Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Division of Pediatric Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Reprod Sci. 2024 Jan;31(1):275-287. doi: 10.1007/s43032-023-01351-4. Epub 2023 Sep 18.
Pregnant women in sub-Saharan Africa have high rates of maternal morbidity. There is interest in the impact of the vaginal microbiome on maternal health, including HIV and sexually transmitted infection (STI) acquisition. We characterized the vaginal microbiota of South African women ≥ 18 years with and without HIV in a longitudinal cohort over two visits during pregnancy and one visit postpartum. At each visit, we obtained HIV testing and self-collected vaginal swabs for point-of-care testing for STIs and microbiota sequencing. We categorized microbial communities and evaluated changes over pregnancy and associations with HIV status and STI diagnosis. Across 242 women (mean age 29, 44% living with HIV, 33% diagnosed with STIs), we identified four main community state types (CSTs): two lactobacillus-dominant CSTs (dominated by Lactobacillus crispatus and Lactobacillus iners respectively) and two diverse, non-lactobacillus-dominant CSTs (one dominated by Gardnerella vaginalis and one by diverse facultative anaerobes). From the first antenatal visit to the third trimester (24-36 weeks gestation), 60% of women in the Gardnerella-dominant CST shifted to lactobacillus-dominant CSTs. From the third trimester to postpartum (mean 17 days post-delivery), 80% of women in lactobacillus-dominant CSTs shifted to non-lactobacillus-dominant CSTs with a large proportion in the facultative anaerobe-dominant CST. Microbial composition differed by STI diagnosis (PERMANOVA R = 0.002, p = 0.004), and women diagnosed with an STI were more likely to be categorized as L. iners-dominant or Gardnerella-dominant CSTs. Overall, we found a shift toward lactobacillus dominance during pregnancy and the emergence of a distinct, highly diverse anaerobe-dominant microbiota profile in the postpartum period.
撒哈拉以南非洲的孕妇患有高比例的产妇发病率。人们对阴道微生物组对产妇健康的影响（包括 HIV 和性传播感染（STI）的获得）很感兴趣。我们对南非 18 岁以上的 HIV 阳性和阴性女性进行了纵向队列研究，在两次怀孕期间和一次产后期间进行了研究。每次就诊时，我们进行了 HIV 检测，并自行采集阴道拭子进行即时检测 STI 和微生物组测序。我们对微生物群落进行了分类，并评估了它们在怀孕期间的变化以及与 HIV 状态和 STI 诊断的关系。在 242 名女性（平均年龄 29 岁，44%携带 HIV，33%诊断为 STI）中，我们确定了四种主要的群落状态类型（CST）：两种乳杆菌主导的 CST（分别由 Lactobacillus crispatus 和 Lactobacillus iners 主导）和两种多样化的非乳杆菌主导的 CST（一种由 Gardnerella vaginalis 主导，另一种由多样化的兼性厌氧菌主导）。从第一次产前就诊到第三个孕期（24-36 周妊娠），60%的阴道加德纳菌主导的 CST 女性转变为乳杆菌主导的 CST。从第三个孕期到产后（平均产后 17 天），80%的乳杆菌主导的 CST 女性转变为非乳杆菌主导的 CST，其中很大一部分为兼性厌氧菌主导的 CST。微生物组成因 STI 诊断而异（PERMANOVA R = 0.002，p = 0.004），被诊断为 STI 的女性更有可能被归类为 L. iners 主导或阴道加德纳菌主导的 CST。总体而言，我们发现怀孕期间乳杆菌主导地位的转变以及产后时期出现的一种独特的、高度多样化的厌氧菌主导的微生物组特征。
