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Published on: February 16, 2024
Relationship of Lactobacillus Vaginal Microbiota Changes and the Risk of Preterm Birth: A Systematic Review and
Qian Zhou1, Yi Yu1, Jingwen Zhou1
1Department of Obstetrics & Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
Insights
Higher levels of vaginal Lactobacillus bacteria, including specific species like L. crispatus and L. gasseri, are linked to a reduced risk of preterm birth (PTB). This finding highlights the protective role of these beneficial bacteria in pregnancy.
Area of Science:
- Reproductive Health
- Microbiome Research
- Obstetrics
Background:
- Preterm birth (PTB) affects over 10% of global pregnancies, posing significant health risks.
- The vaginal microbiome plays a crucial role in maintaining reproductive tract health.
- Understanding the relationship between vaginal microbiota and PTB is vital for developing preventative strategies.
Approach:
- A systematic review and meta-analysis was performed, analyzing 11 studies with 1577 participants.
- Data from PubMed, Web of Science, Cochrane Library, and EMBASE were synthesized.
- The association between vaginal Lactobacillus abundance and PTB risk was quantified using odds ratios (ORs) and 95% confidence intervals (CIs).
Key Points:
- Increased abundance of Lactobacillus in the vaginal microbiota was significantly associated with a lower risk of PTB (OR = 0.49).
- Four dominant Lactobacillus species—L. crispatus (OR = 0.3), L. gasseri (OR = 0.34), L. iners (OR = 0.68), and L. jensenii (OR = 0.43)—showed a negative correlation with PTB risk.
- Significant protective associations were observed in studies from America and Asia, but not Europe.
Conclusions:
- The study demonstrates a significant protective effect of vaginal Lactobacillus, including specific species, against preterm birth.
- Maintaining a healthy vaginal microbiome rich in Lactobacillus may be a key factor in reducing PTB incidence.
- Further research into probiotic interventions or microbiome modulation could offer new avenues for PTB prevention.
Abstract:
Objective: With a global incidence of more than 10%, preterm birth (PTB) remains a significant concern. The vaginal microbiome strongly influences the well-being of the female reproductive tract. This study examines the correlation between changes in Lactobacillus vaginal microbiota and the PTB risk. Materials and Methods: A thorough search of PubMed, Web of Science, Cochrane Library, and EMBASE was conducted to locate studies that examined the association between changes in Lactobacillus vaginal microbiota and the risk of PTB from January 1, 2010, to January 30, 2023. The risk of PTB was determined by calculating odds ratios (ORs) with 95% confidence intervals (CIs). Results: In our analysis, there were 11 studies with 1577 pregnant women. The findings revealed a significant negative correlation between higher Lactobacillus abundance and the PTB risk (OR = 0.49, 95% CI: 0.29-0.84, p = 0.009 < 0.05). Similarly, the four individual dominant species, Lactobacillus crispatus (OR = 0.3, 95% CI: 0.14-0.67, p = 0.003 < 0.05), Lactobacillus gasseri (OR = 0.34, 95% CI: 0.17-0.69, p = 0.003 < 0.05), Lactobacillus iners (OR = 0.68, 95% CI: 0.49-0.93, p = 0.016 < 0.05), and Lactobacillus jensenii (OR = 0.43, 95% CI: 0.21-0.89, p = 0.024 < 0.05), were also negatively associated with the PTB risk. The risk of Lactobacillus for PTB was significant in both America (OR = 0.67; 95% CI: 0.50-0.92) and Asia (OR = 0.20; 95% CI: 0.09-0.47), whereas no significant risk was found in Europe (OR = 0.49; 95% CI: 0.11-2.15). Conclusions: Our study demonstrated that the abundance of Lactobacillus and the four dominant individual species (L. crispatus, L. jensenii, L. iners, and L. gasseri) were significantly and negatively associated with the PTB risk.
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