Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Kløvervænget 10, 10(th)floor, 5000, Odense C, Denmark.
Placenta. 2019 Apr;79:30-39. doi: 10.1016/j.placenta.2019.03.011. Epub 2019 Apr 8.
This systematic review aims to identify, critically appraise and summarize the results of studies examining the relationship between the vaginal microbiota and preterm birth (PTB).
We searched the electronic databases Medline, EMBASE and the Cochrane Controlled Register of Trials for studies in any language reporting on vaginal microbiota and PTB published from 1990 to November 29th, 2017. We included any study that performed lower genital tract microbiota assessment in asymptomatic pregnant women and reported on spontaneous preterm birth, with either intact or ruptured membranes.
The search strategy yielded 2171 unique citations, of which nine studies were eligible for inclusion in this review. In six studies an association was found between the composition of the vaginal microbiota and PTB, but findings differed between subgroups, ethnicities and degree of risk of PTB. In three studies no association was found. Two of these studies found a significant difference in richness and Shannon diversity between term and PTB.
We have demonstrated that there is a paucity of molecular based, culture-independent studies that analyse the relationship between the vaginal microbiota and PTB as an outcome. The heterogeneity precluded a meta-analysis. Studies provide contradictory evidence and the quality of the clinical information in the studies is poor. To improve quality of future studies we have provided a database of essential and desirable items of quality that are method and topic specific.
本系统评价旨在识别、批判性评价并总结研究阴道微生物群与早产（PTB）之间关系的结果。
我们检索了电子数据库 Medline、EMBASE 和 Cochrane 对照试验注册库，以检索 1990 年至 2017 年 11 月 29 日发表的任何语言报道阴道微生物群与 PTB 的研究。我们纳入了任何在无症状孕妇中进行下生殖道微生物群评估并报告自发性早产（无论胎膜是否完整或破裂）的研究。
搜索策略产生了 2171 条独特的引文，其中有 9 项研究符合本综述的纳入标准。在 6 项研究中，阴道微生物群的组成与 PTB 之间存在关联，但亚组、种族和 PTB 风险程度之间的研究结果存在差异。在 3 项研究中未发现关联。其中两项研究发现足月和 PTB 之间的丰富度和 Shannon 多样性存在显著差异。
我们已经证明，基于分子的、非培养依赖性研究分析阴道微生物群与 PTB 之间关系的研究很少。异质性使得无法进行荟萃分析。研究提供了相互矛盾的证据，并且研究中的临床信息质量很差。为了提高未来研究的质量，我们提供了一个数据库，其中包含特定方法和主题的必要和理想的质量项目。
