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The interaction between vaginal microbiota, cervical length and vaginal progesterone treatment for preterm birth risk

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Title: The interaction between vaginal microbiota, cervical length and vaginal progesterone treatment for preterm birth risk
Authors: Kindinger, LM
Bennett, PR
Lee, YS
Marchesi, JR
Smith, A
Cacciatore, S
Holmes, E
Nicholson, JK
Teoh, TG
MacIntyre, DA
Item Type: Journal Article
Abstract: Background: Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone reduces this risk. Using 16S rRNA gene sequencing we undertook a prospective study in women at risk of preterm birth (n=161) to assess 1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth-risk, and 2) the impact of vaginal progesterone on vaginal bacterial communities in women with a short cervix. Results: Lactobacillus iners dominance at 16 weeks gestation was significantly associated with both a short cervix <25mm (n=15, P<0.05), and preterm birth <34+0 weeks (n=18, 38P<0.01; 69% PPV). In contrast, L. crispatus dominance was highly predictive of term birth (n=127, 98% PPV). Cervical shortening and preterm birth were not associated with vaginal dysbiosis. A longitudinal characterization of vaginal microbiota (<18, 22, 28 and 34 weeks) was then undertaken in women receiving vaginal progesterone (400mg/OD, n=25) versus controls (n=42). Progesterone did not alter vaginal bacterial community structure nor reduce L. iners-associated preterm birth (<34 weeks). Conclusions: L. iners dominance of the vaginal microbiota at 16 weeks gestation is a risk factor for preterm birth, whereas L. crispatus dominance is protective against preterm birth. Vaginal progesterone does not appear to impact the pregnancy vaginal microbiota. Patients and clinicians who may be concerned about ‘infection risk’ associated with use of a vaginal pessary during high-risk pregnancy can be reassured.
Issue Date: 19-Jan-2017
Date of Acceptance: 15-Dec-2016
URI: http://hdl.handle.net/10044/1/43266
DOI: https://dx.doi.org/10.1186/s40168-016-0223-9
ISSN: 2049-2618
Publisher: BioMed Central
Journal / Book Title: Microbiome
Volume: 5
Copyright Statement: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: MR/L009226/1
MR/L009226/1
RDD03 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
Microbiology
Vaginal microbiome
Progesterone
Lactobacillus
Preterm birth
Cervical length
PLACEBO-CONTROLLED TRIAL
HUMAN MYOMETRIAL CELLS
BACTERIAL VAGINOSIS
HORMONAL CONTRACEPTION
PREGNANT-WOMEN
DOUBLE-BLIND
GENITAL-TRACT
FLORA
LACTOBACILLUS
DELIVERY
Adult
Bacterial Load
Cervical Length Measurement
Cervix Uteri
Cross-Sectional Studies
Dysbiosis
Female
Humans
Microbiota
Pessaries
Pregnancy
Pregnancy Outcome
Pregnancy, High-Risk
Premature Birth
Prospective Studies
RNA, Ribosomal, 16S
Vagina
Young Adult
Publication Status: Published
Open Access location: http://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-016-0223-9
Article Number: 6
Appears in Collections:Division of Surgery
Faculty of Medicine



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