 Dec 27.
Vaginal bacterial community composition influences pregnancy outcome. Preterm prelabor rupture of the fetal membranes (PPROM), which precedes 30% of all spontaneous preterm births, is associated with high vaginal bacterial diversity prior to rupture. The point at which vaginal bacterial diversity is established before PPROM is unknown. In this study, we use metataxonomics to longitudinally characterize the vaginal bacterial composition from as early as 6 weeks of gestation in women at high (n = 38) and low (n = 22) risk of preterm birth who subsequently experience PPROM and in women delivering at term without complications (n = 36). Reduced Lactobacillus spp. abundance and high diversity was observed prior to PPROM in 20% and 26% of women at low and high risk of preterm births respectively, but in only 3% of women who delivered at term. PPROM was associated with instability of bacterial community structure during pregnancy and a shift toward higher diversity predominately occurring during the second trimester. This was characterized by increased relative abundance of potentially pathogenic species including Prevotella, Peptoniphilus, Streptococcus, and Dialister. This study identifies reduced Lactobacillus spp. abundance and increasing vaginal bacterial diversity as an early risk factor for PPROM and highlights the need for interventional studies designed to assess the impact of modifying vaginal bacterial composition for the prevention of preterm birth.
阴道细菌群落组成影响妊娠结局。早产胎膜早破（PPROM）是所有自发性早产的 30%的前兆，与胎膜破裂前阴道细菌多样性增加有关。PPROM 之前阴道细菌多样性建立的时间点尚不清楚。在这项研究中，我们使用分类组学技术，从妊娠 6 周开始对处于早产高风险（n=38）和低风险（n=22）的妇女的阴道细菌组成进行纵向描述，这些妇女随后经历了 PPROM，以及在无并发症的足月分娩的妇女（n=36）。在早产低风险和高风险的妇女中，分别有 20%和 26%的人在发生 PPROM 之前观察到乳酸杆菌属丰度降低和多样性增加，但在足月分娩的妇女中仅占 3%。PPROM 与妊娠期间细菌群落结构不稳定以及向更高多样性的转变有关，主要发生在孕中期。这表现为潜在致病性物种的相对丰度增加，包括普雷沃氏菌、消化链球菌属、和戴利氏菌属。本研究确定了乳酸杆菌属丰度降低和阴道细菌多样性增加是 PPROM 的早期危险因素，并强调需要进行干预性研究，以评估改变阴道细菌组成对预防早产的影响。
