Julie A.K. McDonald
Relationship between vaginal microbial dysbiosis, inflammation, and pregnancy outcomes in cervical cerclage
McDonald, Julie A.K.; Kindinger, Lindsay M.; MacIntyre, David A.; Lee, Yun S.; Marchesi, Julian R.; Smith, Ann; Terzidou, Vasso; Cook, Joanna R.; Lees, Christoph; Israfil-Bayli, Fidan; Faiza, Yazmin; Toozs-Hobson, Philip; Slack, Mark; Cacciatore, Stefano; Holmes, Elaine; Nicholson, Jeremy K.; Teoh, T. G.; Bennett, Phillip R.
Authors
Lindsay M. Kindinger
David A. MacIntyre
Yun S. Lee
Julian R. Marchesi
Ann Smith
Vasso Terzidou
Joanna R. Cook
Christoph Lees
Fidan Israfil-Bayli
Yazmin Faiza
Philip Toozs-Hobson
Mark Slack
Stefano Cacciatore
Elaine Holmes
Jeremy K. Nicholson
T. G. Teoh
Phillip R. Bennett
Abstract
Preterm birth, the leading cause of death in children under 5 years, may be caused by inflammation triggered by ascending vaginal infection. About 2 million cervical cerclages are performed annually to prevent preterm birth. The procedure is thought to provide structural support and maintain the endocervical mucus plug as a barrier to ascending infection. Two types of suture material are used for cerclage: monofilament or multifilament braided. Braided sutures are most frequently used, although no evidence exists to favor them over monofilament sutures. We assessed birth outcomes in a retrospective cohort of 678 women receiving cervical cerclage in five UK university hospitals and showed that braided cerclage was associated with increased intrauterine death (15% versus 5%; P = 0.0001) and preterm birth (28% versus 17%; P = 0.0006) compared to monofilament suture. To understand the potential underlying mechanism, we performed a prospective, longitudinal study of the vaginal microbiome in women at risk of preterm birth because of short cervical length (≥25 mm) who received braided (n = 25) or monofilament (n = 24) cerclage under comparable circumstances. Braided suture induced a persistent shift toward vaginal microbiome dysbiosis characterized by reduced Lactobacillus spp. and enrichment of pathobionts. Vaginal dysbiosis was associated with inflammatory cytokine and interstitial collagenase excretion into cervicovaginal fluid and premature cervical remodeling. Monofilament suture had comparatively minimal impact upon the vaginal microbiome and its interactions with the host. These data provide in vivo evidence that a dynamic shift of the human vaginal microbiome toward dysbiosis correlates with preterm birth.
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 23, 2016 |
Online Publication Date | Aug 3, 2016 |
Publication Date | Aug 3, 2016 |
Deposit Date | Oct 2, 2019 |
Publicly Available Date | Oct 4, 2019 |
Journal | Science Translational Medicine |
Print ISSN | 1946-6234 |
Electronic ISSN | 1946-6242 |
Publisher | American Association for the Advancement of Science |
Peer Reviewed | Peer Reviewed |
Volume | 8 |
Issue | 350 |
Article Number | 350ra102 |
DOI | https://doi.org/10.1126/scitranslmed.aag1026 |
Public URL | https://uwe-repository.worktribe.com/output/3453599 |
Related Public URLs | https://spiral.imperial.ac.uk:8443/handle/10044/1/34435 |
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Relationship between vaginal microbial dysbiosis, inflammation and pregnancy outcomes in cervical cerclage
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Copyright Statement
This is the author’s version of the work. It is posted here by permission of the AAAS for personal use, not for redistribution. The definitive version was published in Science Translational Medicine on Volume 8 number 350 4 Aug 2016, DOI: 10.1126/scitranslmed.aag1026
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