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Persistent Bacterial Vaginosis and Risk for Spontaneous Preterm Birth.

Yair J Blumenfeld1, Ivana Marić2, David K Stevenson2

  • 1Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California.

American Journal of Perinatology
|June 28, 2023
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Summary
This summary is machine-generated.

Persistent bacterial vaginosis (BV) during pregnancy, especially when lasting beyond one trimester or requiring multiple antibiotic treatments, is linked to an increased risk of spontaneous preterm birth (sPTB). This highlights the importance of monitoring and managing BV throughout gestation.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Infectious Diseases in Pregnancy

Background:

  • Bacterial vaginosis (BV) is a common vaginal condition in pregnant individuals.
  • The association between BV and adverse pregnancy outcomes, such as spontaneous preterm birth (sPTB), is a significant concern in maternal health.
  • Understanding the impact of persistent or recurrent BV is crucial for effective management.

Purpose of the Study:

  • To investigate the association between persistent bacterial vaginosis (BV) during pregnancy and the risk of spontaneous preterm birth (sPTB).
  • To compare the sPTB risk in women with treated BV versus those without BV.
  • To evaluate the impact of persistent BV, defined by duration or treatment frequency, on sPTB rates.

Main Methods:

  • Retrospective analysis of a large commercial insurance database (IBM MarketScan).
  • Inclusion of women aged 12-55 years with singleton gestations, linked to medication data.
  • BV diagnosis and treatment (metronidazole/clindamycin) were identified; persistence defined by multiple trimesters or prescriptions. Odds ratios and survival analysis were used.

Main Results:

  • A cohort of over 2.5 million women was analyzed, with over 63,000 treated for BV.
  • Women treated for BV had a higher sPTB frequency (7.5%) compared to those without BV (5.7%).
  • The highest sPTB odds ratios were observed in women treated for BV in both the first and second trimesters (1.66) or with three or more prescriptions (1.48).

Conclusions:

  • Persistent bacterial vaginosis during pregnancy is associated with an elevated risk of spontaneous preterm birth.
  • The risk of sPTB appears higher with more persistent or frequently treated BV compared to a single episode.
  • A significant proportion of BV antibiotic prescriptions are issued after 20 weeks gestation, underscoring the need for timely diagnosis and management.