Wu Jianru, Zhu Xiaoqi, Tang Biyu, Wu Jingying, Wei Fenfang, Wang Xinru, Li Limin, Li Hongqiao, Zhang Yi, Wang Bei, Wu Wenyu, Hong Xiang
Shenzhen Institute of Pharmacovigilance and Risk Management Guangdong China.
Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009 China.
Eur J Obstet Gynecol Reprod Biol. 2025 Apr;307:175-183. doi: 10.1016/j.ejogrb.2025.02.008. Epub 2025 Feb 7.
Bacterial vaginosis (BV) can lead to adverse pregnancy outcomes such as preterm delivery. However, it is unclear whether BV treatment during pregnancy can reduce the incidence of adverse maternal-fetal outcomes.
We performed a meticulous literature search across various databases, including PubMed, EMBASE, Web of Science, and the Cochrane Database. Utilizing meta-analysis, we delved into the relationship between diverse drug treatments, encompassing probiotics, antibiotics, and combination therapy, and their potential impact on adverse pregnancy outcomes. We also used network meta-analysis to explore the effects of different medications on the primary outcome of preterm delivery and ranked the intervention effects using P-scores.
Twenty-four eligible randomized controlled trials (RCTs) were included. Regardless of the type of treatment administered, the meta-analysis demonstrated that there was no decrease in the occurrence of preterm delivery following BV treatment during pregnancy (RR = 1.00, 95 % CI = 0.80-1.24, P = 0.96). But among the UK population, it was found that BV treatment during pregnancy was significantly associated with a reduced risk of preterm delivery (RR = 0.47, 95 % CI = 0.30-0.73, P < 0.001). Through network meta-analysis, oral probiotics obtained the highest P-scores (P-score = 0.86), but with a low quality evidence. This was followed by vaginal clindamycin plus clotrimazole (P-score = 0.78), and oral clindamycin (P-score = 0.58). Furthermore, it has not been discovered that BV treatment during pregnancy can decrease the likelihood of various other adverse outcomes, such as puerperal infections, miscarriages, premature rupture of membranes, low birth weight, and neonatal intensive care unit (NICU) admission rates.
The current evidence fails to endorse the treatment of BV during pregnancy as a means to mitigate the risk of preterm delivery. Although probiotic therapies exhibit promising potential, the available data remains inadequate. Future research is necessary to further establish the safety and effectiveness of antibiotics and probiotics in the prevention or management of BV during pregnancy.
细菌性阴道病（BV）可导致不良妊娠结局，如早产。然而，孕期治疗BV是否能降低母婴不良结局的发生率尚不清楚。
我们在包括PubMed、EMBASE、Web of Science和Cochrane数据库在内的多个数据库中进行了细致的文献检索。利用荟萃分析，我们深入研究了包括益生菌、抗生素和联合治疗在内的不同药物治疗与它们对不良妊娠结局的潜在影响之间的关系。我们还使用网络荟萃分析来探讨不同药物对早产这一主要结局的影响，并使用P值对干预效果进行排名。
纳入了24项符合条件的随机对照试验（RCT）。无论采用何种治疗方式，荟萃分析表明，孕期治疗BV后早产的发生率并未降低（RR = 1.00，95% CI = 0.80 - 1.24，P = 0.96）。但在英国人群中，发现孕期治疗BV与早产风险降低显著相关（RR = 0.47，95% CI = 0.30 - 0.73，P < 0.001）。通过网络荟萃分析，口服益生菌获得了最高的P值（P值 = 0.86），但证据质量较低。其次是阴道用克林霉素加克霉唑（P值 = 0.78）和口服克林霉素（P值 = 0.58）。此外，尚未发现孕期治疗BV能降低其他各种不良结局的可能性，如产褥感染、流产、胎膜早破、低出生体重以及新生儿重症监护病房（NICU）入住率。
目前的证据不支持孕期治疗BV作为降低早产风险的手段。尽管益生菌疗法显示出有前景的潜力，但现有数据仍然不足。未来有必要进一步研究抗生素和益生菌在孕期预防或治疗BV中的安全性和有效性。
