1
|
Ramachandran A, Clottey KD, Gordon A, Hyett JA. Prediction and prevention of preterm birth: Quality assessment and systematic review of clinical practice guidelines using the AGREE II framework. Int J Gynaecol Obstet 2024. [PMID: 38619379 DOI: 10.1002/ijgo.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 03/02/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Prediction of pregnancies at risk of preterm birth (PTB) may allow targeted prevention strategies. OBJECTIVES To assess quality of clinical practice guidelines (CPGs) and identify areas of agreement and contention in prediction and prevention of spontaneous PTB. SEARCH STRATEGY We searched for CPGs regarding PTB prediction and prevention in asymptomatic singleton pregnancies without language restriction in January 2024. SELECTION CRITERIA CPGs included were published between July 2017 and December 2023 and contained statements intended to direct clinical practice. DATA COLLECTION AND ANALYSIS CPG quality was assessed using the AGREE-II tool. Recommendations were extracted and grouped under domains of prediction and prevention, in general populations and high-risk groups. MAIN RESULTS We included 37 CPGs from 20 organizations; all were of moderate or high quality overall. There was consensus in prediction of PTB by identification of risk factors and cervical length screening in high-risk pregnancies and prevention of PTB by universal screening and treatment for asymptomatic bacteriuria, screening and treatment for BV in high-risk pregnancies, and use of preventative progesterone and cerclage. Areas of contention or limited consensus were the role of PTB clinics, universal cervical length measurement, biomarkers and cervical pessaries. CONCLUSIONS This review identified strengths and limitations of current PTB CPGs, and areas for future research.
Collapse
Affiliation(s)
- Aparna Ramachandran
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Sydney Institute for Women, Children and Their Families, Sydney, Australia
| | - Klorkor D Clottey
- Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Sydney Institute for Women, Children and Their Families, Sydney, Australia
- Department of Neonatology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jon A Hyett
- Sydney Institute for Women, Children and Their Families, Sydney, Australia
- Department of Obstetrics and Gynecology, School of Medicine, Western Sydney University, Sydney, Australia
| |
Collapse
|
2
|
Klebanoff MA, Schuit E, Lamont RF, Larsson PG, Odendaal HJ, Ugwumadu A, Kiss H, Petricevic L, Andrews WW, Hoffman MK, Shennan A, Seed PT, Goldenberg RL, Emel LM, Bhandaru V, Weiner S, Larsen MD. Antibiotic treatment of bacterial vaginosis to prevent preterm delivery: Systematic review and individual participant data meta-analysis. Paediatr Perinat Epidemiol 2023; 37:239-251. [PMID: 36651636 PMCID: PMC10171232 DOI: 10.1111/ppe.12947] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bacterial vaginosis (BV) increases preterm delivery (PTD) risk, but treatment trials showed mixed results in preventing PTD. OBJECTIVES Determine, using individual participant data (IPD), whether BV treatment during pregnancy reduced PTD or prolonged time-to-delivery. DATA SOURCES Cochrane Systematic Review (2013), MEDLINE, EMBASE, journal searches, and searches (January 2013-September 2022) ("bacterial vaginosis AND pregnancy") of (i) clinicaltrials.gov; (ii) Cochrane Central Register of Controlled Trials; (iii) World Health Organization International Clinical Trials Registry Platform Portal; and (iv) Web of Science ("bacterial vaginosis"). STUDY SELECTION AND DATA EXTRACTION Studies randomising asymptomatic pregnant individuals with BV to antibiotics or control, measuring delivery gestation. Extraction was from original data files. Bias risk was assessed using the Cochrane tool. Analysis used "one-step" logistic and Cox random effect models, adjusting gestation at randomisation and PTD history; heterogeneity by I2 . Subgroup analysis tested interactions with treatment. In sensitivity analyses, studies not providing IPD were incorporated by "multiple random-donor hot-deck" imputation, using IPD studies as donors. RESULTS There were 121 references (96 studies) with 23 eligible trials (11,979 participants); 13 studies (6915 participants) provided IPD; 12 (6115) were incorporated. Results from 9 (4887 participants) not providing IPD were imputed. Odds ratios for PTD for metronidazole and clindamycin versus placebo were 1.00 (95% CI 0.84, 1.17), I2 = 62%, and 0.59 (95% CI 0.42, 0.82), I2 = 0 before; and 0.95 (95% CI 0.81, 1.11), I2 = 59%, and 0.90 (95% CI: 0.72, 1.12), I2 = 0, after imputation. Time-to-delivery did not differ from null with either treatment. Including imputed IPD, there was no evidence that either drug was more effective when administered earlier, or among those with a PTD history. CONCLUSIONS Clindamycin, but not metronidazole, was beneficial in studies providing IPD, but after imputing data from missing IPD studies, treatment of BV during pregnancy did not reduce PTD, nor prolong pregnancy, in any subgroup or when started earlier in gestation.
Collapse
Affiliation(s)
- Mark A. Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
- Departments of Pediatrics and Obstetrics and Gynecology, and Division of Epidemiology, The Ohio State University, Columbus, Ohio, USA
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, and Cochrane Netherlands, both at University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald F. Lamont
- Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
- Odense University Hospital, Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, Odense, Denmark
| | - Per-Göran Larsson
- Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden
- Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Austin Ugwumadu
- Department of Obstetrics and Gynecology, St. George’s Hospital, University of London, London, UK
| | - Herbert Kiss
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Wien, Austria
| | - Ljubomir Petricevic
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Wien, Austria
| | - William W. Andrews
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Health Services, Newark, Delaware, USA
| | - Andrew Shennan
- Department of Women and Children’s Health, School of Life Course Sciences, FoLSM, King’s College, London, UK
| | - Paul T. Seed
- Division of Women’s Health, King’s College, London, UK
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York City, New York, USA
| | - Lynda M. Emel
- Biostatistics, Bioinformatics, and Epidemiology/VIDD, Fred Hutchinson Cancer Center Seattle, Seattle, Washington, USA
| | - Vinay Bhandaru
- The Biostatistics Center, Milken School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Steven Weiner
- The Biostatistics Center, Milken School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Michael D. Larsen
- The Biostatistics Center, Milken School of Public Health, The George Washington University, Washington, District of Columbia, USA
- Department of Mathematics and Statistics, St. Michael’s College, Colchester, Vermont, USA
| |
Collapse
|
3
|
Zavala E, Rhodes M, Christian P. Pregnancy Interventions to Improve Birth Outcomes: What Are the Effects on Maternal Outcomes? A Scoping Review. Int J Public Health 2022; 67:1604620. [PMID: 36405527 PMCID: PMC9666362 DOI: 10.3389/ijph.2022.1604620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Interventions in pregnancy are commonly evaluated for their effects on birth outcomes because maternal infection and poor nutrition are the primary contributors to adverse pregnancy outcomes, especially in low- and middle-income countries (LMICs). However, the extent to which such interventions directly impact maternal health and nutrition has not been succinctly characterized. Methods: We conducted a scoping review of systematic reviews and meta-analyses of 27 pregnancy interventions to summarize the evidence of impact on maternal outcomes. Results: Overall, these were reported incompletely, and we failed to find any evidence for eight interventions. Influenza vaccination, insecticide-treated bed nets, intermittent preventive treatment for malaria, anthelmintic therapy, and treatment of bacterial vaginosis, asymptomatic bacteriuria, and periodontal disease during pregnancy provided direct benefit to women, with reductions in infection risk. Nutritional interventions such as micronutrient supplementation and balanced energy and protein improved outcomes of maternal anemia and gestational weight gain, particularly in deficient populations. Calcium and low dose aspirin significantly reduced the risk of pre-eclampsia. Conclusion: These findings highlight antenatal interventions benefitting maternal health and provide insights into pathways for impacting birth and infant outcomes.
Collapse
|
4
|
Dunlop AL, Jordan SL, Ferranti EP, Hill CC, Patel S, Hao L, Corwin EJ, Tangpricha V. Total and Free 25-Hydroxy-Vitamin D and Bacterial Vaginosis in Pregnant African American Women. Infect Dis Obstet Gynecol 2019; 2019:9426795. [PMID: 30692844 PMCID: PMC6332941 DOI: 10.1155/2019/9426795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/07/2018] [Indexed: 11/30/2022] Open
Abstract
Objective This study sought to investigate associations between serum total and free 25(OH)D and bacterial vaginosis (BV) in early and later pregnancy among US black women to provide insight into the most clinically relevant measure of vitamin D status among pregnant black women with respect to risk for BV as well as insights into critical time points for measuring and/or addressing vitamin D status in pregnancy. Methods Data and biospecimens were derived from a subsample (N = 137) of women from the Emory University African American Vaginal, Oral, and Gut Microbiome in Pregnancy Cohort, for whom data related to vitamin D status (serum assays for total and free 25(OH)D) and Nugent score of Gram stained vaginal specimens in early (8-14 weeks) and later (24-30 weeks) were available. We compared total and free 25(OH)D concentrations for women according to Nugent score category (normal flora, intermediate flora, and BV) and assessed the odds of BV according to measures of vitamin D status. Results Thirty-seven (27%) women had adequate vitamin D status at baseline, whereas 70 (51%) had insufficient vitamin D and 30 (22%) were vitamin D deficient; there were not significant differences in the proportion of women with adequate, insufficient, or deficient vitamin D according to Nugent score category. However, the odds of BV later in pregnancy were significantly higher for women who experienced a smaller rise in total 25(OH)D and free 25(OH)D from 8-14 through 24-30 weeks gestation. Conclusion The change in measures of vitamin D status from early to later pregnancy is associated with the occurrence of BV in pregnancy. Further research is needed to examine the association between the change in vitamin D status over pregnancy and the occurrence of BV and other measures of vaginal microbial composition as well as to identify factors that influence change in vitamin D status over pregnancy.
Collapse
Affiliation(s)
- Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
- Department of Family & Preventive Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Sheila L. Jordan
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - Erin P. Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - Cherie C. Hill
- Department of Obstetrics & Gynecology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Shiven Patel
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- Atlanta VA Medical Center, Atlanta, GA 30033, USA
| | - Li Hao
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- Atlanta VA Medical Center, Atlanta, GA 30033, USA
| | - Elizabeth J. Corwin
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- Atlanta VA Medical Center, Atlanta, GA 30033, USA
| |
Collapse
|
5
|
Obiero J, Rulisa S, Ogongo P, Wiysonge CS. Nifuratel-Nystatin combination for the treatment of mixed infections of bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jael Obiero
- Institute of Primate Research; Department of Reproductive Health and Biology; Nairobi Kenya
| | - Stephen Rulisa
- University of Rwanda; Department of Obstetrics and gynecology, School of Medicine and Pharmacy; BP 655 Kigali Rwanda
| | - Paul Ogongo
- Institute of Primate Research; Tropical and Infectious Diseases; P.O Box 24481 -00502, Karen Nairobi Kenya
| | - Charles S Wiysonge
- South African Medical Research Council; Cochrane South Africa; Francie van Zijl Drive, Parow Valley Cape Town Western Cape South Africa 7505
| |
Collapse
|
6
|
Sanders AP, Gennings C, Svensson K, Motta V, Mercado-Garcia A, Solano M, Baccarelli AA, Tellez-Rojo MM, Wright RO, Burris HH. Bacterial and cytokine mixtures predict the length of gestation and are associated with miRNA expression in the cervix. Epigenomics 2016; 9:33-45. [PMID: 27936911 DOI: 10.2217/epi-2016-0095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Bacterial vaginosis may lead to preterm birth through epigenetic programming of the inflammatory response, specifically via miRNA expression. METHODS We quantified bacterial 16S rRNA, cytokine mRNA and 800 miRNA from cervical swabs obtained from 80 women at 16-19 weeks' gestation. We generated bacterial and cytokine indices using weighted quantile sum regression and examined associations with miRNA and gestational age at delivery. RESULTS & DISCUSSION Each decile of the bacterial and cytokine indices was associated with shorter gestations (p < 0.005). The bacterial index was associated with miR-494, 371a, 4286, 185, 320e, 888 and 23a (p < 0.05). miR-494 remained significant after false discovery rate correction (q < 0.1). The cytokine index was associated with 27 miRNAs (p < 0.05; q < 0.01). CONCLUSION Future investigation into the role of bacterial vaginosis- and inflammation-associated miRNA and preterm birth is warranted.
Collapse
Affiliation(s)
- Alison P Sanders
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Chris Gennings
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Katherine Svensson
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Valeria Motta
- Laboratory of Environmental Epigenetics, Exposure Epidemiology & Risk Program, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.,Department of Clinical Sciences & Community Health University of Milan - Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Adriana Mercado-Garcia
- Center for Evaluation Research & Surveys, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Maritsa Solano
- Center for Evaluation Research & Surveys, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Andrea A Baccarelli
- Laboratory of Environmental Epigenetics, Exposure Epidemiology & Risk Program, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.,Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Martha M Tellez-Rojo
- Center for Evaluation Research & Surveys, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Robert O Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Heather H Burris
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.,Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
7
|
de Ruiter A, Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, O'Shea S, Tookey P, Tosswill J, Welch S, Wilkins E. British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review). HIV Med 2015; 15 Suppl 4:1-77. [PMID: 25604045 DOI: 10.1111/hiv.12185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
8
|
Braundmeier AG, Lenz KM, Inman KS, Chia N, Jeraldo P, Walther-António MRS, Berg Miller ME, Yang F, Creedon DJ, Nelson H, White BA. Individualized medicine and the microbiome in reproductive tract. Front Physiol 2015; 6:97. [PMID: 25883569 PMCID: PMC4381647 DOI: 10.3389/fphys.2015.00097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/12/2015] [Indexed: 01/02/2023] Open
Abstract
Humans have evolved along with the millions of microorganisms that populate their bodies. These microbes (10(14)) outnumber human cells by 10 to 1 and account for 3 × 10(6) genes, more than ten times the 25,000 human genes. This microbial metagenome acts as our "other genome" and like our own genes, is unique to the individual. Recent international efforts such as the Human Microbiome Project (HMP) and the MetaHIT Project have helped catalog these microbial genomes using culture-independent, high-throughput, next-generation sequencing. This manuscript will describe recent efforts to define microbial diversity in the female reproductive tract because of the impact that microbial function has on reproductive efficiency. In this review, we will discuss current evidence that microbial communities are critical for maintaining reproductive health and how perturbations of microbial community structures can impact reproductive health from the aspect of infection, reproductive cyclicity, pregnancy, and disease states. Investigations of the human microbiome are propelling interventional strategies from treating medical populations to treating individual patients. In particular, we highlight how understanding and defining microbial community structures in different disease and physiological states have lead to the discovery of biomarkers and, more importantly, the development and implementation of microbial intervention strategies (probiotics) into modern day medicine. Finally this review will conclude with a literature summary of the effectiveness of microbial intervention strategies that have been implemented in animal and human models of disease and the potential for integrating these microbial intervention strategies into standard clinical practice.
Collapse
Affiliation(s)
- Andrea G Braundmeier
- Department of Medical Microbiology, Immunology and Cell Biology, Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine Springfield, IL, USA
| | - Katherine M Lenz
- Department of Medical Microbiology, Immunology and Cell Biology, Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine Springfield, IL, USA
| | - Kristin S Inman
- Department of Cancer Biology, Mayo Clinic College of Medicine Jacksonville, FL, USA
| | - Nicholas Chia
- The Center for Individualized Medicine, Mayo Clinic Rochester, MN, USA ; Division of Nutritional Sciences, University of Illinois Urbana, IL, USA ; Biomedical Engineering and Physiology, Mayo College Rochester, MN, USA
| | - Patricio Jeraldo
- The Center for Individualized Medicine, Mayo Clinic Rochester, MN, USA ; Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana, IL, USA ; Department of Surgery, Mayo Clinic Rochester, MN, USA
| | - Marina R S Walther-António
- The Center for Individualized Medicine, Mayo Clinic Rochester, MN, USA ; Department of Surgery, Mayo Clinic Rochester, MN, USA
| | | | - Fang Yang
- Division of Nutritional Sciences, University of Illinois Urbana, IL, USA ; Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana, IL, USA
| | - Douglas J Creedon
- Department of Obstetrics and Gynecology, Mayo Clinic Rochester, MN, USA
| | - Heidi Nelson
- The Center for Individualized Medicine, Mayo Clinic Rochester, MN, USA ; Department of Surgery, Mayo Clinic Rochester, MN, USA
| | - Bryan A White
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana, IL, USA
| |
Collapse
|
9
|
Diejomaoh MF. Recurrent spontaneous miscarriage is still a challenging diagnostic and therapeutic quagmire. Med Princ Pract 2014; 24 Suppl 1:38-55. [PMID: 25428171 PMCID: PMC6489083 DOI: 10.1159/000365973] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/17/2014] [Indexed: 01/12/2023] Open
Abstract
Recurrent spontaneous miscarriage (RSM), affecting 1-2% of women of reproductive age seeking pregnancy, has been a clinical quagmire and a formidable challenge for the treating physician. There are many areas of controversy in the definition, aetiology, investigations and treatment of RSM. This review will address the many factors involved in the aetiology of RSM which is multifactorial in many patients, with antiphospholipid syndrome (APS) being the most recognized aetiological factor. There is no identifiable cause in about 40-60% of these patients, in which case the condition is classified as idiopathic or unexplained RSM. The RSM investigations are extensive and should be undertaken in dedicated, specialized, well-equipped clinics/centres where services are provided by trained specialists. The challenges faced by the treating physician are even more overwhelming regarding the decision of what should be the most appropriate therapy offered to patients with RSM. Our review will cover the diverse modalities of therapy available including the role of preimplantation genetic testing using recent microarray technology, such as single nucleotide polymorphism and comparative genomic hybridization, as well as preimplantation genetic diagnosis; the greatest emphasis will be on the treatment of APS, and there will be important comments on the management of patients presenting with idiopathic RSM. The controversial areas of the role of natural killer cells in RSM, the varied modalities in the management of idiopathic RSM and the need for better-planned studies will be covered as well.
Collapse
Affiliation(s)
- Michael F.E. Diejomaoh
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kuwait University, and Maternity Hospital, Kuwait City, Kuwait
| |
Collapse
|
10
|
11.0 References. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.1030_12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
11
|
4.0 Screening and monitoring of HIV-positive pregnant women. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.1030_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
12
|
Taylor GP, Clayden P, Dhar J, Gandhi K, Gilleece Y, Harding K, Hay P, Kennedy J, Low-Beer N, Lyall H, Palfreeman A, Tookey P, Welch S, Wilkins E, de Ruiter A. British HIV Association guidelines for the management of HIV infection in pregnant women 2012. HIV Med 2012. [DOI: 10.1111/j.1468-1293.2012.01030.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- GP Taylor
- Communicable Diseases; Section of Infectious Diseases; Imperial College London; UK
| | - P Clayden
- UK Community Advisory Board representative/HIV treatment advocates network; London; UK
| | - J Dhar
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - K Gandhi
- Heart of England NHS Foundation Trust; Birmingham; UK
| | | | - K Harding
- Guy's and St Thomas′ Hospital NHS Foundation Trust; London; UK
| | - P Hay
- St George's Healthcare NHS Trust; London; UK
| | - J Kennedy
- Homerton University Hospital NHS Foundation Trust; London; UK
| | - N Low-Beer
- Chelsea and Westminster Hospital NHS Foundation Trust; London; UK
| | - H Lyall
- Imperial College Healthcare NHS Trust; London; UK
| | - A Palfreeman
- Genitourinary Medicine; University Hospitals of Leicester NHS Trust; Leicester; UK
| | - P Tookey
- UCL Institute of Child Health; London; UK
| | - S Welch
- Paediatric Infectious Diseases; Heart of England NHS Foundation Trust; Birmingham; UK
| | - E Wilkins
- Infectious Diseases and Director of the HIV Research Unit; North Manchester General Hospital; Manchester; UK
| | - A de Ruiter
- Genitourinary Medicine; Guy's and St Thomas' NHS Foundation Trust; London; UK
| |
Collapse
|
13
|
Maternal vitamin D, folate, and polyunsaturated fatty acid status and bacterial vaginosis during pregnancy. Infect Dis Obstet Gynecol 2011; 2011:216217. [PMID: 22190843 PMCID: PMC3235789 DOI: 10.1155/2011/216217] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/25/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate associations among serum 25-hydroxy-vitamin D (25-OH-D), folate, omega-6/omega-3 fatty acid ratio and bacterial vaginosis (BV) during pregnancy. METHODS Biospecimens and data were derived from a random sample (N = 160) of women from the Nashville Birth Cohort. We compared mean plasma nutrient concentrations for women with and without BV during pregnancy (based on Nugent score ≥7) and assessed the odds of BV for those with 25-OH-D <12 ng/mL, folate <5 ug/L, and omega-6/omega-3 ratio >15. RESULTS The mean plasma 25-OH-D was significantly lower among women with BV during pregnancy (18.00±8.14 ng/mL versus 24.34±11.97 ng/mL, P = 0.044). The adjusted odds of BV were significantly increased among pregnant women with 25-OH-D <12 ng/mL (aOR 5.11, 95% CI: 1.19-21.97) and folate <5 ug/L (aOR 7.06, 95% CI: 1.07-54.05). CONCLUSION Vitamin D and folate deficiencies were strongly associated with BV (Nugent score ≥7) during pregnancy.
Collapse
|
14
|
Anderson BL, Cu-Uvin S, Raker CA, Fitzsimmons C, Hillier SL. Subtle perturbations of genital microflora alter mucosal immunity among low-risk pregnant women. Acta Obstet Gynecol Scand 2011; 90:510-5. [PMID: 21306340 DOI: 10.1111/j.1600-0412.2011.01082.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Alteration in the vaginal flora has been associated with adverse pregnancy outcomes. The objective of this study was to examine the impact of changes in individual microflora on genital immunity among low-risk pregnant women in early pregnancy. DESIGN Cross-sectional study. SETTING Large, tertiary care, academic hospital clinic. POPULATION Low-risk women were enrolled prior to 14 weeks' gestation. METHODS Women were included if they had no medical or previous obstetrical complications, were non-smokers, had no sexually transmitted infections and no intercourse in the last 48 hours. Consenting women underwent speculum examination for collection of vaginal culture and Dacron swabs for cytokine analysis. Semi-quantitative vaginal cultures were performed in a reference laboratory. MAIN OUTCOME MEASURES Concentrations of immune mediators were compared in the presence of various organisms. Concentrations were converted to multiples of the median to standardize the values of each mediator. Regression analyses were performed to control for race. RESULTS We enrolled 47 women. The frequencies of genital microorganisms were: H(2)O(2) -producing lactobacilli (70%), Ureaplasma urealyticum (66%), Gardnerella vaginalis (45%), anaerobic non-pigmented Gram-negative rods (ANPGNR, 40%), anaerobic pigmented Gram-negative rods (APGNR, 17%). After adjusting for race and body mass index, interleukin-1β, interferon-γ, tumor necrosis factor-α and granulocyte macrophage-colony stimulating factor were increased in the presence of G. vaginalis, ANPGNR, and APGNR. There was no consistent impact on the other markers of immune activation. CONCLUSION The presence of individual species impacts genital immunity among low-risk pregnant women. Perturbations in genital immunity could partially explain heterogeneity in adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Brenna L Anderson
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | | | | | | | | |
Collapse
|
15
|
de Ruiter A, Mercey D, Anderson J, Chakraborty R, Clayden P, Foster G, Gilling-Smith C, Hawkins D, Low-Beer N, Lyall H, O'Shea S, Penn Z, Short J, Smith R, Sonecha S, Tookey P, Wood C, Taylor G. British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008. HIV Med 2009; 9:452-502. [PMID: 18840151 DOI: 10.1111/j.1468-1293.2008.00619.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A de Ruiter
- Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Bodnar LM, Krohn MA, Simhan HN. Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. J Nutr 2009; 139:1157-61. [PMID: 19357214 PMCID: PMC2682987 DOI: 10.3945/jn.108.103168] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bacterial vaginosis (BV) is a highly prevalent vaginal infection that is associated with adverse pregnancy outcomes. Vitamin D exerts an influence on the immune system and may play a role in BV. The objective of this study was to examine the association between maternal vitamin D status and the prevalence of BV in early pregnancy. Women (n = 469) enrolled in a pregnancy cohort study at <16 wk underwent a pelvic examination and provided a blood sample for determination of serum 25-hydroxyvitamin D [25(OH)D]. BV was diagnosed using Gram-stained vaginal smears interpreted using the method of Nugent. Approximately 41% of women had BV (Nugent score 7-10) and 52% had a serum 25(OH)D concentration <37.5 nmol/L. The mean unadjusted serum 25(OH)D concentration was lower among BV cases (29.5 nmol/L; 95% CI: 27.1, 32.0) compared with women with normal vaginal flora (40.1 nmol/L; 95% CI: 37.0, 43.5; P < 0.001). BV prevalence decreased as vitamin D status improved (P < 0.001). Approximately 57% of the women with a serum 25(OH)D concentration <20 nmol/L had BV compared with 23% of women with a serum 25(OH)D concentration >80 nmol/L. There was a dose-response association between 25(OH)D and the prevalence of BV. The prevalence declined as 25(OH)D increased to 80 nmol/L, then reached a plateau. Compared with a serum 25(OH)D concentration of 75 nmol/L, there were 1.65-fold (95% CI: 1.01, 2.69) and 1.26-fold (1.01, 1.57) increases in the prevalence of BV associated with a serum 25(OH)D concentration of 20 and 50 nmol/L, respectively, after adjustment for race and sexually transmitted diseases. Vitamin D deficiency is associated with BV and may contribute to the strong racial disparity in the prevalence of BV.
Collapse
Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213; and Magee-Womens Research Institute, Pittsburgh, PA 15213
| | - Marijane A. Krohn
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213; and Magee-Womens Research Institute, Pittsburgh, PA 15213
| | - Hyagriv N. Simhan
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213; and Magee-Womens Research Institute, Pittsburgh, PA 15213
| |
Collapse
|
17
|
Bodnar LM, Krohn MA, Simhan HN. Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. J Nutr 2009. [PMID: 19357214 DOI: 10.3945/jn.108.103168.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bacterial vaginosis (BV) is a highly prevalent vaginal infection that is associated with adverse pregnancy outcomes. Vitamin D exerts an influence on the immune system and may play a role in BV. The objective of this study was to examine the association between maternal vitamin D status and the prevalence of BV in early pregnancy. Women (n = 469) enrolled in a pregnancy cohort study at <16 wk underwent a pelvic examination and provided a blood sample for determination of serum 25-hydroxyvitamin D [25(OH)D]. BV was diagnosed using Gram-stained vaginal smears interpreted using the method of Nugent. Approximately 41% of women had BV (Nugent score 7-10) and 52% had a serum 25(OH)D concentration <37.5 nmol/L. The mean unadjusted serum 25(OH)D concentration was lower among BV cases (29.5 nmol/L; 95% CI: 27.1, 32.0) compared with women with normal vaginal flora (40.1 nmol/L; 95% CI: 37.0, 43.5; P < 0.001). BV prevalence decreased as vitamin D status improved (P < 0.001). Approximately 57% of the women with a serum 25(OH)D concentration <20 nmol/L had BV compared with 23% of women with a serum 25(OH)D concentration >80 nmol/L. There was a dose-response association between 25(OH)D and the prevalence of BV. The prevalence declined as 25(OH)D increased to 80 nmol/L, then reached a plateau. Compared with a serum 25(OH)D concentration of 75 nmol/L, there were 1.65-fold (95% CI: 1.01, 2.69) and 1.26-fold (1.01, 1.57) increases in the prevalence of BV associated with a serum 25(OH)D concentration of 20 and 50 nmol/L, respectively, after adjustment for race and sexually transmitted diseases. Vitamin D deficiency is associated with BV and may contribute to the strong racial disparity in the prevalence of BV.
Collapse
Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA.
| | | | | |
Collapse
|
18
|
Abstract
OBJECTIVES To assess and summarize the published literature on the extent to which bacterial vaginosis may increase the risk of HIV acquisition. DESIGN Meta-analysis of published studies. METHODS Medline and other electronic databases were systematically searched for eligible publications. The association between bacterial vaginosis and incident HIV was separately analyzed from that between bacterial vaginosis and prevalent HIV. The latter was further analyzed, stratified by bacterial vaginosis diagnostic method, HIV risk profile of the study population, and whether or not adjusted estimates were presented. RESULTS Twenty-three eligible publications were identified, including a total of 30,739 women. Bacterial vaginosis was associated with an increased risk of HIV acquisition in HIV-incidence studies (relative risk = 1.6, 95% confidence interval: 1.2, 2.1). All but one of 21 HIV-prevalence studies reported estimates above the null. The latter results were heterogeneous and showed some evidence of funnel plot asymmetry, precluding the estimation of a single summary measure. The association between bacterial vaginosis and HIV in prevalence studies appeared stronger for women without high-risk sexual behavior. CONCLUSION Bacterial vaginosis was consistently associated with an increased risk of HIV infection. High bacterial vaginosis prevalence may result in a high number of HIV infections being attributable to bacterial vaginosis. More prospective studies are needed to accurately evaluate the role of bacterial vaginosis in HIV acquisition in low-risk versus high-risk women. Furthermore, randomized clinical trials may be worth considering to determine the effect of bacterial vaginosis control measures on HIV acquisition.
Collapse
|
19
|
Chatterjee J, Gullam J, Vatish M, Thornton S. The management of preterm labour. Arch Dis Child Fetal Neonatal Ed 2007; 92:F88-93. [PMID: 17337673 PMCID: PMC2675479 DOI: 10.1136/adc.2005.082289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2006] [Indexed: 11/04/2022]
Affiliation(s)
- Jayanta Chatterjee
- Department of Obstetrics and Gynaecology, Warford General Hospital, Watford, UK.
| | | | | | | |
Collapse
|
20
|
Abstract
BACKGROUND Bacterial vaginosis is an imbalance of the normal vaginal flora with an overgrowth of anaerobic bacteria and a lack of the normal lactobacillary flora. Bacterial vaginosis during pregnancy has been associated with poor perinatal outcome and, in particular, preterm birth (PTB). Identification and treatment may reduce the risk of PTB and its consequences. OBJECTIVES To assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2006). SELECTION CRITERIA Randomized trials comparing antibiotic treatment with placebo or no treatment, or comparing two or more antibiotic regimens in pregnant women with bacterial vaginosis or intermediate vaginal flora. DATA COLLECTION AND ANALYSIS Two review authors assessed trials and extracted data independently. We contacted study authors for additional information. MAIN RESULTS We included fifteen trials of good quality, involving 5888 women. Antibiotic therapy was effective at eradicating bacterial vaginosis during pregnancy (Peto odds ratio (OR) 0.17, 95% confidence interval (CI) 0.15 to 0.20; 10 trials, 4357 women). Treatment did not reduce the risk of PTB before 37 weeks (Peto OR 0.91, 95% CI 0.78 to 1.06; 15 trials, 5888 women), or the risk of preterm prelabour rupture of membranes (PPROM) (Peto OR 0.88, 95% CI 0.61 to 1.28; four trials, 2579 women). However, treatment before 20 weeks' gestation may reduce the risk of preterm birth less than 37 weeks (Peto OR 0.63, 95% CI 0.48 to 0.84; five trials, 2387 women). In women with a previous PTB, treatment did not affect the risk of subsequent PTB (Peto OR 0.83, 95% CI 0.59 to 1.17, five trials of 622); however, it may decrease the risk of PPROM (Peto OR 0.14, 95% CI 0.05 to 0.38) and low birthweight (Peto OR 0.31, 95% CI 0.13 to 0.75)(two trials, 114 women). In women with abnormal vaginal flora (intermediate flora or bacterial vaginosis) treatment may reduce the risk of PTB before 37 weeks (Peto OR 0.51, 95% CI 0.32 to 0.81; two trials, 894 women). Clindamycin did not reduce the risk of PTB before 37 weeks (Peto OR 0.80, 95% CI 0.60 to 1.05; six trials, 2406 women). AUTHORS' CONCLUSIONS Antibiotic treatment can eradicate bacterial vaginosis in pregnancy. This review provides little evidence that screening and treating all pregnant women with asymptomatic bacterial vaginosis will prevent PTB and its consequences. However, there is some suggestion that treatment before 20 weeks' gestation may reduce the risk of PTB. This needs to be further verified by future trials.
Collapse
Affiliation(s)
- H M McDonald
- Women's and Children's Hospital, Microbiology and Infectious Diseases, 72 King William Road, North Adelaide, South Australia, Australia, 5006.
| | | | | |
Collapse
|
21
|
Romero R, Espinoza J, Kusanovic JP, Gotsch F, Hassan S, Erez O, Chaiworapongsa T, Mazor M. The preterm parturition syndrome. BJOG 2006; 113 Suppl 3:17-42. [PMID: 17206962 PMCID: PMC7062298 DOI: 10.1111/j.1471-0528.2006.01120.x] [Citation(s) in RCA: 917] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The implicit paradigm that has governed the study and clinical management of preterm labour is that term and preterm parturition are the same processes, except for the gestational age at which they occur. Indeed, both share a common pathway composed of uterine contractility, cervical dilatation and activation of the membranes/decidua. This review explores the concept that while term labour results from physiological activation of the components of the common pathway, preterm labour arises from pathological signalling and activation of one or more components of the common pathway of parturition. The term "great obstetrical syndromes" has been coined to reframe the concept of obstetrical disease. Such syndromes are characterised by: (1) multiple aetiology; (2) long preclinical stage; (3) frequent fetal involvement; (4) clinical manifestations that are often adaptive in nature; and (5) gene-environment interactions that may predispose to the syndromes. This article reviews the evidence indicating that the pathological processes implicated in the preterm parturition syndrome include: (1) intrauterine infection/inflammation; (2) uterine ischaemia; (3) uterine overdistension; (4) abnormal allograft reaction; (5) allergy; (6) cervical insufficiency; and (7) hormonal disorders (progesterone related and corticotrophin-releasing factor related). The implications of this conceptual framework for the prevention, diagnosis, and treatment of preterm labour are discussed.
Collapse
Affiliation(s)
- R Romero
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Bresson L, Massoni S, Jailloux-Beaurain C, Bissinger MC, Subtil D, Husson MO, Courcol R, Fruchart A. Autoprélèvement vaginal à la recherche d'une vaginose bactérienne pendant la grossesse : étude pilote. ACTA ACUST UNITED AC 2006; 34:701-5. [PMID: 16919493 DOI: 10.1016/j.gyobfe.2006.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Accepted: 06/28/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the feasibility of a screening for bacterial vaginosis by a self-collected vaginal swab during pregnancy. To measure bacterial vaginosis prevalence in a non-representative sample of women. PATIENTS AND METHODS A self-collected swab was suggested to 398 women who consulted between 15 and 33 weeks of gestation in three different centres. Gram stain evaluation using Nugent criteria was used for the diagnosis of bacterial vaginosis. RESULTS Three hundred and forty-one women agreed to take part in the study (86%). The quality of the swabs was satisfactory in 93% of the cases. Concerning the 15 non-interpretable slides, the cellular and bacterial density was too poor, owing to a poor quality or a low vaginal flora. Thirty-one women (9%) had a bacterial vaginosis--Nugent score included between 7 and 10--and this frequency did not vary according to the centre. Thirty-five women (10%) had an intermediate flora--score between 4 and 6--and this result varied from 2 to 12% depending on the centre, but the difference was not significant. DISCUSSION AND CONCLUSION Self-collected swabs to detect bacterial vaginosis are well accepted by most of pregnant women, and the quality of the swabs seems to be satisfactory. In case vaginal flora is intermediate--between 4 and 6--the interpretation of the slides could be difficult.
Collapse
Affiliation(s)
- L Bresson
- Service de gynécologie-obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, université Lille-II, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Goto A, Nguyen QV, Pham NM, Kato K, Cao TPN, Le THC, Hoang QK, Le TQN, Nguyen BT, Katsube M, Ishii S, Yasumura S. Prevalence of and factors associated with reproductive tract infections among pregnant women in ten communes in Nghe An Province, Vietnam. J Epidemiol 2005; 15:163-72. [PMID: 16195636 PMCID: PMC7904302 DOI: 10.2188/jea.15.163] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A community-based survey was conducted to investigate reproductive tract infections (RTIs) among pregnant women in Vietnam, where epidemiologic data on these infections are scarce. METHODS The focus of the study were: candidiasis, bacterial vaginosis, group B streptococcal infection,trichomoniasis, gonorrhea, syphilis, and hepatitis B. In addition to their prevalence, a generalized estimating equation was used to analyze infection-associated factors and diagnostic test analysis to examine the accuracy of currently performed presumptive clinical diagnoses. RESULTS Among 505 pregnant women in 10 communes, 182 (36%) had at least one infection with a wide regional variation in prevalence. The most prevalent infection was candidiasis (17%); sexually transmitted infections were rare except hepatitis B (10%); and the prevalence of bacterial vaginosis and group B streptococcal infections was 7% and 4%, respectively. Two factors were associated with the decreased risk of endogenous infections: a higher household assets score (odds ratio [OR] = 0.67) and condom use (OR = 0.15). Not living with a husband (OR = 1.55) was associated with an increased risk. For hepatitis B, three factors were associated with a decreased risk: employment by the government (OR = 0.26), higher education (OR = 0.18), and being older at the time of first sexual intercourse (OR = 0.58). Women's self-reported symptoms and clinical findings had low positive predictive values. Only clinical findings from the vaginal wall showed both a sensitivity and specificity over 50%. CONCLUSIONS Suggested recommendations are: extensive application of microscopic diagnosis, prevention of hepatitis B transmission, and addressing the issues of regional differences in the prevalence of RTI and of less wealthy people.
Collapse
Affiliation(s)
- Aya Goto
- Department of Public Health, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima 960-1295, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Bacterial vaginosis is the most common lower genital tract infection among women of reproductive age. It has been associated with a number of significant obstetric and gynecologic complications, such as preterm labor and delivery, preterm premature rupture of membranes, spontaneous abortion, chorioamnionitis, postpartum endometritis, postcesarean delivery wound infections, postsurgical infections, and subclinical pelvic inflammatory disease. This article focuses on bacterial vaginosis in pregnancy, and discusses approaches to diagnosis, screening, and management.
Collapse
Affiliation(s)
- Mark H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, 15 Cardinal Carter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
| |
Collapse
|
25
|
Abstract
Mothers at increased risk of preterm birth often receive glucocorticoids (GC), antibiotics and tocolytics by the obstetrician but the question is whether such interventions affect the risk of brain injury and neurological outcome. We suggest that one single course of antenatal GC is the most important treatment that can be offered to patients at risk of preterm birth at 24-34 weeks of gestation to prevent brain injury. Betamethasone seems advantageous to dexamethasone and repeated courses of GC should probably be avoided. Antibiotics given to patients with preterm premature rupture of membranes reduce neonatal morbidity and decrease the risk of sonographic cerebral abnormalities even though the effect on long-term neurological outcome is uncertain. From the perspective of the immature CNS, there is no evidence for treatment with tocolytics even though it allows transfer of the patient to a tertiary center and increases the likelihood of administration of a complete course of corticosteroids which may affect outcome.
Collapse
Affiliation(s)
- Henrik Hagberg
- Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska Academy, East Hospital, 416 85 Göteborg, Sweden.
| | | |
Collapse
|
26
|
Abstract
In industrialized countries, 5-11% of infants are born preterm (<37 weeks' gestation), and the rate has been increasing since the early 1980s. Preterm births account for 70% of neonatal deaths and up to 75% of neonatal morbidity, and contribute to long-term neurocognitive deficits, pulmonary dysfunction and ophthalmologic disorders. In the past several decades, major progress has been made in improving the survival of extremely premature newborns, mostly attributable to timely access to effective interventions that ameliorate prematurity-associated mortality and morbidity such as antenatal administration of corticosteroids and exogenous surfactant therapy, rather than preventing preterm births. However, the societal and healthcare costs to care for survivors with severe morbidity and neurological handicaps remain substantial. Future research should concentrate on the ways to reduce long-term health sequelae and developmental handicaps among survivors of infants born preterm, as well as elucidating the mechanisms and aetiology of preterm births.
Collapse
Affiliation(s)
- Shi Wu Wen
- OMNI Research Group, Department of Obstetrics & Gynecology, University of Ottawa, Ontario, Canada.
| | | | | | | |
Collapse
|
27
|
Vázquez F, Otero L, Ordás J, Junquera ML, Varela JA. [Up to date in sexually transmitted infections: epidemiology, diagnostic approaches and treatments]. Enferm Infecc Microbiol Clin 2004; 22:392-411. [PMID: 15355770 DOI: 10.1016/s0213-005x(04)73123-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last years, there have been important advances in sexually transmitted infections such as genome sequencing of Treponema pallidum, Chlamydia trachomatis or Mycoplasma genitalium; the new taxonomic position of Calymmatobacterium granulomatis; commercial diagnostic systems based on nucleic acid amplification; the emergence of quinolone resistance in Neisseria gonorrhoeae; new therapeutic approaches in vulvovaginal candidiasis that include boric acid; the demonstration that valacyclovir reduces the risk of transmission of genital herpes or the availability of immune-response modifier in the treatment of genital warts, and that are questions in the goal of this review. Viral hepatitis and HIV were no reviewed by space reasons.
Collapse
Affiliation(s)
- Fernando Vázquez
- Servicio de Microbiología, Hospital Monte Naranco, Departamento de Biología Funcional, Area de Microbiología, Facultad de Medicina, Universidad de Oviedo, Asturias, Spain.
| | | | | | | | | |
Collapse
|
28
|
Abstract
Vaginal immunity in response to microbial perturbation is still poorly understood and may be crucial for protection from adverse outcomes associated with bacterial vaginosis (BV). BV is the most prevalent vaginal disorder in adult women worldwide. However, its pathogenesis is still elusive. In BV-positive women, inflammatory signs are scant--approximately 50% of women are asymptomatic. The number of vaginal neutrophils in the BV-positive patient is not increased with respect to healthy women. In contrast, vaginal interleukin (IL)-1beta levels are largely increased. Recent findings indicate that microbial hydrolytic enzymes could be responsible for dampening the expected proinflammatory response cascade after IL-1beta increase. In other words, BV causes a large increase of vaginal IL-1beta, which is not paralleled by an increase of IL-8 levels, suggesting that BV-associated factors specifically dampen IL-8. The impairment of IL-8 increase may explain the absence of neutrophil increase in most women exposed to a massive abnormal anaerobic vaginal colonization (BV). Among BV-positive women, vaginal innate immunity is strongly correlated to a specific adaptive immune response: the immunoglobulin A (IgA) against the hemolysin produced by Gardnerella vaginalis (anti-Gvh IgA), which is the main bacterium present in BV. High anti-Gvh IgA levels are protective for adverse pregnancy outcomes. However, an exaggerated inflammatory response, mainly attributed to genetic polymorphisms, is also implicated in BV-associated adverse outcomes.
Collapse
Affiliation(s)
- Sabina Cauci
- Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy.
| |
Collapse
|
29
|
Affiliation(s)
- Erica Weir
- Kingston, Frontenac and Lennox & Addington Health Unit, Kingston, Ont
| |
Collapse
|
30
|
Affiliation(s)
- Deirdre J Murphy
- Maternal and Child Health Sciences, Ninewells Hospital and Medical School, Dundee
| | | | | |
Collapse
|
31
|
Affiliation(s)
- Anna Alanen
- Department of Obstetrics and Gynaecology, University of Turku, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland.
| |
Collapse
|
32
|
Kiss H, Petricevic L, Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ 2004; 329:371. [PMID: 15294856 PMCID: PMC509340 DOI: 10.1136/bmj.38169.519653.eb] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate whether a screening strategy in pregnancy lowers the rate of preterm delivery in a general population of pregnant women. DESIGN Multicentre, prospective, randomised controlled trial. SETTING Non-hospital based antenatal clinics. PARTICIPANTS 4429 pregnant women presenting for their routine prenatal visits early in the second trimester were screened by Gram stain for asymptomatic vaginal infection. In the intervention group, the women's obstetricians received the test results and women received standard treatment and follow up for any detected infection. In the control group, the results of the vaginal smears were not revealed to the caregivers. MAIN OUTCOME MEASURES The primary outcome variable was preterm delivery at less than 37 weeks. Secondary outcome variables were preterm delivery at less than 37 weeks combined with different birth weight categories equal to or below 2500 g and the rate of late miscarriage. RESULTS Outcome data were available for 2058 women in the intervention group and 2097 women in the control group. In the intervention group, the number of preterm births was significantly lower than in the control group (3.0% v 5.3%, 95% confidence interval 1.2 to 3.6; P = 0.0001). Preterm births were also significantly reduced in lower weight categories at less than 37 weeks and <or= 2500 g. Eight late miscarriages occurred in the intervention group and 15 in the control group. CONCLUSION Integrating a simple infection screening programme into routine antenatal care leads to a significant reduction in preterm births and reduces the rate of late miscarriage in a general population of pregnant women.
Collapse
Affiliation(s)
- Herbert Kiss
- Department of Obstetrics and Gynaecology, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | | | | |
Collapse
|
33
|
Abstract
OBJECTIVE The purpose of this study was to determine whether the vaginal cytokine concentration varies during the course of uncomplicated pregnancy. STUDY DESIGN Prenatal visits of healthy women to University Hospital Gasthuisberg, Leuven, Belgium were considered. Cytokine levels in vaginal washings from 30 unselected healthy women with uncomplicated pregnancies were monitored during pregnancy and compared with those from 62 nonpregnant healthy control subjects. Exclusion criteria included bacterial vaginosis, moderate or severe aerobic vaginitis, Trichomonas vaginalis, Candida vaginitis (wet mount or culture), gonorrhea, and Chlamydia. Interleukin-6, interleukin-8, interleukin-1beta, interleukin-1-receptor antagonist, leukemia inhibitory factor, and tumor necrosis factor were measured. Nonparametric Kruskal-Wallis and Welch tests were used for univariate analysis, and the Spearman rank test was used for multivariate analysis. RESULTS Compared with concentrations in nonpregnant women, interleukin-1beta concentrations were similar, but interleukin-1-receptor antagonist production was depressed throughout pregnancy. Vaginal interleukin-6 and interleukin-8 were less often discovered during pregnancy than outside pregnancy and dipped significantly in the middle trimester, to rise again to prepregnancy levels in the third trimester. Leukemia inhibitory factor was lower during the beginning of pregnancy (P=.038) but otherwise did not differ from nonpregnant values throughout pregnancy nor did tumor necrosis factor. Sexual activity could not explain these findings. CONCLUSION Vaginal cytokine levels, especially interleukin-1 receptor antagonist, from pregnant women may differ from nonpregnant values; some levels, such as interleukin-6 and interleukin-8, may fluctuate during normal pregnancy. These spontaneous variations during pregnancy must be taken into account when mucosal immunologic responses to infection of the lower genital tract are being studied.
Collapse
Affiliation(s)
- Gilbert G G Donders
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 45, Leuven 3000, Belgium.
| | | | | | | |
Collapse
|