Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2023 | Premature Birth | Research

Vaginal flora during pregnancy and subsequent risk of preterm birth or prelabor rupture of membranes: a nested case–control study from China

Authors: Xiaomei Liu, Shuting Si, Li Huang, Meiliang Zhang, Wenya Chen, Liquan Wang, Yunxian Yu

Published in: BMC Pregnancy and Childbirth | Issue 1/2023

Abstract

Background

The findings of the association of vaginal flora with preterm birth (PTB) or prelabor rupture of membranes (PROM) were conflicts. Moreover, vaginal flora was different by ethnicity and the evidence from China was limited.

Methods

This study was a nested case control study, based on Yiwu birth cohort. We assessed vaginal microbiota in the second or third trimester, using 16S rDNA Amplicon Sequencing and explored the association between the diversity and composition of vaginal flora and PTB or PROM.

Results

We finally included 144 pregnant women. In present study, the alpha diversity of TPROM (Term prelabor rupture of membranes) samples was lower than that of full term samples (Chao1 index: P < 0.05). When we further categorized PTB (Preterm birth) into SPB (PTB without PROM) and PPROM (Preterm prelabor rupture of membranes), there was no difference between SPB and full term. In addition, we found that the proportion of PCoA2 in TPROM group was different from that in full term group and preterm group. The difference between groups was significant according to anosim analysis (R = 0.059, P < 0.001). With LEfSe (Linear discriminant analysis Effect Size) analysis, we found that the abundance of Lactobacillus in the vaginal flora of pregnant women with preterm birth was the highest (P = 0.003).

Conclusion

In Chinese pregnant women, the alpha diversity in TPROM group was significantly lower than that in both PTB and full term group. However, there was no difference between PTB and full term. Lactobacillus was the most abundant in preterm birth group. More studies should be conducted to confirm our findings.

Available only for authorised users

Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(1):e37–46. https://doi.org/10.1016/S2214-109X(18)30451-0.CrossRefPubMed

Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015;385(9966):430–40. https://doi.org/10.1016/S0140-6736(14)61698-6.CrossRefPubMed

Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261–9. https://doi.org/10.1016/S0140-6736(08)60136-1.CrossRefPubMed

Lawn JE, Cousens S. Zupan J and Lancet Neonatal Survival Steering T, 4 million neonatal deaths: when? Where? Why?. Lancet. 2005;365(9462):891–900. https://doi.org/10.1016/S0140-6736(05)71048-5.CrossRefPubMed

Prelabor Rupture of Membranes. ACOG Practice Bulletin, Number 217. Obstet Gynecol. 2020;135(3):e80–97. https://doi.org/10.1097/AOG.0000000000003700.CrossRef

Wang K, Tian Y, Zheng H, Shan S, Zhao X, Liu C. Maternal exposure to ambient fine particulate matter and risk of premature rupture of membranes in Wuhan, Central China: a cohort study. Environ Health. 2019;18(1):96. https://doi.org/10.1186/s12940-019-0534-y.CrossRefPubMedPubMedCentral

Huang S, Xia W, Sheng X, Qiu L, Zhang B, Chen T, et al. Maternal lead exposure and premature rupture of membranes: a birth cohort study in China. BMJ Open. 2018;8(7):e021565. https://doi.org/10.1136/bmjopen-2018-021565.CrossRefPubMedPubMedCentral

Liu J, Feng ZC, Wu J. The incidence rate of premature rupture of membranes and its influence on fetal-neonatal health: a report from mainland China. J Trop Pediatr. 2010;56(1):36–42. https://doi.org/10.1093/tropej/fmp051.CrossRefPubMed

Clark EA, Varner M. Impact of preterm PROM and its complications on long-term infant outcomes. Clin Obstet Gynecol. 2011;54(2):358–69. https://doi.org/10.1097/GRF.0b013e318217ee18.CrossRefPubMed

10.

Mark SP, Croughan-Minihane MS, Kilpatrick SJ. Chorioamnionitis and uterine function. Obstet Gynecol. 2000;95(6 Pt 1):909–12. https://doi.org/10.1016/s0029-7844(00)00816-4.CrossRefPubMed

11.

Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev. 2017;1:CD005302. https://doi.org/10.1002/14651858.CD005302.pub3.CrossRefPubMed

12.

Donati L, Di Vico A, Nucci M, Quagliozzi L, Spagnuolo T, Labianca A, et al. Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet. 2010;281(4):589–600. https://doi.org/10.1007/s00404-009-1318-3.CrossRefPubMed

13.

Tabatabaei N, Eren AM, Barreiro LB, Yotova V, Dumaine A, Allard C, et al. Vaginal microbiome in early pregnancy and subsequent risk of spontaneous preterm birth: a case-control study. BJOG. 2019;126(3):349–58. https://doi.org/10.1111/1471-0528.15299.CrossRefPubMed

14.

Tano S, Ueno T, Mayama M, Yamada T, Takeda T, Uno K, et al. Relationship between vaginal group B streptococcus colonization in the early stage of pregnancy and preterm birth: a retrospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):141. https://doi.org/10.1186/s12884-021-03624-9.CrossRefPubMedPubMedCentral

15.

Freitas AC, Bocking A, Hill JE, Money DM, Group VR. Increased richness and diversity of the vaginal microbiota and spontaneous preterm birth. Microbiome. 2018;6(1):117. https://doi.org/10.1186/s40168-018-0502-8.CrossRefPubMedPubMedCentral

16.

Goodfellow L, Verwijs MC, Care A, Sharp A, Ivandic J, Poljak B, et al. Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case-control study. BJOG. 2021. https://doi.org/10.1111/1471-0528.16816.CrossRefPubMed

17.

Newton ER, Piper J, Peairs W. Bacterial vaginosis and intraamniotic infection. Am J Obstet Gynecol. 1997;176(3):672–7. https://doi.org/10.1016/s0002-9378(97)70568-4.CrossRefPubMed

18.

Brown RG, Marchesi JR, Lee YS, Smith A, Lehne B, Kindinger LM, et al. Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin. BMC Med. 2018;16(1):9. https://doi.org/10.1186/s12916-017-0999-x.CrossRefPubMedPubMedCentral

19.

Romero R, Hassan SS, Gajer P, Tarca AL, Fadrosh DW, Bieda J, et al. The vaginal microbiota of pregnant women who subsequently have spontaneous preterm labor and delivery and those with a normal delivery at term. Microbiome. 2014;2:18. https://doi.org/10.1186/2049-2618-2-18.CrossRefPubMedPubMedCentral

20.

You YA, Kwon EJ, Choi SJ, Hwang HS, Choi SK, Lee SM, et al. Vaginal microbiome profiles of pregnant women in Korea using a 16S metagenomics approach. Am J Reprod Immunol. 2019;82(1):e13124. https://doi.org/10.1111/aji.13124.CrossRefPubMed

21.

Blostein F, Gelaye B, Sanchez SE, Williams MA, Foxman B. Vaginal microbiome diversity and preterm birth: results of a nested case-control study in Peru. Ann Epidemiol. 2020;41:28–34. https://doi.org/10.1016/j.annepidem.2019.11.004.CrossRefPubMed

22.

Callahan BJ, DiGiulio DB, Goltsman DSA, Sun CL, Costello EK, Jeganathan P, et al. Replication and refinement of a vaginal microbial signature of preterm birth in two racially distinct cohorts of US women. Proc Natl Acad Sci U S A. 2017;114(37):9966–71. https://doi.org/10.1073/pnas.1705899114.CrossRefPubMedPubMedCentral

23.

Hyman RW, Fukushima M, Jiang H, Fung E, Rand L, Johnson B, et al. Diversity of the vaginal microbiome correlates with preterm birth. Reprod Sci. 2014;21(1):32–40. https://doi.org/10.1177/1933719113488838.CrossRefPubMedPubMedCentral

24.

Li C, Xu JJ, He YC, Chen L, Dennis CL, Huang HF, et al. Effects of acute ambient pollution exposure on preterm prelabor rupture of membranes: a time-series analysis in Shanghai China. Environ Pollut. 2021;276:116756. https://doi.org/10.1016/j.envpol.2021.116756.CrossRefPubMed

25.

Grice EA, Kong HH, Conlan S, Deming CB, Davis J, Young AC, et al. Topographical and temporal diversity of the human skin microbiome. Science. 2009;324(5931):1190–2. https://doi.org/10.1126/science.1171700.CrossRefPubMedPubMedCentral

26.

Brown RG, Al-Memar M, Marchesi JR, Lee YS, Smith A, Chan D, et al. Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes. Transl Res. 2019;207:30–43. https://doi.org/10.1016/j.trsl.2018.12.005.CrossRefPubMedPubMedCentral

27.

Stout MJ, Zhou Y, Wylie KM, Tarr PI, Macones GA, Tuuli MG. Early pregnancy vaginal microbiome trends and preterm birth. Am J Obstet Gynecol. 2017;217(3):356 e1-356 e18. https://doi.org/10.1016/j.ajog.2017.05.030.CrossRefPubMed

28.

Hein M, Valore EV, Helmig RB, Uldbjerg N, Ganz T. Antimicrobial factors in the cervical mucus plug. Am J Obstet Gynecol. 2002;187(1):137–44. https://doi.org/10.1067/mob.2002.123034.CrossRefPubMed

29.

Romero R, Hassan SS, Gajer P, Tarca AL, Fadrosh DW, Nikita L, 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. https://doi.org/10.1186/2049-2618-2-4.CrossRefPubMedPubMedCentral

30.

DiGiulio DB, Callahan BJ, McMurdie PJ, Costello EK, Lyell DJ, Robaczewska A, et al. Temporal and spatial variation of the human microbiota during pregnancy. Proc Natl Acad Sci U S A. 2015;112(35):11060–5. https://doi.org/10.1073/pnas.1502875112.CrossRefPubMedPubMedCentral

Title: Vaginal flora during pregnancy and subsequent risk of preterm birth or prelabor rupture of membranes: a nested case–control study from China
Authors: Xiaomei Liu
Shuting Si
Li Huang
Meiliang Zhang
Wenya Chen
Liquan Wang
Yunxian Yu
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Premature Birth
Published in: BMC Pregnancy and Childbirth / Issue 1/2023
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-023-05564-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Vaginal flora during pregnancy and subsequent risk of preterm birth or prelabor rupture of membranes: a nested case–control study from China

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Direct standardization method according to Robson classification for comparison of cesarean rates

Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study

Factors influencing the free maternal health care policy under the national health insurance scheme’s provision for skilled delivery services in Ghana: a narrative literature review

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

Perinatal and pediatric outcomes associated with the use of fertility treatment: a population-based retrospective cohort study in Ontario, Canada

Development and validation of a facile rapid assessment scale for perinatal venous thromboembolism in puerperium in Chinese women