1
|
Bretelle F, Loubière S, Desbriere R, Loundou A, Blanc J, Heckenroth H, Schmitz T, Benachi A, Haddad B, Mauviel F, Danoy X, Mares P, Chenni N, Ménard JP, Cocallemen JF, Slim N, Sénat MV, Chauleur C, Bohec C, Kayem G, Trastour C, Bongain A, Rozenberg P, Serazin V, Fenollar F. Effectiveness and Costs of Molecular Screening and Treatment for Bacterial Vaginosis to Prevent Preterm Birth: The AuTop Randomized Clinical Trial. JAMA Pediatr 2023; 177:894-902. [PMID: 37459059 PMCID: PMC10352927 DOI: 10.1001/jamapediatrics.2023.2250] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023]
Abstract
Importance Bacterial vaginosis (BV) is a well-known risk factor for preterm birth. Molecular diagnosis of BV is now available. Its impact in the screening and treatment of BV during pregnancy on preterm births has not been evaluated to date. Objective To evaluate the clinical and economic effects of point-of-care quantitative real-time polymerase chain reaction screen and treat for BV in low-risk pregnant women on preterm birth. Design, Setting, and Participants The AuTop trial was a prospective, multicenter, parallel, individually randomized, open-label, superiority trial conducted in 19 French perinatal centers between March 9, 2015, and December 18, 2017. Low-risk pregnant women before 20 weeks' gestation without previous preterm births or late miscarriages were enrolled. Data were analyzed from October 2021 to November 2022. Interventions Participants were randomized 1:1 to BV screen and treat using self-collected vaginal swabs (n = 3333) or usual care (n = 3338). BV was defined as Atopobium vaginae (Fannyhessea vaginae) load of 108 copies/mL or greater and/or Gardnerella vaginalis load of 109 copies/mL or greater, using point-of-care quantitative real-time polymerase chain reaction assays. The control group received usual care with no screening of BV. Main Outcomes and Measures Overall rate of preterm birth before 37 weeks' gestation and total costs were calculated in both groups. Secondary outcomes were related to treatment success as well as maternal and neonate health. Post hoc subgroup analyses were conducted. Results Among 6671 randomized women (mean [SD] age, 30.6 [5.0] years; mean [SD] gestational age, 15.5 [2.8] weeks), the intention-to-treat analysis of the primary clinical and economic outcomes showed no evidence of a reduction in the rate of preterm birth and total costs with the screen and treat strategy compared with usual care. The rate of preterm birth was 3.8% (127 of 3333) in the screen and treat group and 4.6% (153 of 3338) in the control group (risk ratio [RR], 0.83; 95% CI, 0.66-1.05; P = .12). On average, the cost of the intervention was €203.6 (US $218.0) per participant, and the total average cost was €3344.3 (US $3580.5) in the screen and treat group vs €3272.9 (US $3504.1) in the control group, with no significant differences being observed. In the subgroup of nulliparous women (n = 3438), screen and treat was significantly more effective than usual care (RR, 0.62; 95% CI, 0.45-0.84; P for interaction = .003), whereas no statistical difference was found in multiparous (RR, 1.30; 95% CI, 0.90-1.87). Conclusion and Relevance In this clinical trial of pregnant women at low risk of preterm birth, molecular screening and treatment for BV based on A vaginae (F vaginae) and/or G vaginalis quantification did not significantly reduce preterm birth rates. Post hoc analysis suggests a benefit of screen and treat in low-risk nulliparous women, warranting further evaluation in this group. Trial Registration ClinicalTrials.gov Identifier: NCT02288832.
Collapse
Affiliation(s)
- Florence Bretelle
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
- Aix-Marseille Univ, IRD, Assistance Publique–Hopitaux de Marseille, UMRD-258 Microbes, Evolution, Phylogenie and Infection (MEPHI), Marseille, France
| | - Sandrine Loubière
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Fondation Hopital Saint Joseph, Marseille, France
| | - Anderson Loundou
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Julie Blanc
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Obstetrics and Gynecology, Hopital Nord, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Hélène Heckenroth
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Thomas Schmitz
- Service de Gynécologie Obstétrique, Assistance Publique–Hôpitaux de Paris Hôpital Robert Debré, Université Paris Cité, Paris, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, DMU Santé des Femmes et des nouveau-nés Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Clamart, France
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Université Paris Saclay, Clamart, France
| | - Bassam Haddad
- Centre Hospitalier de Créteil, Créteil, France
- Department of Obstetrics and Gynecology, Institut Mondor de Recherche Biomedicale, Université Paris Est Creteil, Centre Hospitalier Creteil, Creteil, France
| | - Franck Mauviel
- Department of Obstetrics and Gynecology, Centre hospitalier de Toulon sainte Musse, Toulon, France
| | - Xavier Danoy
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aix en Provence, Centre hospitalier de Pertuis, Aix en Provence, France
| | - Pierre Mares
- Departement of Obstetrics and Gynecology, Centre hospitalier universitaire de Nimes, Nimes, France
| | - Nawal Chenni
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aubagne, Aubagne, France
| | - Jean-Pierre Ménard
- Direction de la Protection Maternelle et Infantile et de la Promotion de la Santé, Conseil départemental du Val-de-Marne, Créteil, France
| | - Jean-François Cocallemen
- Departement de recherche clinique, Hopital Nord, Assistance hôpitaux de Marseille, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | | | - Marie Victoire Sénat
- Departement Gynécologie Obstétrique, Centre hospitalier Universitaire du Kremlin Bicetre, Kremlin Bicetre, France
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
| | - Céline Chauleur
- Service de Gynécologie-obstétrique, CHU de Saint Etienne, INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne, France
| | | | - Gilles Kayem
- Service de Gynécologie Obstétrique de l’hôpital Trousseau, Université Pierre et Marie Curie, INSERM U1153, Paris, France
| | - Cynthia Trastour
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - André Bongain
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - Patrick Rozenberg
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
- American Hospital of Paris, Neuilly-sur-Seine, France
| | - Valerie Serazin
- Service de Biologie Médicale, CHI de Poissy-Saint-Germain-en-Laye, Poissy, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Institut national de la recherche agronomique, Biologie de la Reproduction, Environnement, Epigénétique et Développement, Paris, France
| | - Florence Fenollar
- Department of Infectious Diseases, Hopital de la Timone, Assistance Publique–Hopitaux de Marseille, IHU-Méditerranée Infection, Marseille, France
- Aix-Marseille Univ, Institut recherche et développement, Assistance Publique–Hopitaux de Marseille, SSA, Vecteurs – Infections Tropicales et Méditeranéennes, Marseille, France
| |
Collapse
|
2
|
Haddad ME, Karlmark K, Donato XC, Martin G, Bretelle F, Lesavre N, Cocallemen JF, Martin M, Picard C, Roudier J, Desbriere R, Lambert NC. Corrigendum: Factors Predicting the Presence of Maternal Cells in Cord Blood and Associated Changes in Immune Cell Composition. Front Immunol 2021; 12:763236. [PMID: 34659269 PMCID: PMC8518619 DOI: 10.3389/fimmu.2021.763236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marina El Haddad
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Karlin Karlmark
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Xavier-Côme Donato
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Gabriel Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France
| | | | - Jean-François Cocallemen
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France
| | - Marielle Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Christophe Picard
- Centre National de la Recherche Scientifique (CNRS) UMR7268 (ADES), "Biologie des Groupes Sanguin", Marseille, France.,Etablissement Français du Sang (EFS), Marseille, France
| | - Jean Roudier
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France.,Service de Rhumatologie, Hôpital Sainte Marguerite, AP-HM, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Nathalie C Lambert
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| |
Collapse
|
3
|
Haddad ME, Karlmark KR, Donato XC, Martin GV, Bretelle F, Lesavre N, Cocallemen JF, Martin M, Picard C, Roudier J, Desbriere R, Lambert NC. Factors Predicting the Presence of Maternal Cells in Cord Blood and Associated Changes in Immune Cell Composition. Front Immunol 2021; 12:651399. [PMID: 33968049 PMCID: PMC8100674 DOI: 10.3389/fimmu.2021.651399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Cord blood (CB) samples are increasingly used as a source of hematopoietic stem cells in transplantation settings. Maternal cells have been detected in CB samples and their presence is associated with a better graft outcome. However, we still do not know what influences the presence of maternal microchimerism (MMc) in CB samples and whether their presence influences CB hematopoietic cell composition. Patients and Methods Here we test whether genetic, biological, anthropometric and/or obstetrical parameters influence the frequency and/or quantity of maternal Mc in CB samples from 55 healthy primigravid women. Mc was evaluated by targeting non-shared, non-inherited Human Leukocyte Antigen (HLA)-specific real-time quantitative PCR in whole blood and four cell subsets (T, B lymphocytes, granulocytes and/or hematopoietic progenitor cells). Furthermore CB samples were analyzed for their cell composition by flow cytometry and categorized according to their microchimeric status. Results MMc was present in 55% of CB samples in at least one cell subset or whole blood, with levels reaching up to 0.3% of hematopoietic progenitor cells. Two factors were predictive of the presence of MMc in CB samples: high concentrations of maternal serological Pregnancy-Associated-Protein-A at first trimester of pregnancy (p=0.018) and feto-maternal HLA-A and/or –DR compatibility (p=0.009 and p=0.01 respectively). Finally, CB samples positive for MMc were significantly enriched in CD56+ cells compared to CB negative for MMc. Conclusions We have identified two factors, measurable at early pregnancy, predicting the presence of maternal cells in CB samples at delivery. We have shown that MMc in CB samples could have an influence on the hematopoietic composition of fetal cells. CD56 is the phenotypic marker of natural killer cells (NK) and NK cells are known to be the main effector for graft versus leukemia reactions early after hematopoietic stem cell transplantation. These results emphasize the importance of MMc investigation for CB banking strategies.
Collapse
Affiliation(s)
- Marina El Haddad
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Karlin R Karlmark
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Xavier-Côme Donato
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Gabriel V Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France
| | | | - Jean-François Cocallemen
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France
| | - Marielle Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Christophe Picard
- Centre National de la Recherche Scientifique (CNRS) UMR7268 (ADES), "Biologie des Groupes Sanguins", Marseille, France.,Etablissement Français du Sang PACA Corse, Immunogenetics Laboratory, Marseille, France
| | - Jean Roudier
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France.,Service de Rhumatologie, Hôpital Sainte Marguerite, AP-HM, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Nathalie C Lambert
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| |
Collapse
|
4
|
Diop K, Diop A, Bretelle F, Cadoret F, Michelle C, Richez M, Cocallemen JF, Raoult D, Fournier PE, Fenollar F. Olegusella massiliensis gen. nov., sp. nov., strain KHD7 T, a new bacterial genus isolated from the female genital tract of a patient with bacterial vaginosis. Anaerobe 2017; 44:87-95. [PMID: 28223255 DOI: 10.1016/j.anaerobe.2017.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 12/13/2022]
Abstract
Strain KHD7T, a Gram-stain-positive rod-shaped, non-sporulating, strictly anaerobic bacterium, was isolated from the vaginal swab of a woman with bacterial vaginosis. We studied its phenotypic characteristics and sequenced its complete genome. The major fatty acids were C16:0 (44%), C18:2n6 (22%), and C18:1n9 (14%). The 1,806,744 bp long genome exhibited 49.24% G+C content; 1549 protein-coding and 51 RNA genes. Strain KHD7T exhibited a 93.5% 16S rRNA similarity with Olsenella uli, the phylogenetically closest species in the family Coriobacteriaceae. Therefore, strain KHD7T is sufficiently distinct to represent a new genus, for which we propose the name Olegusella massiliensis gen. nov., sp. nov. The type strain is KHD7T.
Collapse
Affiliation(s)
- Khoudia Diop
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Awa Diop
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Florence Bretelle
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France; Department of Gynecology and Obstetrics, Gynépole, Marseille, Pr Boubli et D'Ercole, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France
| | - Frédéric Cadoret
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Caroline Michelle
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Magali Richez
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jean-François Cocallemen
- Department of Gynecology and Obstetrics, Gynépole, Marseille, Pr Boubli et D'Ercole, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France
| | - Didier Raoult
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France; Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pierre-Edouard Fournier
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France
| | - Florence Fenollar
- Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée-Infection, URMITE, UM63, CNRS 7278, IRD 198, Inserm U1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France.
| |
Collapse
|