open access
The association between imbalances in vaginal microflora and duration of pregnancy as well as selected maternal and neonatal parameters
, 2, 2, 3, 4, 3, 1
Affiliations- Department of Surgical and Oncologic Gynecology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Poland
- Student’s Scientific Society, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Poland
- Department of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Poland
- 2nd Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, Warsaw, Poland
open access
Abstract
Objectives: Abnormal vaginal flora (AVF) is a result of excessive growth of some aerobic bacteria and fungi in relation to the scarce presence of Lactobacillus spp. It has been suggested that AVF is responsible for preterm birth and such neonatal conditions as infections or sepsis.
The aim of the study was to assess the influence of excessive vaginal colonization with aerobic bacteria and fungi on the selected postnatal parameters of newborns, duration of pregnancy and length of hospitalisation of neonates.
Material and methods: Retrospective data of all 1057 patients who delivered between 01.2019 and 06.2019 in the Department of Perinatology of Medical University of Lodz was analyzed. Eight hundred nine patients were included in this retrospective study. The study group consisted of 396 patients with abundant growth of aerobic bacteria and fungi obtained between 26 and 42 weeks of gestation, while 413 patients with physiologic vaginal biocenosis constituted the control group. Two hundred forty-eight patients (23.46%) were excluded from the study due to incomplete data.
Results: Patients with abnormal vaginal flora (AVF) gave birth prematurely (9.09%) more often than patients with balanced microflora (5.31%), p = 0.038. Newborns of mothers with AVF obtained an Apgar score under four more frequently (1.21% vs 0%; p = 0.024). Eutrophic neonates were born less frequently in the study group (82.08% vs 88.65%; p = 0.025). Hospitalisation period was longer for children of mothers with AVF (mean of 6.30 ± 9.87 days) than those of mothers from the control group (mean of 5.06 ± 5.30), p = 0.025. Newborns of mothers with AVF developed perinatal infections more often (23.97% vs 15.94%; p = 0.004). Four infants died in the study group whereas no deaths were recorded in the control group (p = 0.045). The most prevalent pathogens were: Streptococcus agalactiae (GBS) 57.32%, Candida spp. 39.64%, Klebsiella spp. 9.85%, Staphylococcus aureus 7.32%. Signs of infection were more frequently recorded in newborns of mothers infected with Klebsiella spp. (35.90% vs 19.16%; p = 0.011). Premature birth was more prevalent in GBS carriers (11.81% vs 6.28%; p = 0.022).
Conclusions: Abundant growth of aerobic bacteria in the 3rd trimester of gestation contributes to preterm birth, causes the development of infection signs in newborns, increases their mortality rate and prolongs hospitalisation period.
Abstract
Objectives: Abnormal vaginal flora (AVF) is a result of excessive growth of some aerobic bacteria and fungi in relation to the scarce presence of Lactobacillus spp. It has been suggested that AVF is responsible for preterm birth and such neonatal conditions as infections or sepsis.
The aim of the study was to assess the influence of excessive vaginal colonization with aerobic bacteria and fungi on the selected postnatal parameters of newborns, duration of pregnancy and length of hospitalisation of neonates.
Material and methods: Retrospective data of all 1057 patients who delivered between 01.2019 and 06.2019 in the Department of Perinatology of Medical University of Lodz was analyzed. Eight hundred nine patients were included in this retrospective study. The study group consisted of 396 patients with abundant growth of aerobic bacteria and fungi obtained between 26 and 42 weeks of gestation, while 413 patients with physiologic vaginal biocenosis constituted the control group. Two hundred forty-eight patients (23.46%) were excluded from the study due to incomplete data.
Results: Patients with abnormal vaginal flora (AVF) gave birth prematurely (9.09%) more often than patients with balanced microflora (5.31%), p = 0.038. Newborns of mothers with AVF obtained an Apgar score under four more frequently (1.21% vs 0%; p = 0.024). Eutrophic neonates were born less frequently in the study group (82.08% vs 88.65%; p = 0.025). Hospitalisation period was longer for children of mothers with AVF (mean of 6.30 ± 9.87 days) than those of mothers from the control group (mean of 5.06 ± 5.30), p = 0.025. Newborns of mothers with AVF developed perinatal infections more often (23.97% vs 15.94%; p = 0.004). Four infants died in the study group whereas no deaths were recorded in the control group (p = 0.045). The most prevalent pathogens were: Streptococcus agalactiae (GBS) 57.32%, Candida spp. 39.64%, Klebsiella spp. 9.85%, Staphylococcus aureus 7.32%. Signs of infection were more frequently recorded in newborns of mothers infected with Klebsiella spp. (35.90% vs 19.16%; p = 0.011). Premature birth was more prevalent in GBS carriers (11.81% vs 6.28%; p = 0.022).
Conclusions: Abundant growth of aerobic bacteria in the 3rd trimester of gestation contributes to preterm birth, causes the development of infection signs in newborns, increases their mortality rate and prolongs hospitalisation period.
Keywords
vaginal microflora; aerobic vaginitis; PROM
About this articleTitle
The association between imbalances in vaginal microflora and duration of pregnancy as well as selected maternal and neonatal parameters
Journal
Issue
Article type
Research paper
Pages
624-630
Published online
2021-04-08
Page views
1549
Article views/downloads
1034
DOI
Pubmed
Bibliographic record
Ginekol Pol 2021;92(9):624-630.
Keywords
vaginal microflora
aerobic vaginitis
PROM
Authors
Maria Szubert
Monika Weteska
Joanna Zgliczynska
Olga Olszak
Magdalena Zgliczynska
Jaroslaw Kalinka
Jacek R. Wilczynski
References (35)- Amabebe E, Anumba DOC. The Vaginal Microenvironment: The Physiologic Role of . Front Med (Lausanne). 2018; 5: 181.
- Kaambo E, Africa C, Chambuso R, et al. Vaginal Microbiomes Associated With Aerobic Vaginitis and Bacterial Vaginosis. Front Public Health. 2018; 6: 78.
- Larsen B, Monif GR. Understanding the bacterial flora of the female genital tract. Clin Infect Dis. 2001; 32(4): e69–e77.
- Turnbaugh PJ, Ley RE, Hamady M, et al. The human microbiome project. Nature. 2007; 449(7164): 804–810.
- Romero R, Hassan SS, Gajer P, et al. The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women. Microbiome. 2014; 2(1): 4.
- MacIntyre DA, Chandiramani M, Lee YS, et al. The vaginal microbiome during pregnancy and the postpartum period in a European population. Sci Rep. 2015; 5: 8988.
- DiGiulio DB, Callahan BJ, McMurdie PJ, et al. Temporal and spatial variation of the human microbiota during pregnancy. Proc Natl Acad Sci U S A. 2015; 112(35): 11060–11065.
- Turovskiy Y, Sutyak Noll K, Chikindas ML. The aetiology of bacterial vaginosis. J Appl Microbiol. 2011; 110(5): 1105–1128.
- Reiter S, Kellogg Spadt S. Bacterial vaginosis: a primer for clinicians. Postgrad Med. 2019; 131(1): 8–18.
- Klebanoff MA, Hillier SL, Nugent RP, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Is bacterial vaginosis a stronger risk factor for preterm birth when it is diagnosed earlier in gestation? Am J Obstet Gynecol. 2005; 192(2): 470–477.
- Bretelle F, Rozenberg P, Pascal A, et al. Groupe de Recherche en Obstetrique Gynecologie. High Atopobium vaginae and Gardnerella vaginalis vaginal loads are associated with preterm birth. Clin Infect Dis. 2015; 60(6): 860–867.
- Donders G. Definition and classification of abnormal vaginal flora. Best Pract Res Clin Obstet Gynaecol. 2007; 21(3): 355–373.
- Donders GGG, Vereecken A, Bosmans E, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG. 2002; 109(1): 34–43.
- Han C, Li H, Han L, et al. Aerobic vaginitis in late pregnancy and outcomes of pregnancy. Eur J Clin Microbiol Infect Dis. 2019; 38(2): 233–239.
- Donders G, Bellen G, Rezeberga D. Aerobic vaginitis in pregnancy. BJOG. 2011; 118(10): 1163–1170.
- Vieira-Baptista P, Lima-Silva J, Pinto C, et al. Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities. Eur J Clin Microbiol Infect Dis. 2016; 35(4): 657–664.
- Oeser C, Pond M, Butcher P, et al. PCR for the detection of pathogens in neonatal early onset sepsis. PLoS One. 2020; 15(1): e0226817.
- Hasperhoven GF, Al-Nasiry S, Bekker V, et al. Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis. BJOG. 2020; 127(6): 680–691.
- Sobel J. Vulvovaginal candidosis. The Lancet. 2007; 369(9577): 1961–1971.
- Roberts CL, Algert CS, Rickard KL, et al. Treatment of vaginal candidiasis for the prevention of preterm birth: a systematic review and meta-analysis. Syst Rev. 2015; 4: 31.
- Farr A, Kiss H, Holzer I, et al. Effect of asymptomatic vaginal colonization with Candida albicans on pregnancy outcome. Acta Obstet Gynecol Scand. 2015; 94(9): 989–996.
- Chan GJ, Lee ACC, Baqui AH, et al. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med. 2013; 10(8): e1001502.
- Liu J, Shi Y, Dong Jy, et al. Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates. Chin Med J (Engl). 2010; 123(19): 2640–2644.
- Sochocka L, Kędra E, Bensz D. Planowanie opieki pielęgniarskiej nad urodzonym przedwcześnie noworodkiem z zaburzeniami oddychania, wentylowanym mechanicznie. Studium przypadku. Pielęgniarstwo Polskie. 2017; 64(2): 338–345.
- Hassan MF, Rund NMA, El-Tohamy O, et al. Does Aerobic Vaginitis Have Adverse Pregnancy Outcomes? Prospective Observational Study. Infect Dis Obstet Gynecol. 2020; 2020: 5842150.
- Bianchi-Jassir F, Seale AC, Kohli-Lynch M, et al. Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis. 2017; 65(suppl_2): S133–S142.
- Oh KY, Jin CH, Sohn YH, et al. The prevalence of abnormal vaginal flora and predictive factors for intrauterine infection in pregnant Korean women with preterm labor. Clin Exp Obstet Gynecol. 2017; 44(3): 429–433.
- Omwandho COA, Gruessner SEM, Tinneberg HR. Early pregnancy loss and neonatal deaths associated with Klebsiella pneumonia infection: a mini review of possible occupational health risk. Arch Gynecol Obstet. 2006; 273(5): 258–260.
- Di Renzo GC, Melin P, Berardi A, et al. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med. 2015; 28(7): 766–782.
- Cisse CT, Mbengue-Diop R, Moubarek M, et al. [Neonatal bacterial infections at the CUH of Dakar]. Gynecol Obstet Fertil. 2001; 29(6): 433–439.
- Ogata JF, Fonseca MC, Miyoshi MH, et al. Costs of hospitalization in preterm infants: impact of antenatal steroid therapy. J Pediatr (Rio J). 2016; 92(1): 24–31.
- Geng Nv, Wu W, Fan A, et al. Analysis of the Risk Factors for Aerobic Vaginitis: A Case-Control Study. Gynecol Obstet Invest. 2015 [Epub ahead of print].
- Heather L, et al. Paladine, Vaginitis: Diagnosis and Treatment. Am Fam Physician. 2018; 97(5): 321–329.
- Roberts CL, Algert CS, Rickard KL, et al. Treatment of vaginal candidiasis for the prevention of preterm birth: a systematic review and meta-analysis. Syst Rev. 2015; 4: 31.
- Maki Y, Fujisaki M, Sato Y, et al. Candida Chorioamnionitis Leads to Preterm Birth and Adverse Fetal-Neonatal Outcome. Infectious Diseases in Obstetrics and Gynecology. 2017; 2017: 1–11.
