Jiang Xiang, Bao Yirong, Li Xiang, Qu Xiaoxian, Mao Xiaoyunan, Dong Jiaqi, Wang Luyao, Liu Xiaohua, Zhang Feng, Ying Hao
Shanghai Key Laboratory of Maternal-Foetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 2699, Gaoke Road, Shanghai, 200092, China.
Nutritional Department, Affiliated Hospital of Jiangnan University, No. 1800, Lihu Avenue, Wuxi, 214122, Jiangsu, China.
J Transl Med. 2025 May 14;23(1):541. doi: 10.1186/s12967-025-06460-z.
Failure to understand the causes of recurrent spontaneous preterm birth (sPTB) has limited effective interventions. This study aimed to examine the relationship between the vaginal microbiota and the risk of sPTB recurrence.
A prospective cohort study was conducted involving 152 pregnant women at a high risk of sPTB recurrence due to a history of sPTB between 16 and 27 weeks of gestation. Vaginal swabs were collected sequentially during early pregnancy (before 16 weeks) and late pregnancy (16-24 weeks) for 16 S ribosomal RNA (16 S rRNA) sequencing. The vaginal microbiota was subsequently compared between the recurrence and non-recurrence groups and the results analysed longitudinally.
Fifty-three (34.9%) participants experienced recurrent sPTB. Using random forest classification models and the linear discriminant analysis effect size method, Lactobacillus iners (L. iners) and Lactobacillus crispatus (L. crispatus) were identified as featured species that distinguished the recurrent group from the non-recurrent group. Following the hierarchical clustering of the vaginal microbiota into six community state types (CSTs), in the recurrent group, CST III (dominated by L. iners) was more prevalent in early pregnancy, whereas in late pregnancy, CST IVA and CST IVB (dominated by nonlactobacilli) were more prevalent. In contrast, CST IA (dominated by L. crispatus) was more prevalent in the non-recurrent group. The six CSTs was simplified into three vaginal community types, L. iners dominant type exhibited decreased instability and a greater likelihood of transitioning to the non-lactobacillus dominant type compared with other (non-iners) Lactobacilli dominant types.
L. iners dominance in the vaginal microbiota before 16 weeks of gestation is associated with an increased risk of recurrent sPTB, partly because of its propensity to transition to an unfavorable non-Lactobacillus-dominant state. This finding highlights the potential role of vaginal microbiota as an intervention target for reducing the risk of recurrent sPTB in early pregnancy.
由于未能了解复发性自发性早产（sPTB）的病因，有效的干预措施受到限制。本研究旨在探讨阴道微生物群与sPTB复发风险之间的关系。
进行了一项前瞻性队列研究，纳入了152名因妊娠16至27周有sPTB病史而有sPTB复发高风险的孕妇。在孕早期（16周前）和孕晚期（16 - 24周）依次采集阴道拭子进行16S核糖体RNA（16S rRNA）测序。随后比较复发组和非复发组的阴道微生物群，并对结果进行纵向分析。
53名（34.9%）参与者经历了复发性sPTB。使用随机森林分类模型和线性判别分析效应大小方法，惰性乳杆菌（L. iners）和卷曲乳杆菌（L. crispatus）被确定为区分复发组和非复发组的特征菌种。将阴道微生物群分层聚类为六种群落状态类型（CSTs）后，在复发组中，CST III（以L. iners为主）在孕早期更为普遍，而在孕晚期，CST IVA和CST IVB（以非乳酸杆菌为主）更为普遍。相比之下，CST IA（以L. crispatus为主）在非复发组中更为普遍。将六种CSTs简化为三种阴道群落类型，与其他（非惰性）乳酸杆菌主导类型相比，L. iners主导类型表现出较低的不稳定性和向非乳酸杆菌主导类型转变的更大可能性。
妊娠16周前阴道微生物群中L. iners占优势与复发性sPTB风险增加有关，部分原因是其倾向于转变为不利的非乳酸杆菌主导状态。这一发现突出了阴道微生物群作为降低孕早期复发性sPTB风险干预靶点的潜在作用。
