Harris Wellbeing Research Centre, Department of Women's and Children's, Health, University of Liverpool, Liverpool, UK.
Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK.
BJOG. 2021 Dec;128(13):2061-2072. doi: 10.1111/1471-0528.16816. Epub 2021 Jul 19.
To assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)/preterm prelabour rupture of membranes (PPROM).
Nested case-control study.
UK tertiary referral hospital.
High-risk women with previous sPTB/PPROM <34 weeks' gestation who had a recurrence (n = 22) or delivered at ≥37 weeks without PPROM (n = 87).
Vaginal swabs collected between 15 and 22 weeks' gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR.
Recurrent early sPTB/PPROM.
Of the 109 high-risk women, 28 had anaerobic vaginal dysbiosis, with the remainder dominated by lactobacilli (Lactobacillus iners 36/109, Lactobacillus crispatus 23/109, or other 22/109). VMB type and diversity were not associated with recurrence. Women with a recurrence, compared to those without, had a higher median vaginal bacterial load (8.64 versus 7.89 log cells/mcl, adjusted odds ratio [aOR] 1.90, 95% CI 1.01-3.56, P = 0.047) and estimated Lactobacillus concentration (8.59 versus 7.48 log cells/mcl, aOR 2.35, (95% CI 1.20-4.61, P = 0.013). A higher recurrence risk was associated with higher median bacterial loads for each VMB type after stratification, although statistical significance was reached only for L. iners domination (aOR 3.44, 95% CI 1.06-11.15, P = 0.040). Women with anaerobic dysbiosis or L. iners domination had a higher median vaginal bacterial load than women with a VMB dominated by L. crispatus or other lactobacilli (8.54, 7.96, 7.63, and 7.53 log cells/mcl, respectively).
Vaginal bacterial load is associated with early sPTB/PPROM recurrence. Domination by lactobacilli other than L. iners may protect women from developing high bacterial loads. Future PTB studies should quantify vaginal bacteria and yeasts.
Increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.
评估阴道微生物组（VMB）组成与复发性早期自发性早产（sPTB）/早产胎膜早破（PPROM）之间的关联。
嵌套病例对照研究。
英国三级转诊医院。
有既往 sPTB/PPROM<34 周早产史的高危孕妇，复发（n=22）或在无 PPROM 的情况下≥37 周分娩（n=87）。
在 15 至 22 周妊娠时采集阴道拭子，通过 16S rRNA 基因测序和 16S 定量 PCR 进行分析。
复发性早期 sPTB/PPROM。
在 109 名高危孕妇中，28 名存在厌氧菌性阴道菌群失调，其余均以乳杆菌为主（Lactobacillus iners 36/109、Lactobacillus crispatus 23/109 或其他 22/109）。VMB 类型和多样性与复发无关。与无复发者相比，复发者的阴道细菌负荷中位数更高（8.64 与 7.89 log 细胞/ml，调整后优势比[aOR]1.90，95%CI 1.01-3.56，P=0.047）和估计的乳酸杆菌浓度更高（8.59 与 7.48 log 细胞/ml，aOR 2.35，95%CI 1.20-4.61，P=0.013）。分层后，每种 VMB 类型与更高的中位细菌负荷相关联，复发风险更高，但仅在 L. iners 占优势时达到统计学意义（aOR 3.44，95%CI 1.06-11.15，P=0.040）。与乳酸杆菌占优势的阴道微环境相比，厌氧菌失调或 L. iners 占优势的女性阴道细菌负荷中位数更高（8.54、7.96、7.63 和 7.53 log 细胞/ml）。
阴道细菌负荷与早期 sPTB/PPROM 复发相关。除 L. iners 以外的乳杆菌占优势可能使女性免受高细菌负荷的影响。未来的早产研究应定量检测阴道细菌和酵母菌。
妊娠中期阴道细菌负荷增加可能与复发性早期自发性早产相关。
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