Abstract
BACKGROUND: Preterm birth before 37 weeks' gestation is associated with 70% of perinatal morbidity and nearly half of long-term neurological morbidity. Hospital-based studies have shown that bacterial vaginosis is associated with preterm birth. AIM: To estimate the relative risk of preterm birth in women with and without bacterial vaginosis, detected by self-administered vaginal swab at < 10 weeks' gestation. DESIGN: Prospective cohort study. SETTING: Thirty-two general practices and five family planning clinics in South London. PARTICIPANTS: A total of 1216 women with bacterial vaginosis status established before 10 weeks' gestation, by analysis of Gram stained vaginal smears by two independent observers. METHOD: All women who did not miscarry or have a termination of pregnancy before 16 weeks' gestation were sent a brief confidential questionnaire at 16 weeks and at term asking about pregnancy outcome. Data on non-responders were obtained by searches of hospital and general practice records and by telephone calls to patients. RESULTS: Ascertainment was 87% (937/1072). The mean age of the women was 31 years. Thirteen per cent (122/925) had bacterial vaginosis and 5% (44/897) had a spontaneous preterm birth. The relative risk (RR) of preterm birth in women with bacterial vaginosis was 0.9 (95% confidence interval [CI] = 0.4 to 2.2). However, bacterial vaginosis was associated with late miscarriage at 13-23 weeks (R = 4.0, 95%CI = 1.3 to 12.1). Preterm birth was not associated with previous preterm birth, black ethnicity, age < 20 years, low social class, single marital status, or chlamydial infection. However, it was more common in women who reported smoking in pregnancy (RR = 2.9, 95% CI = 1.5 to 5.5). Of 867 responders, 552 (64%) said that providing a vaginal swab was at least as easy as providing a urine specimen. CONCLUSIONS: In this low-risk community-based cohort, bacterial vaginosis was not a strong risk factor for preterm birth.
Full Text
The Full Text of this article is available as a PDF (28.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brocklehurst P. Infection and preterm delivery. BMJ. 1999 Feb 27;318(7183):548–549. doi: 10.1136/bmj.318.7183.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Carey J. C., Klebanoff M. A., Hauth J. C., Hillier S. L., Thom E. A., Ernest J. M., Heine R. P., Nugent R. P., Fischer M. L., Leveno K. J. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 2000 Feb 24;342(8):534–540. doi: 10.1056/NEJM200002243420802. [DOI] [PubMed] [Google Scholar]
- Goldenberg R. L., Hauth J. C., Andrews W. W. Intrauterine infection and preterm delivery. N Engl J Med. 2000 May 18;342(20):1500–1507. doi: 10.1056/NEJM200005183422007. [DOI] [PubMed] [Google Scholar]
- Hay P. E., Lamont R. F., Taylor-Robinson D., Morgan D. J., Ison C., Pearson J. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ. 1994 Jan 29;308(6924):295–298. doi: 10.1136/bmj.308.6924.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kenyon S. L., Taylor D. J., Tarnow-Mordi W., ORACLE Collaborative Group Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. ORACLE Collaborative Group. Lancet. 2001 Mar 31;357(9261):989–994. doi: 10.1016/s0140-6736(00)04234-3. [DOI] [PubMed] [Google Scholar]
- Kristensen J., Langhoff-Roos J., Kristensen F. B. Implications of idiopathic preterm delivery for previous and subsequent pregnancies. Obstet Gynecol. 1995 Nov;86(5):800–804. doi: 10.1016/0029-7844(95)00275-V. [DOI] [PubMed] [Google Scholar]
- Kurki T., Sivonen A., Renkonen O. V., Savia E., Ylikorkala O. Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol. 1992 Aug;80(2):173–177. [PubMed] [Google Scholar]
- Lamont R. F. Antibiotics for the prevention of preterm birth. N Engl J Med. 2000 Feb 24;342(8):581–583. doi: 10.1056/NEJM200002243420810. [DOI] [PubMed] [Google Scholar]
- McGregor J. A., French J. I., Parker R., Draper D., Patterson E., Jones W., Thorsgard K., McFee J. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am J Obstet Gynecol. 1995 Jul;173(1):157–167. doi: 10.1016/0002-9378(95)90184-1. [DOI] [PubMed] [Google Scholar]
- Oakeshott Pippa, Hay Phillip, Hay Sima, Steinke Frances, Rink Elizabeth, Kerry Sally. Association between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks' gestation: prospective community based cohort study. BMJ. 2002 Dec 7;325(7376):1334–1334. doi: 10.1136/bmj.325.7376.1334. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Oakeshott Pippa, Hay Phillip, Hay Sima, Steinke Frances, Rink Elizabeth, Thomas Brenda, Oakeley Penny, Kerry Sally. Detection of Chlamydia trachomatis infection in early pregnancy using self-administered vaginal swabs and first pass urines: a cross-sectional community-based survey. Br J Gen Pract. 2002 Oct;52(483):830–832. [PMC free article] [PubMed] [Google Scholar]
- Peacock J. L., Bland J. M., Anderson H. R. Preterm delivery: effects of socioeconomic factors, psychological stress, smoking, alcohol, and caffeine. BMJ. 1995 Aug 26;311(7004):531–535. doi: 10.1136/bmj.311.7004.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Slattery Michael M., Morrison John J. Preterm delivery. Lancet. 2002 Nov 9;360(9344):1489–1497. doi: 10.1016/S0140-6736(02)11476-0. [DOI] [PubMed] [Google Scholar]
- Ugwumadu Austin, Manyonda Isaac, Reid Fiona, Hay Phillip. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet. 2003 Mar 22;361(9362):983–988. doi: 10.1016/S0140-6736(03)12823-1. [DOI] [PubMed] [Google Scholar]