Differences in vaginal microbiome between preterm and full-term delivery parturients
Objective To compare the differences in vaginal microbiome between preterm and full-term parturients in early pregnance,and explore the potential factors that predict preterm birth.Methods A total of 2,247 pregnant women who gave birth in our hospital from June 2022 to December 2023 were selected,including 98 cases of preterm delivery par-turients(preterm group)and 2,149 cases of full-term delivery parturients(full-term group),among which 98 full-term par-turients were matched with the baseline indicators of maternal age,gravidity and parity as covariables by propensity score matching(PSM).The results of vaginal microbiota testing at 6-8 weeks of pregnancy were retrospectively analyzed,and the differences in the function and morphology of vaginal microbiome,and onset of vaginitis between the two groups were compared.Results Before and after PSM,the mean gestational age and mean weight of newborns in the preterm delivery group were lower than those in the full-term delivery group(all P＜0.050).There were no significant differences in age,gravidity and parity between the two groups(all P＞0.050).Before and after PSM,the proportion of G+b(L)and Lactoba-cillary grades(LBG)in the preterm group were lower than those in the full-term group(all P＜0.050).There were no signi-ficant differences in vaginal flora density and diversity between the two groups(x2=0.002,P=0.963;x2=0.416,P=0.519),but the difference in vaginal flora diversity was statistically significant after PSM(x2=5.120,P=0.024).The average pH value of vaginal discharge in the preterm group was 5.09±0.37,higher than the 4.96±0.43 in the full-term group(t=3.470,P＜0.001);the difference in pH value was statistically significant after PSM(t=4.570,P＜0.001).There was no significant difference in the positive rate of hydrogen peroxide(H2O2)between the two groups before and after PSM(x2=0.725,P=0.338;x2=0.014,P=0.906).The detection rate of aerobic vaginitis(AV)in the preterm group was 12.4％,higher than the 5.2％in the full-term group(x2=9.049,P=0.003);the difference in AV was statistically significant after PSM(x2=6.727,P=0.009).Before and after PSM,There were no significant differences in the detection rates of bacterial vaginosis(BV),vulvovaginal candidiasis(VVC)and mixed vaginitis between the two groups(all P＞0.05).Dominant bacteria G+b(L)(P=0.021,adjusted OR=0.218,95％CI:0.060-0.793)and pH values(P＜0.001,adjusted OR=4.555,95％CI:1.992-10.419)were retained in the model.The results of the model suggested that the preterm birth rate of the women with dom-inant bacteria G+b(L)in early pregnancy reduced by about 80％compared with non-G+b(L).For every one increment in the pH of vaginal secretions during early pregnancy,the probability of preterm birth increased by about 4.6 times.The sensitiv-ity of the final conditional Logistic model that included the dominant bacteria G+b(L)and pH value was about 0.78(95％CI:0.690-0.860)at the default threshold of 0.5;the specificity was about 0.76(95％CI:0.670-0.840).Conclusion Va-ginal microecological screening is recommended in early pregnancy.Dominant bacteria G+b(L),pH value and AV in vagin-al secretions are expected to predict premature delivery.Both less G+b(L)and rising pH value can be used to predict the risk of preterm birth in early pregnancy.
Prediction of preterm birthVaginal microbiomeEarly pregnanceVagina dominant bacteriapH valueVa-ginitis
万方数据
维普
