OBJECTIVE: The purpose of this study was to determine if a change in the vaginal flora was associated with an increased risk of preterm birth, and to determine if metronidazole therapy before 32 weeks increased the risk of preterm birth. STUDY DESIGN: We compared cultures taken at 23 to 26 weeks of gestation with cultures taken at delivery from women enrolled in the Vaginal Infections and Preterm Birth study to analyze the association of changes in the vaginal flora with preterm birth. RESULTS: Metronidazole therapy before 32 weeks was associated with an increased risk of preterm birth (OR 1.5, 95%CI 1.05-2.1) in an unadjusted model. A change to heavy growth of Escherichia coli or Klebsiella pneumoniae at delivery was found to be associated with preterm birth (OR 2.4, 95%CI 1.6-3.8). After controlling for race, parity, prepregnancy weight <100 pounds, smoking or drinking during pregnancy, Trichomonas vaginalis, bacterial vaginosis, chlamydia, mycoplasmas, group B streptococcus, metronidazole therapy before 32 weeks, vaginal pH >5.0, and an increase in E coli or K pneumoniae , only prepregnancy weight <100 pounds (adjusted odds ratio [AOR] 2.07, 95%CI 1.01-4.21) and increased E coli or K pneumoniae in the vagina at delivery (AOR 2.99, 95%CI 1.37-6.53) were found to be significantly associated with preterm birth. CONCLUSION: An increase in E coli or K pneumoniae in the vagina is an independent risk factor for preterm birth. Changes in the vaginal flora may explain the increased risk of preterm birth seen with vaginal clindamycin or oral metronidazole therapy.
OBJECTIVE: The purpose of this study was to determine if a change in the vaginal flora was associated with an increased risk of preterm birth, and to determine if metronidazole therapy before 32 weeks increased the risk of preterm birth. STUDY DESIGN: We compared cultures taken at 23 to 26 weeks of gestation with cultures taken at delivery from women enrolled in the Vaginal Infections and Preterm Birth study to analyze the association of changes in the vaginal flora with preterm birth. RESULTS:Metronidazole therapy before 32 weeks was associated with an increased risk of preterm birth (OR 1.5, 95%CI 1.05-2.1) in an unadjusted model. A change to heavy growth of Escherichia coli or Klebsiella pneumoniae at delivery was found to be associated with preterm birth (OR 2.4, 95%CI 1.6-3.8). After controlling for race, parity, prepregnancy weight <100 pounds, smoking or drinking during pregnancy, Trichomonas vaginalis, bacterial vaginosis, chlamydia, mycoplasmas, group B streptococcus, metronidazole therapy before 32 weeks, vaginal pH >5.0, and an increase in E coli or K pneumoniae , only prepregnancy weight <100 pounds (adjusted odds ratio [AOR] 2.07, 95%CI 1.01-4.21) and increased E coli or K pneumoniae in the vagina at delivery (AOR 2.99, 95%CI 1.37-6.53) were found to be significantly associated with preterm birth. CONCLUSION: An increase in E coli or K pneumoniae in the vagina is an independent risk factor for preterm birth. Changes in the vaginal flora may explain the increased risk of preterm birth seen with vaginal clindamycin or oral metronidazole therapy.
Authors: Ronald F Lamont; Chia-Ling Nhan-Chang; Jack D Sobel; Kimberly Workowski; Agustin Conde-Agudelo; Roberto Romero Journal: Am J Obstet Gynecol Date: 2011-04-02 Impact factor: 8.661
Authors: Brenna Anderson; Yuan Zhao; William W Andrews; Donald J Dudley; Baha Sibai; Jay D Iams; Ronald J Wapner; Michael W Varner; Steve N Caritis; Mary Jo O'Sullivan Journal: Obstet Gynecol Date: 2011-04 Impact factor: 7.661
Authors: Brenna L Anderson; Susan Cu-Uvin; Christina A Raker; Christine Fitzsimmons; Sharon L Hillier Journal: Acta Obstet Gynecol Scand Date: 2011-03-14 Impact factor: 3.636
Authors: Betsy Foxman; Ai Wen; Usha Srinivasan; Deborah Goldberg; Carl F Marrs; John Owen; Deborah A Wing; Dawn Misra Journal: Am J Obstet Gynecol Date: 2013-10-04 Impact factor: 8.661
Authors: Akila Subramaniam; William J Van Der Pol; Travis Ptacek; Elena Lobashevsky; Cherry Neely; Joseph R Biggio; Elliot J Lefkowitz; Casey D Morrow; Rodney K Edwards Journal: J Matern Fetal Neonatal Med Date: 2018-07-22
Authors: Roderick A MacPhee; Wayne L Miller; Gregory B Gloor; John K McCormick; Jo-Anne Hammond; Jeremy P Burton; Gregor Reid Journal: Appl Environ Microbiol Date: 2013-01-11 Impact factor: 4.792
Authors: Natalia E Schlabritz-Loutsevitch; Charleen M Moore; Juan Carlos Lopez-Alvarenga; Betty G Dunn; Donald Dudley; Gene B Hubbard Journal: J Med Primatol Date: 2008-12 Impact factor: 0.667
Authors: Jeny P Ghartey; Colleen Carpenter; Philip Gialanella; Charlotte Rising; Thomas C McAndrew; Mohak Mhatre; Jessica Tugetman; Mark H Einstein; Cynthia Chazotte; Betsy C Herold Journal: Am J Obstet Gynecol Date: 2012-07-26 Impact factor: 8.661