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

Lee, Yun S.; Kindinger, Lindsay M.; Bennett, Phillip R.; Marchesi, Julian R.; Smith, Ann; Cacciatore, Stefano; Holmes, Elaine; Nicholson, Jeremy K.; Teoh, T. G.; MacIntyre, David A.

Authors

Yun S. Lee

Lindsay M. Kindinger

Phillip R. Bennett

Julian R. Marchesi

Ann Smith

Stefano Cacciatore

Elaine Holmes

Jeremy K. Nicholson

T. G. Teoh

David A. MacIntyre



Abstract

© The Author(s) 2017. 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 of gestation was significantly associated with both a short cervix < 25 mm (n = 15, P < 0.05) and preterm birth < 34+0 weeks (n = 18; P < 0.01; 69% PPV). In contrast, Lactobacillus 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 (400 mg/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 of 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 the use of a vaginal pessary during high-risk pregnancy can be reassured.

Citation

Lee, Y. S., Kindinger, L. M., Bennett, P. R., Marchesi, J. R., Smith, A., Cacciatore, S., …MacIntyre, D. A. (2017). The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome, 5(1), https://doi.org/10.1186/s40168-016-0223-9

Journal Article Type Article
Acceptance Date Jul 31, 2017
Online Publication Date Aug 29, 2017
Publication Date Jan 1, 2017
Deposit Date Oct 2, 2019
Publicly Available Date Oct 4, 2019
Journal Microbiome
Electronic ISSN 2049-2618
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 5
Issue 1
Article Number 9802
DOI https://doi.org/10.1186/s40168-016-0223-9
Public URL https://uwe-repository.worktribe.com/output/3453491

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http://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/

Copyright Statement
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





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