细菌性阴道病与低体重儿早产之间的关联。阴道感染与早产研究组。

Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group.

作者信息

Hillier S L, Nugent R P, Eschenbach D A, Krohn M A, Gibbs R S, Martin D H, Cotch M F, Edelman R, Pastorek J G, Rao A V

机构信息

University of Washington, Seattle, USA.

出版信息

N Engl J Med. 1995 Dec 28;333(26):1737-42. doi: 10.1056/NEJM199512283332604.

DOI:10.1056/NEJM199512283332604

PMID:7491137

Abstract

BACKGROUND

Bacterial vaginosis is believed to be a risk factor for preterm delivery. We undertook a study of the association between bacterial vaginosis and the preterm delivery of infants with low birth weight after accounting for other known risk factors.

METHODS

In this cohort study, we enrolled 10,397 pregnant women from seven medical centers who had no known medical risk factors for preterm delivery. At 23 to 26 weeks' gestation, bacterial vaginosis was determined to be present or absent on the basis of the vaginal pH and the results of Gram's staining. The principal outcome variable was the delivery at less than 37 weeks' gestation of an infant with a birth weight below 2500 g.

RESULTS

Bacterial vaginosis was detected in 16 percent of the 10,397 women. The women with bacterial vaginosis were more likely to be unmarried, to be black, to have low incomes, and to have previously delivered low-birth-weight infants. In a multivariate analysis, the presence of bacterial vaginosis was related to preterm delivery of a low-birth-weight infant (odds ratio, 1.4; 95 percent confidence interval, 1.1 to 1.8). Other risk factors that were significantly associated with such a delivery in this population were the previous delivery of a low-birth-weight infant (odds ratio, 6.2; 95 percent confidence interval, 4.6 to 8.4), the loss of an earlier pregnancy (odds ratio, 1.7; 1.3 to 2.2), primigravidity (odds ratio, 1.6; 1.1 to 1.9), smoking (odds ratio, 1.4; 1.1 to 1.7); and black race (odds ratio, 1.4; 1.1 to 1.7). Among women with bacterial vaginosis, the highest risk of preterm delivery of a low-birth-weight infant was found among those with both vaginal bacteroides and Mycoplasma hominis (odds ratio, 2.1; 95 percent confidence interval, 1.5 to 3.0).

CONCLUSIONS

Bacterial vaginosis was associated with the preterm delivery of low-birth-weight infants independently of other recognized risk factors.

摘要

背景

细菌性阴道病被认为是早产的一个危险因素。在考虑了其他已知危险因素后，我们对细菌性阴道病与低出生体重儿早产之间的关联进行了一项研究。

方法

在这项队列研究中，我们纳入了来自七个医疗中心的10397名无已知早产医学危险因素的孕妇。在妊娠23至26周时，根据阴道pH值和革兰氏染色结果确定是否存在细菌性阴道病。主要结局变量是妊娠不足37周分娩出生体重低于2500g的婴儿。

结果

在10397名女性中，16%检测出细菌性阴道病。患有细菌性阴道病的女性更可能未婚、为黑人、收入低且既往分娩过低出生体重儿。在多变量分析中，细菌性阴道病与低出生体重儿早产相关（比值比为1.4；95%置信区间为1.1至1.8）。在该人群中与这种分娩显著相关的其他危险因素包括既往分娩过低出生体重儿（比值比为6.2；95%置信区间为4.6至8.4）、早期妊娠丢失（比值比为1.7；1.3至2.2）、初孕（比值比为1.6；1.1至1.9）、吸烟（比值比为1.4；1.1至1.7）以及黑人种族（比值比为1.4；1.1至1.7）。在患有细菌性阴道病的女性中，同时存在阴道拟杆菌和人型支原体的女性发生低出生体重儿早产的风险最高（比值比为2.1；95%置信区间为1.5至3.0）。