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Bacterial vaginosis in pregnancy
1Department of Obstetrics and Gynaecology, St George's Hospital, London, UK. augwumad@sghms.ac.uk
Insights
Bacterial vaginosis (BV) in pregnancy is linked to adverse outcomes like preterm birth and fetal loss. Further research into BV
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Microbiology
Background:
- Bacterial vaginosis (BV) is a prevalent vaginal condition linked to numerous adverse pregnancy outcomes.
- These include fetal loss, preterm delivery, low birth weight, and maternal/neonatal infections.
- Infants born preterm, especially with chorioamnionitis, face higher risks of neurodevelopmental issues.
Purpose of the Study:
- To highlight the significant association between BV and adverse pregnancy outcomes.
- To underscore the incomplete understanding of the pathogenic mechanisms of BV in pregnancy.
- To emphasize the need for improved intervention strategies based on a deeper understanding of BV's pathobiology.
Main Methods:
- This review synthesizes existing literature on bacterial vaginosis and pregnancy outcomes.
- It analyzes the impact of BV across different gestational ages and associated complications.
- The study discusses the limitations and conflicting results of current intervention trials.
Main Results:
- BV is consistently associated with adverse pregnancy outcomes, including fetal loss and preterm birth.
- The mechanisms by which BV causes harm remain poorly understood.
- Intervention studies in pregnant women with BV have yielded inconsistent results.
Conclusions:
- A comprehensive understanding of BV's pathobiology during pregnancy is crucial.
- Future research should focus on elucidating specific cellular and biochemical pathways.
- Targeted interventions before conception and in early pregnancy may offer benefits, requiring further investigation.
Abstract:
Bacterial vaginosis is associated with adverse pregnancy outcomes across all gestational ages. It is linked to first and second trimester fetal loss, chorioamnionitis, preterm delivery, low-birthweight infants and maternal/neonatal infectious morbidity. Infants who survive preterm birth are at an increased risk of subsequent neurodevelopmental delays and handicap, more so if there was underlying choriomnionitis. The exact mechanisms and pathways through which bacterial vaginosis exerts these adverse effects are incompletely understood. Not surprisingly, intervention studies in bacterial vaginosis-positive pregnant women have shown conflicting results, both in women at high and low risk of preterm birth. A much better understanding of the pathobiology of bacterial vaginosis in pregnancy is required to focus the designs of intervention studies on the disturbed cellular and biochemical pathways. Such studies may address the benefits of the treatment of bacterial vaginosis before conception and during early pregnancy, to determine whether treatment in populations of pregnant women may be beneficial.