Prevalence and Risk Factors for Infections in a Pregnant Adolescent Population

Maternal and Neonatal Outcomes of Cervical Colonization in Adolescent Pregnancies: A Brief Report

OBJECTIVE

This study examines early neonatal adaptation and birth complications in adolescents with term pregnancies who had positive cervical canal cultures upon hospital admission.

METHODS

This retrospective study analyzed data from 1 January 2015 to 15 November 2024. Conducted at Bonifraters Medical Center in Katowice, Poland, the study included 267 individuals, with 178 over the age of 19 and 89 under the age of 19.

RESULTS

Adolescents exhibited significantly higher rates of positive GBS cultures in the third trimester (62.92% vs. 38.20%; p < 0.001) than older individuals. Neonates of adolescent mothers experienced increased congenital pneumonia (7.87% vs. 1.12%; p = 0.012) and antibiotic administration (10.11% vs. 2.81%; p = 0.026). Lactation failure was markedly higher in adolescent mothers (10.11% vs. 1.12%; p = 0.002). Adolescents also showed more postpartum blood loss (median: 250 mL vs. 200 mL; p < 0.001) and more extended hospital stays (median: 3 vs. 2 days; p = 0.002). Neonatal anthropometric measures revealed shorter body lengths in the adolescent group (median: 53 cm vs. 54 cm; p = 0.003).

CONCLUSIONS

Adolescent pregnancies are associated with significantly higher rates of complications and adverse neonatal outcomes, especially infectious causes. Although our study results are preliminary, it appears that chronic GBS colonization in pregnant adolescents may impact pregnancy and newborn outcomes.

Prevalence, Antimicrobial Susceptibility Pattern and Associated Factors of Group B Streptococcus Among Pregnant Women Attending Antenatal Care at Bule Hora University Teaching Hospital, Southern Ethiopia

Background

In many parts of the world, Group B Streptococcus (GBS) is a major cause of maternal and neonatal illness and mortality. It has a negative impact on neonatal and pregnancy outcomes. A worrisome problem in Ethiopia is the unknown rate of antibiotic resistance and the risk factors connected to GBS infections.

Objective

This study was to determine the prevalence, antibiotic susceptibility pattern, and related variables of Group B Streptococcus among pregnant women receiving prenatal treatment conducted at Bule Hora University Teaching Hospital, Southern Ethiopia, between June 1 and August 30, 2022.

Methods

An institutional-based cross-sectional study was conducted among 213 pregnant women attending antenatal care at Bule Hora University Teaching Hospital. Data on sociodemographic and related factors were gathered using structured questionnaires. The study's participants were selected using the consecutive sampling method. The lower vaginal/rectum area was brushed with a sterile cotton swab to capture the vaginal/rectum swab sample, which was then examined using microbiological techniques. The Kirby-Bauer disc diffusion method was used to assess antibiotic susceptibility in GBS isolates. Logistic regression analysis was performed on the data using SPSS version 26. It was deemed statistically significant when the p-value was 0.05 with a 95% confidence interval (CI).

Results

The overall prevalence of GBS was 16.9% (CI: 0.12-0.23). A history of prematurity of the membrane (AOR: 3.35, 95% CI: 1.19-9.45), a history of stillbirth (AOR: 2.88, 95% CI: 1.07-7.71), and preterm delivery history (AOR: 3.41, 95% CI: 1.31-8.89) (p 0.05) were independent predictors of GBS infection. Cefepime had the highest resistance at 58.3%. Most GBS isolates showed high susceptibility to vancomycin (97.2%) and ampicillin (91.7%). Multidrug resistance was 13.9%.

Conclusion

The prevalence of GBS was considerably high among pregnant women in this study. This finding emphasises the need for routine screening and testing of antimicrobial susceptibility to provide antibiotic prophylaxis and minimise newborn infection and comorbidity.

A randomized controlled trial of an oral probiotic to reduce antepartum group B Streptococcus colonization and gastrointestinal symptoms

BACKGROUND

Probiotics have been suggested as a strategy to reduce antenatal group B Streptococcus colonization. Although probiotics are known to improve gastrointestinal symptoms, this has not been studied during pregnancy.

OBJECTIVE

This study aimed to evaluate the efficacy of a probiotic to reduce: (1) standard-of-care antenatal group B Streptococcus colonization and colony counts and (2) gastrointestinal symptoms of pregnancy.

STUDY DESIGN

In a double-blind fashion, 109 healthy adult pregnant people were randomized to Florajen3 probiotic or placebo capsules once daily from 28 weeks' gestation until labor onset. Baseline vaginal and rectal study swabs for group B Streptococcus colony-forming units and microbiome analysis were collected at 28 and 36 weeks' gestation. Standard-of-care vaginal to rectal group B Streptococcus swabs were collected from all participants at 36 weeks' gestation and determined the need for intrapartum antibiotic prophylaxis. Data collection included solicitation of adverse events, demographic information, Antepartum Gastrointestinal Symptom Assessment score, yogurt ingestion, sexual activity, and vaginal cleaning practices.

RESULTS

A total of 83 participants completed the study to 36 weeks' gestation with no adverse events. Standard-of-care group B Streptococcus colonization was 20.4% in the control group and 15.4% in probiotic group participants (-5%; P=.73). The relative risk for positive standard-of-care vaginal-rectal group B Streptococcus colonization was 1.33 (95% confidence interval, 0.5-3.40) times higher in the control group than in the probiotic group (P=.55). There were no differences in median vaginal (P=.16) or rectal (P=.20) group B streptococcus colony-forming units at baseline or at 36 weeks (vaginal P>.999; rectal P=.56). Antepartum Gastrointestinal Symptom Assessment scores were similar at baseline (P=.19), but significantly decreased in probiotic group participants at 36 weeks (P=.02). No covariates significantly altered group B Streptococcus colonization. Significantly more Florajen3 bacteria components were recovered from the vaginal-rectal samples of probiotic group participants (32%; P=.04) compared with controls.

CONCLUSION

The findings of this study provided insufficient evidence for the clinical application of the Florajen3 probiotic intervention to reduce standard-of-care vaginal-rectal group B Streptococcus colonization. The prevalence of group B Streptococcus was lower than expected in the study population, and intervention adherence was poor. Probiotic bacteria colonization of the genitourinary tract occurred more in intervention group participants than in controls and significantly reduced gastrointestinal symptoms of pregnancy.

Antimicrobial Resistance Profile and Associated Factors of Group B Streptococci Colonization among Pregnant Women Attending Antenatal Clinics in Jigjiga, Southeast Ethiopia

Background

Streptococcus agalactiae (group B Streptococcus, GBS) is one of the causes of maternal and neonatal morbidity and mortality in many parts of the world. It is associated with severe maternal and neonatal outcomes. The colonization rate, associated factors, and antimicrobial sensitivity (AST) profile of GBS among pregnant women in Eastern Ethiopia is less studied.

Methods

A cross-sectional study was conducted from 1^st  March to 30^th May, 2021 in Jigjiga. A total of 182 pregnant women with a gestational period of ≥36 weeks were included. A structured questionnaire was used to collect data on the participants' demographic and clinical history. Vaginal-rectal samples were collected by brushing the lower vagina and rectum with a sterile cotton swab for bacteriological culture. An antimicrobial sensitivity test (AST) was performed using the Kary-Bauer disk diffusion method. Data were entered and analyzed using SPSS version 25. The logistic regression model was used to find out factors associated with GBS colonization.

Results

GBS colonization among pregnant women attending antenatal care was at 15.9% (29/182). The AST result showed that the majority of the isolates were sensitive to vancomycin (96.6%), chloramphenicol (96.6%), ampicillin (93.1%) azithromycin (89.7%), and penicillin (86.2%). In contrast, the isolates were found to be resistant to ceftriaxone, erythromycin, ciprofloxacin, clindamycin, and tetracycline at 17.2%, 20.7%, 27.6%, 27.6%, and 34.5%, respectively. Multidrug resistance (MDR) was noted in 4 isolates (13.79%). GBS colonization was significantly associated a with history of preterm labor (<37 weeks of gestation) (AOR = 3.87, 95% CI = 1.36–10.9) and a history of prolonged ruptured membrane (>18 hr.) (AOR = 3.44, 95% CI = 1.34–8.83).

Conclusions

The colonization rate of GBS was considerably high among pregnant women attending antenatal care in the present study area. The observed antimicrobial resistance for the common drugs and the reported MDR level calls for routine screening of pregnant women for GBS and actions to minimize antimicrobial resistance (AMR) should be strengthened.

Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis

OBJECTIVE

To systematically review and meta-analyse studies of the efficacy of probiotics to reduce antenatal Group B Streptococcus (GBS) colonisation.

PARTICIPANTS

Antenatal participants with known positive GBS colonisation or unknown GBS status.

INTERVENTION

Probiotic interventions containing species of Lactobacillus or Streptococcus.

DESIGN

Systematic review and meta-analysis.

MEASUREMENTS AND FINDINGS

The systematic review included 10 studies. Five articles contained in vitro studies of probiotic interventions to determine antagonistic activity against GBS. Six clinical trials of probiotics to reduce antenatal GBS were systematically reviewed and meta-analysed. The meta-analysis revealed that the use of an antenatal probiotic increased the probability of a negative GBS result by 79% (OR = 0.56, 95% CI = 8.7%, 194.1%, p = 0.02) (n = 709). However, only one clinical trial of 6 had a low risk of bias.

KEY CONCLUSIONS

The probiotic interventions subjected to in vitro testing showed antagonistic activity against GBS through the mechanisms of acidification, immune modulation, and adhesion. The findings of the meta-analysis of the clinical trials revealed that probiotics are a moderately effective intervention to reduce antenatal GBS colonisation. More well-controlled trials with diverse participants and with better elucidation of variables influencing GBS colonisation rates are needed.

IMPLICATIONS FOR PRACTICE

Probiotic interventions appear to be a safe and effective primary prevention strategy for antenatal GBS colonisation. Application of this low-risk intervention needs more study but may reduce the need for intrapartum antibiotic prophylaxis in countries or regions where antenatal GBS screening is used. Midwives can be instrumental in conducting and supporting larger well-controlled clinical trials.

Gonorrhoea: a systematic review of prevalence reporting globally

BACKGROUND

The World Health Organization (WHO) recommends periodic gonorrhoea prevalence assessments in the general population or proxies thereof (including pregnant women, women attending family planning clinics, military recruits, and men undergoing employment physicals for example) and in population groups at increased risk, including men-who-have-sex-with-men (MSM) and sex workers.

METHOD

We evaluated reported prevalence data, including estimates from proxy general population samples to reflect the WHO recommendations. We describe the outcomes from the general population country-by-country and extend previous reviews to include MSM, sex workers, and extragenital infections.

RESULT AND CONCLUSION

In our systematic search, 2015 titles were reviewed (January 2010-April 2019) and 174 full-text publications were included. National, population-based prevalence data were identified in only four countries (the United States of America, the United Kingdom, Peru, New Caledonia) and local population-based estimates were reported in areas within five countries (China, South Africa, Brazil, Benin, and Malawi). The remaining studies identified only reported test positivity from non-probability, proxy general population samples. Due to the diversity of the reviewed studies, detailed comparison across studies was not possible. In MSM, data were identified from 64 studies in 25 countries. Rectal infection rates were generally higher than urogenital or pharyngeal infection rates, where extragenital testing was conducted. Data on sex workers were identified from 41 studies in 23 countries; rates in female sex workers were high. Current prevalence monitoring was shown to be highly suboptimal worldwide. Serial prevalence monitoring of critical epidemiological variables, and guidelines to optimize prevalence study conduct and reporting beyond antenatal settings are recommended.

Complications of Pregnancy in Adolescents

Teenage pregnancy is a complex issue that can have negative socioeconomic and health outcomes. About 11% of births worldwide are by adolescents aged between 15 and 19 years and middle- and low-income countries account for more than 90% of these births. Despite the downward trend in international adolescent pregnancy rates, 10 million unplanned adolescent pregnancies occur annually. Adolescents are also at increase risks of poor obstetric outcomes including preterm delivery, low birth weight, eclampsia, postpartum hemorrhage, anemia, and infant, as well as maternal morbidity. Important additional considerations include increased risk of depression, poor social support, and the need for a multidisciplinary approach to their obstetric care. We look to highlight both the unique socioeconomic and medical factors to consider when caring for these patients and demonstrate that these factors are intertwined.

Nonviral sexually transmitted infections in pregnancy: current controversies and new challenges

PURPOSE OF REVIEW

This review provides an update of nonviral, curable sexually transmitted infections (STIs) in pregnancy and summarizes our understanding of the current issues and controversies surrounding risk factors, screening, and treatment of STIs in pregnancy primarily in high-income countries (using the United States and the United Kingdom as examples). The infections covered in this review are syphilis, gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium infections.

RECENT FINDINGS

Overall, limited modern data is available to update researchers and clinicians on the epidemiology and care of STIs in pregnancy. Though common risk factors can be identified among these STIs, like socioeconomic status and inadequate antenatal care, specific screening and treatment challenges vary by geography and pathogen. Wherever available, surveillance data and research evidence are often limited to nonpregnant patients, leading to imperfect pregnancy-specific risk estimates and obstetric lags in the development and adoption of new guidelines. We have identified three areas of opportunity that may enhance the effectiveness of current approaches and inform new ones: improved data collection and evidence-based screening practices; prompt and comprehensive therapy, including partner services, and evaluations of new treatment modalities; and equitable antenatal and sexual healthcare for all pregnant persons and their partners.

SUMMARY

These findings highlight the need to revisit standards of screening and management of STIs in pregnancy in high-income countries.

A Prospective Cohort Study of the Association Between Body Mass Index and Incident Bacterial Vaginosis

Some studies suggest that higher body mass index is associated with increased susceptibility to bacterial vaginosis (BV), but results are conflicting.

METHODS

Female sex workers aged 16 to 45 years and participating in an open, prospective cohort study in Mombasa, Kenya between 2000 and 2014 were included in this analysis. Up to 2 years of follow-up were included per woman. Body mass index (BMI) was categorized as underweight (≤18.5), normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Bacterial vaginosis was assessed using Nugent scores. Generalized estimating equations were used to estimate relative risks of the association between BMI and BV.

RESULTS

At baseline, 32.1% (n = 625) of 1946 women had BV. Half of women were overweight (31.1%, n = 606) or obese (20.1%, n = 391). Participants contributed 14,319 follow-up visits. Adjusting for age, compared to women with normal BMI, overweight (adjusted relative risk, 0.91; 95% confidence interval, 0.81-1.02) and obese (adjusted relative risk, 0.82; 95% confidence interval, 0.71-0.94) women were at lower risk for BV (joint P = 0.03).

CONCLUSIONS

Obese women had a nearly 20% lower risk of BV compared with women with normal BMI. Potential mechanisms for this effect, including possible effects of diet, obesity-associated changes in the gut microbiome, and systemic estrogen levels, should be explored.

Multimodality Screening for Lower Genital Tract Infections Between 18 and 24 Weeks of Pregnancy and its Efficacy in Predicting Spontaneous Preterm Delivery

BACKGROUND

Predicting spontaneous preterm birth (SPTB) during mid-trimester would be very useful. We used a multimodality screening approach mainly focusing on urogenital infections among unselected obstetric population between 18 and 24 weeks in a tertiary center.

METHOD

Diagnosis of lower genital tract infection (LGTI) was attempted among 228 pregnant women using several factors-symptom of vaginal discharge, characteristic appearance of discharge on speculum, point of care tests using Amsel's criteria and gram staining of vaginal swab. Nugent's scoring was taken as gold standard. Urine microscopy/culture was obtained. Serum inflammatory markers were done. Total leukocyte count, neutrophil/lymphocyte ratio and C-reactive protein were obtained. Data on cervical length were obtained from mid-trimester scan.

RESULTS

Thirty patients complained of vaginal discharge. Speculum examination revealed discharge in 221 (96.92%), appearing pathological in 192 (86.87%). Amsel's criteria showed poor sensitivity to detect full (57%) and partial (24%) bacterial vaginosis (BV). On gram staining, 104 (45.61%) showed evidence of LGTI; 14 full BV (6.1%); 45 partial BV (19.5%); 40 candidiasis (17.5%); and two each of trichomoniasis and aerobic vaginitis. Appearance of vaginal discharge and microscopic diagnosis of LGTI were poorly correlated. Forty women (17.5%) had SPTB, 24 following membrane rupture and 16 following spontaneous labor. The presence of BV (specifically partial) increased the likelihood of SPTB with OR of 3.347 (CI 1.642, 6.823). Three of seven women with short cervix delivered preterm. No other screening modality was associated with SPTB.

CONCLUSION

Active screening for LGTI between 18 and 24 weeks shows high prevalence of BV in Indian setting. There is a strong link between partial BV and SPTB.

Associations Between Latent Classes of Interpersonal Polyvictimization and Polyperpetration and Sexual Risk Behaviors Among Young Pregnant Couples: A Dyadic Analysis

Interpersonal violence victimization and perpetration have been associated with sexual risk behaviors among adolescents and young adults, but research is lacking on: (1) how patterns of interpersonal polyvictimization and polyperpetration are associated with sexual risk among young pregnant couples, and (2) how individual and partner experiences of violence differentially impact sexual risk. The current analyses used baseline data from a longitudinal study that followed 296 pregnant young couples from pregnancy to 12 months postpartum. Couples were recruited at obstetrics and gynecology clinics, and an ultrasound clinic in the U.S. Latent class analysis identified subgroups based on polyvictimization and polyperpetration. Using the Actor-Partner Interdependence Model, path analyses assessed actor-partner effects of class membership on sexual risk. Three latent classes were used for women: Class 1: Polyvictim-Polyperpetrator; Class 2: Nonvictim-Nonperpetrator; and Class 3: Community and Prior IPV Victim. Four latent classes were used for men: Class 1: Community and Prior IPV Victim; Class 2: Polyvictim-Nonpartner Perpetrator; Class 3: Prior IPV and Peer Victim; and Class 4: Nonvictim-Nonperpetrator. Path analyses revealed that females in Class 2 and their male partners had higher condom use than females in Class 3. Males in Class 2 had more sexual partners than males in Class 1. Among nonmonogamous couples, males in Class 2 were less likely to be involved with a female partner reporting unprotected sex than males in Class 1. Among nonmonogamous couples, females in Class 2 had more acts of unprotected sex than females in Class 1. Males in Class 4 were less likely to have concurrent sexual partners compared to males in Class 1. Risk reduction interventions should address both victimization and perpetration. Additional research is needed to understand how mechanisms driving differential sexual risk by patterns of interpersonal polyvictimization and polyperpetration.

Use of copper intrauterine device is not associated with higher bacterial vaginosis prevalence in Thai HIV-positive women

The study assessed and compared bacterial vaginosis (BV) prevalence in Thai women in reproductive age in four study groups - group 1, HIV-positive with copper intrauterine device (Cu-IUD); group 2, HIV-positive without Cu-IUD; group 3, HIV-negative with Cu-IUD; and group 4, HIV-negative without Cu-IUD. We conducted a cross-sectional study. BV prevalence was assessed by Nugent score and Amsel criteria. Descriptive statistics was used to present baseline characteristics; kwallis rank test - to compare variables between the four groups; logistic regression - to assess factors, related to BV prevalence. The analysis included 137 women in the four study groups with a median age of 39 years. Median BV prevalence by Nugent score was 45%, intermediate vaginal flora - 7% and normal vaginal flora - 48%. There was no statistically significant difference in the BV prevalence between the four study groups, p = 0.711. Threefold lower BV prevalence was found, assessed by Amsel criteria compared to Nugent score. Women with body mass index (BMI) < 20 had higher probability to have BV or intermediate vaginal flora, OR = 3.11, 95% CI (1.2-8.6), p = 0.025. The study found a high BV prevalence in the four study groups, related neither to HIV status, nor to Cu-IUD use. BV prevalence was associated only with low BMI. Thus, Cu-IUD could be a good contraceptive choice for HIV-positive women. Research in defining normal vaginal microbiota and improve diagnostic methods for BV should continue.

Intimate Partner Violence, Sexual Autonomy and Postpartum STD Prevention Among Young Couples: A Mediation Analysis

CONTEXT

The transition to parenthood is a stressful time for young couples and can put them at risk for acquiring STDs. Mechanisms underlying this risk-particularly, intimate partner violence (IPV) and sexual autonomy-have not been well studied.

METHODS

Between 2007 and 2011, a prospective cohort study of the relationships and health of pregnant adolescents and their male partners recruited 296 couples at four hospital-based obstetrics and gynecology clinics in the U.S. Northeast; participants were followed up six and 12 months after the birth. Structural equation modeling identified associations among IPV at baseline and six months, sexual autonomy at six months and STD acquisition at 12 months. Mediating effects of sexual autonomy were tested via bootstrapping.

RESULTS

Females were aged 14-21, and male partners were 14 or older. For females, IPV victimization at baseline was positively associated with the likelihood of acquiring a postpartum STD (coefficient, 0.4); level of sexual autonomy was inversely associated with the likelihood of acquiring an STD and of having a male partner who acquired one by the 12-month follow-up (-0.4 for each). For males, IPV victimization at baseline was negatively correlated with a female partner's sexual autonomy (-0.3) and likelihood of acquiring an STD (-0.7); victimization at six months was positively related to a partner's sexual autonomy (0.2). Sexual autonomy did not mediate these relationships.

CONCLUSIONS

Females' sexual autonomy appears to protect against postpartum STDs for both partners. Future research should explore the efficacy of IPV-informed approaches to improving women's sexual and reproductive health.

Factors influencing access of pregnant women and their infants to their local healthcare system: a prospective, multi-centre, observational study

Background

The successful implementation of maternal vaccination relies on results of clinical trials, considering the prenatal and postnatal attendance at selected healthcare institutions. This study evaluated factors influencing maternal/infant access to healthcare facilities to identify potential barriers to participation in future clinical trials on maternal vaccination.

Methods

In this prospective, multi-centre, observational study, pregnant women (N = 3243) were enrolled at ten sites across Panama, the Dominican Republic, South Africa, and Mozambique between 2012 and 2014. They completed questionnaires at enrolment, delivery, and infant follow-up (90 days post-partum) visits, including questions on transportation, phone accessibility, alternative childcare, gestational age at enrolment, delivery location, and health status of their infant. Logistic regression was used to identify factors significantly associated with return to study site for delivery or infant follow-up visits.

Results

Among 3229 enrolled women with delivery information, 63.6% (range across sites: 25.3–91.5%) returned to study site for delivery. Older women and those at later gestational age at enrolment were more likely to deliver at the study site. While heterogeneities were observed at site level, shorter travel time at delivery and increased transportation costs at enrolment were associated with increased likelihood of women returning to study site for delivery. Among 3145 women with live-born infants, 3077 (95.3%) provided 90-day follow-up information; of these, 68.9% (range across sites: 25.6–98.9%) returned to study site for follow-up visits. Women with other children and with lower transportation costs at delivery were more likely to return to study site for follow-up visits. Among 666 infants reported sick, 94.3% were taken to a healthcare facility, with only 41.9% (range across sites: 4.9–77.3%) to the study site.

Conclusion

Although high retention was observed from enrolment through 90 days after delivery, post-partum surveillance should be broadened beyond the study sites and additional follow-up visits should be planned within the neonatal period. The factors influencing maternal/infant access to healthcare facilities and the issues identified in this study should be taken into consideration in planning future clinical studies on maternal immunisation in low- and middle-income countries.

Trial registration

The study was registered at ClinicalTrial.gov (NCT01734434) on November 22, 2012.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1655-3) contains supplementary material, which is available to authorized users.

Group B Streptococcal Maternal Colonization and Neonatal Disease: Molecular Mechanisms and Preventative Approaches

Group B Streptococcus (GBS) colonizes the gastrointestinal and vaginal epithelium of a significant percentage of healthy women, with potential for ascending intrauterine infection or transmission during parturition, creating a risk of serious disease in the vulnerable newborn. This review highlights new insights on the bacterial virulence determinants, host immune responses, and microbiome interactions that underpin GBS vaginal colonization, the proximal step in newborn infectious disease pathogenesis. From the pathogen perspective, the function GBS adhesins and biofilms, β-hemolysin/cytolysin toxin, immune resistance factors, sialic acid mimicry, and two-component transcriptional regulatory systems are reviewed. From the host standpoint, pathogen recognition, cytokine responses, and the vaginal mucosal and placental immunity to the pathogen are detailed. Finally, the rationale, efficacy, and potential unintended consequences of current universal recommended intrapartum antibiotic prophylaxis are considered, with updates on new developments toward a GBS vaccine or alternative approaches to reducing vaginal colonization.

Low Vitamin D is Associated With Infections and Proinflammatory Cytokines During Pregnancy

Vitamin D is known to regulate innate and adaptive immune processes at the cellular level, but the role of vitamin D status on associated inflammatory processes across pregnancy is unclear. Our primary objective was to evaluate the relationships between serum biomarkers of inflammation (interleukin [IL]-6, IL-10, tumor necrosis factor [TNF]-α), acute-phase proteins (C-reactive protein and hepcidin) and vitamin D status, 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)₂D), measured across pregnancy and in the neonate at birth. A second objective was to identify associations between vitamin D status and clinically diagnosed infections. In this study, 158 racially and ethnically diverse pregnant adolescents were recruited from the Rochester Adolescent Maternity Program (RAMP) in Rochester, NY. Serum 1,25(OH)₂D was significantly lower in adolescents and neonates with IL-6 concentrations above the 75th percentile at delivery ( P = .04) and at birth ( P = .004), respectively. After adjusting for other potential covariates of inflammation, maternal serum 1,25(OH)₂D was significantly positively associated with TNF-α during pregnancy ( P = .02), but at delivery 1,25(OH)₂D and TNF-α were inversely associated with one another ( P = .02). Teens with 25(OH)D concentrations <30 ng/mL were more likely to test positive for candida ( P = .002) and bacterial vaginosis ( P = .02) during pregnancy. African Americans exhibited significantly lower TNF-α concentrations at both mid-gestation ( P = .009) and delivery ( P = .001) compared to the Caucasian adolescents. These results suggest that lower maternal vitamin D status may increase risk of infection across gestation.

Vitamin D mediates the relationship between placental cathelicidin and group B streptococcus colonization during pregnancy

Vitamin D is thought to modulate innate immune responses, and recent studies have highlighted the autocrine and paracrine functions of vitamin D in the placenta. Our objective was to determine the relationship between maternal vitamin D status and placental antimicrobial peptide (AMP) expression in a group of racially and ethnically diverse pregnant adolescents. In this study, 158 pregnant adolescents were recruited from the Rochester Adolescent Maternity Program (RAMP) in Rochester, NY. Maternal serum concentrations of the vitamin D biomarkers, 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)₂D), were measured at mid-gestation (∼26 weeks) and at delivery. At the placental level, vitamin D regulatory proteins (cubilin, megalin, 1α-hydroxylase (CYP27B1), 24-hydroxylase (CYP24A1), vitamin D receptor (VDR)) and AMPs (cathelicidin and hepcidin) were analyzed using quantitative PCR and western blot techniques. Placental CYP27B1 mRNA expression was significantly positively associated with both placental cathelicidin mRNA expression (P<0.0001) and placental hepcidin mRNA expression (P=0.002). In teens with positive recto-vaginal group B streptococcus (GBS) colonization, placental mRNA expression of cathelicidin (P=0.007), cubilin (P=0.03), and CYP27B1 (P=0.04) were significantly lower compared to those who tested negative for this infection. A mediation analysis showed that the indirect relationship between GBS colonization and placental cathelicidin mRNA expression was mediated by the placental mRNA expression of the vitamin D proteins cubilin and CYP27B1 (P=0.02). Additional research is needed to identify the role and relative contributions of placental and systemic vitamin D metabolites in relation to potentially pathogenic microorganisms which may be present during pregnancy.