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Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes
INTRODUCTION: Our objective was to compare the vaginal microbiome in low‐risk and high‐risk pregnant women and to explore a potential association between vaginal microbiome and preterm birth. MATERIAL AND METHODS: A pilot, consecutive, longitudinal, multicenter study was conducted in pregnant women...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9812209/ https://www.ncbi.nlm.nih.gov/pubmed/36168933 http://dx.doi.org/10.1111/aogs.14460 |
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author | Vargas, Mireia Yañez, Francisca Elias, Andrea Bernabeu, Andrea Goya, Maria Xie, Zixuan Farrás, Alba Sánchez, Olga Soler, Zaida Blasquez, Carlos Valle, Leonor Olivella, Anna Muñoz, Begoña Brik, Maia Carreras, Elena Manichanh, Chaysavanh |
author_facet | Vargas, Mireia Yañez, Francisca Elias, Andrea Bernabeu, Andrea Goya, Maria Xie, Zixuan Farrás, Alba Sánchez, Olga Soler, Zaida Blasquez, Carlos Valle, Leonor Olivella, Anna Muñoz, Begoña Brik, Maia Carreras, Elena Manichanh, Chaysavanh |
author_sort | Vargas, Mireia |
collection | PubMed |
description | INTRODUCTION: Our objective was to compare the vaginal microbiome in low‐risk and high‐risk pregnant women and to explore a potential association between vaginal microbiome and preterm birth. MATERIAL AND METHODS: A pilot, consecutive, longitudinal, multicenter study was conducted in pregnant women at 18–22 weeks of gestation. Participants were assigned to one of three groups: control (normal cervix), pessary (cervical length ≤25 mm) and cerclage (cervical length ≤25 mm or history of preterm birth). Analysis and comparison of vaginal microbiota as a primary outcome was performed at inclusion and at 30 weeks of gestation, along with a follow‐up of pregnancy and perinatal outcomes. We assessed the vaginal microbiome of pregnant women presenting a short cervix with that of pregnant women having a normal cervix, and compared the vaginal microbiome of women with a short cervix before and after placement of a cervical pessary or a cervical cerclage. RESULTS: The microbiome of our control cohort was dominated by Lactobacillus crispatus and inners. Five community state types were identified and microbiome diversity did not change significantly over 10 weeks in controls. On the other hand, a short cervix was associated with a lower microbial load and higher microbial richness, and was not correlated with Lactobacillus relative abundance. After intervention, the cerclage group (n = 19) had a significant increase in microbial richness and a shift towards community state types driven by various bacterial species, including Lactobacillus mulieris, unidentified Bifidobacterium or Enterococcus. These changes were not significantly observed in the pessary (n = 26) and control (n = 35) groups. The cerclage group had more threatened preterm labor episodes and poorer outcomes than the control and pessary groups. CONCLUSIONS: These findings indicate that a short cervix is associated with an altered vaginal microbiome community structure. The use of a cerclage for preterm birth prevention, as compared with a pessary, was associated with a microbial community harboring a relatively low abundance of Lactobacillus, with more threatened preterm labor episodes, and with poorer clinical outcomes. |
format | Online Article Text |
id | pubmed-9812209 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-98122092023-01-05 Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes Vargas, Mireia Yañez, Francisca Elias, Andrea Bernabeu, Andrea Goya, Maria Xie, Zixuan Farrás, Alba Sánchez, Olga Soler, Zaida Blasquez, Carlos Valle, Leonor Olivella, Anna Muñoz, Begoña Brik, Maia Carreras, Elena Manichanh, Chaysavanh Acta Obstet Gynecol Scand Pregnancy INTRODUCTION: Our objective was to compare the vaginal microbiome in low‐risk and high‐risk pregnant women and to explore a potential association between vaginal microbiome and preterm birth. MATERIAL AND METHODS: A pilot, consecutive, longitudinal, multicenter study was conducted in pregnant women at 18–22 weeks of gestation. Participants were assigned to one of three groups: control (normal cervix), pessary (cervical length ≤25 mm) and cerclage (cervical length ≤25 mm or history of preterm birth). Analysis and comparison of vaginal microbiota as a primary outcome was performed at inclusion and at 30 weeks of gestation, along with a follow‐up of pregnancy and perinatal outcomes. We assessed the vaginal microbiome of pregnant women presenting a short cervix with that of pregnant women having a normal cervix, and compared the vaginal microbiome of women with a short cervix before and after placement of a cervical pessary or a cervical cerclage. RESULTS: The microbiome of our control cohort was dominated by Lactobacillus crispatus and inners. Five community state types were identified and microbiome diversity did not change significantly over 10 weeks in controls. On the other hand, a short cervix was associated with a lower microbial load and higher microbial richness, and was not correlated with Lactobacillus relative abundance. After intervention, the cerclage group (n = 19) had a significant increase in microbial richness and a shift towards community state types driven by various bacterial species, including Lactobacillus mulieris, unidentified Bifidobacterium or Enterococcus. These changes were not significantly observed in the pessary (n = 26) and control (n = 35) groups. The cerclage group had more threatened preterm labor episodes and poorer outcomes than the control and pessary groups. CONCLUSIONS: These findings indicate that a short cervix is associated with an altered vaginal microbiome community structure. The use of a cerclage for preterm birth prevention, as compared with a pessary, was associated with a microbial community harboring a relatively low abundance of Lactobacillus, with more threatened preterm labor episodes, and with poorer clinical outcomes. John Wiley and Sons Inc. 2022-09-28 /pmc/articles/PMC9812209/ /pubmed/36168933 http://dx.doi.org/10.1111/aogs.14460 Text en © 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Pregnancy Vargas, Mireia Yañez, Francisca Elias, Andrea Bernabeu, Andrea Goya, Maria Xie, Zixuan Farrás, Alba Sánchez, Olga Soler, Zaida Blasquez, Carlos Valle, Leonor Olivella, Anna Muñoz, Begoña Brik, Maia Carreras, Elena Manichanh, Chaysavanh Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes |
title | Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes |
title_full | Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes |
title_fullStr | Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes |
title_full_unstemmed | Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes |
title_short | Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes |
title_sort | cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes |
topic | Pregnancy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9812209/ https://www.ncbi.nlm.nih.gov/pubmed/36168933 http://dx.doi.org/10.1111/aogs.14460 |
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