Department of Obstetrics and Gynecology, Division of Basic Science and Translational Research, University of Texas Medical Branch, Galveston, Texas, USA.
Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas, USA.
Am J Reprod Immunol. 2024 Oct;92(4):e70003. doi: 10.1111/aji.70003.
Limited studies have investigated the role of the microbiota in hypertensive disorders of pregnancy (HDP), particularly preeclampsia, which often results in preterm birth. We evaluated 23 studies that explored the relationship between gut, vaginal, oral, or placental microbiotas and HDP. Scopus, ProQuest Health Research Premium Collection, ProQuest Nursing & Allied Health Database, EBSCO, and Ovid were searched for relevant literature. Majority (18) of studies focused on the gut microbiota, and far fewer examined the oral cavity (3), vagina (3), and placenta (1). One study examined the gut, oral, and vaginal microbiotas. The consensus highlights a potential role for microbiota dysbiosis in preeclampsia and HDP. Especially in the third trimester, preeclampsia is associated with gut dysbiosis-deficient in beneficial species of Akkermansia, Bifidobacterium, and Coprococcus but enriched with pathogenic Campylobacterota and Candidatus Saccharibacteria, with low community α-diversity. Similarly, the preeclamptic vaginal and oral microbiotas are enriched with bacterial vaginosis and periodontal disease-associated species, respectively. The trend is also observed in the placenta, which is colonized by gastrointestinal, respiratory tract, and periodontitis-related pathogens. Consequently, a chronic proinflammatory state that adversely impacts placentation is implicated. These observations however require more mechanistic studies to establish the timing of the preceding immune dysfunction and any causality.
有限的研究调查了微生物群在妊娠高血压疾病（HDP）中的作用，特别是经常导致早产的子痫前期。我们评估了 23 项研究，这些研究探讨了肠道、阴道、口腔或胎盘微生物群与 HDP 之间的关系。我们在 Scopus、ProQuest Health Research Premium Collection、ProQuest Nursing & Allied Health Database、EBSCO 和 Ovid 中搜索了相关文献。大多数（18 项）研究集中在肠道微生物群上，而很少有研究检查口腔（3 项）、阴道（3 项）和胎盘（1 项）。一项研究检查了肠道、口腔和阴道微生物群。共识强调了微生物群失调在子痫前期和 HDP 中的潜在作用。特别是在孕晚期，与肠道微生物群失调有关，有益的阿克曼菌、双歧杆菌和考拉属的物种减少，而致病性弯曲杆菌和拟杆菌的物种增加，群落 α-多样性降低。同样，子痫前期的阴道和口腔微生物群分别富含细菌性阴道病和牙周病相关的物种。这种趋势也在胎盘中观察到，胎盘定植了胃肠道、呼吸道和牙周炎相关的病原体。因此，存在一种慢性促炎状态，对胎盘形成产生不利影响。然而，这些观察结果需要更多的机制研究来确定先前免疫功能障碍的时间以及任何因果关系。
