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

Lokken, Erica; Richardson, Barbra A.; Kinuthia, John; Mwinyikai, Khamis; Abdalla, Amina; Jaoko, Walter; Mandaliya, Kishorchandra; Shafi, Juma; McClelland, R. Scott

doi:10.1097/olq.0000000000000905

Cited by 23 publications

(24 citation statements)

References 27 publications

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“…It is also a major modifiable risk factor for PD 48 – 50 and it is hypothesized that smoking may lead to an increase in the prevalence of periodontal pathogens as well as delays the neutrophils recruitment into periodontal tissues, and thus compromise the immune response 16 , 51 – 56 . Further, our results also show that women with BV had higher BMI compared with women without BV, and this result is in contrast with Loken et al 57 result, however this can be explained due to the distinct types of populations and environmental factors.…”

Section: Discussioncontrasting

confidence: 99%

“…It is also a major modifiable risk factor for PD [48][49][50] and it is hypothesized that smoking may lead to an increase in the prevalence of periodontal pathogens as well as delays the neutrophils recruitment into periodontal tissues, and thus compromise the immune response 16,51-56 . www.nature.com/scientificreports/ Further, our results also show that women with BV had higher BMI compared with women without BV, and this result is in contrast with Loken et al 57 result, however this can be explained due to the distinct types of populations and environmental factors. These results might contribute to increase awareness of obstetricians/gynecologists for the higher risk of women with BV towards the presence of PD and the elevated inflamed burden that these patients may be exposed to.…”

Section: Discussioncontrasting

confidence: 93%

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Association of bacterial vaginosis with periodontitis in a cross-sectional American nationwide survey

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Botelho

Mendes

et al. 2021

Sci Rep

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To explore the association between bacterial vaginosis (BV) and periodontitis (PD) and to determine whether PD and BV might be linked with systemic serum alterations. We used the National Health and Nutrition Examination Survey 2001–2004, with women aged 18–49 years old and diagnosed with or without BV according to Nugent’s method. PD was defined according to the 2012 case definition. We compared serum counts according to the presence of PD and the presence of BV. Multivariable regression was used to explore and identify relevant variables towards the presence of BV. 961 women fulfilled the inclusion criteria. In women with BV, PD was associated with higher inflammation, characterized by increased white blood cells (p = 0.006) and lymphocyte (p = 0.009) counts. Predictive models presented a statistically significant association between PD and BV [Odds Ratio (OD) = 1.69, 95% Confidence Interval (CI): 1.09–2.61 for periodontitis; OD = 2.37, 95% CI: 1.30–4.29 for severe PD]. Fully adjusted models for age, smoking, body mass index, diabetes mellitus and number of systemic conditions reinforced this association [OD = 1.71, 95% CI: 1.06–2.76 for PD; OD = 2.21, 95% CI: 1.15–4.25 for severe PD]. An association between BV and PD is conceivable. PD was associated with higher systemic markers of inflammation in women with BV. Our data is novel and could serve as a foundation to guide future studies in the confirmation of this association and the underlying mechanisms.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 93%

Association of bacterial vaginosis with periodontitis in a cross-sectional American nationwide survey

Escalda

Botelho

Mendes

et al. 2021

Sci Rep

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“…37 This apparent discrepancy may be due to our larger sample size (n¼5918), a larger representation of black women (50.7%), and potential differences in the differential control of confounders and levels of residual confounding between our study and Koumans et al 37 A recent longitudinal study reported obesity was associated with nearly a 20% decrease of BV risk in a cohort of 1946 Kenyan female sex workers. 51 The longitudinal Kenyan study measured relative risk of BV in obese populations; our crosssectional study measured prevalence (eg, 1 infers a causal relationship; the other offers association). Differences in the characteristics of the Kenyan cohort and our cohort may also account for the discrepancy between the 2 studies, for example, our larger sample size (N¼5918 total and n¼3001 black women vs their N¼1946).…”

Section: Commentmentioning

confidence: 99%

Association between obesity and bacterial vaginosis as assessed by Nugent score

Brookheart

Lewis

Peipert

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Bacterial vaginosis is 1 of the most common vaginal conditions in the United States. Recent studies have suggested that obese women have an abnormal microbiota reminiscent of bacterial vaginosis; however, few studies have investigated the prevalence of bacterial vaginosis in overweight and obese populations. Moreover, despite the increased prevalence of obesity and bacterial vaginosis in black women, it is not known whether racial disparities exist in the relationship between obesity and bacterial vaginosis. OBJECTIVE: The objective of this study was to examine the relationship between body mass index and bacterial vaginosis as determined by Nugent score and to determine the influence of race in this context. STUDY DESIGN: We performed a cross-sectional study using patient data and vaginal smears from 5918 participants of the Contraceptive CHOICE Project. Gram-stained vaginal smears were scored with the Nugent method and categorized as bacterial vaginosisenegative (Nugent score, 0e3), bacterial vaginosiseintermediate (Nugent score, 4e6), or bacterial vaginosisepositive (Nugent score, 7e10). Body mass index was determined with Centers for Disease Control and Prevention guidelines, and obese individuals were categorized as class I, II, or III obese based on National Institutes of Health and World Health Organization body mass index parameters. Linear regression was used to model mean differences in Nugent scores; Poisson regression with robust error variance was used to model prevalence of bacterial vaginosis. RESULTS: In our cohort, 50.7% of participants were black; 41.5% were white, and 5.1% were of Hispanic ethnicity; the average age of 25.3 years old. Overall, 28.1% of participants were bacterial vaginosisepositive. Bacterial vaginosis was prevalent in 21.3% of lean, 30.4% of overweight, and 34.5% of obese women (P<.001). The distribution of bacterial vaginosiseintermediate individuals was similar across all body mass index categories. Compared with the scores of lean women, Nugent scores were highest among overweight and obese class I women (adjusted mean difference: overweight women, 0.33 [95% confidence interval, 0.14e0.51] and obese women, 0.51 [95% confidence interval, 0.29e0.72]). Consistent with this, overweight and obese women had a higher frequency of bacterial vaginosis compared with lean women, even after adjustment for variables that included race. Among white women, the prevalence of bacterial vaginosis was higher for overweight and class I and class II/III obese white women compared with lean white women, which is a phenomenon not observed among black women and suggests an effect modification. CONCLUSION: Overweight and obese women have higher Nugent scores and a greater occurrence of bacterial vaginosis compared with lean women. Black women have a greater prevalence of bacterial vaginosis independent of their body mass index compared with white women.

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“…Regarding the landscape of the vaginal microbiota, data showed that the vaginal bacterial community was less diverse than in the gut. Rarefaction analysis found that the RIF group had the lowest microbial diversity of the three groups, suggesting a healthy vaginal microbiota in the RIF group (Lokken, Richardson et al 2019). We posit that through TNF-α-driven systemic insulin resistance, gut dysbiosis in the RIF group causes hyperglycemia and consequently increases glycogen levels in the vaginal epithelium, which is required for the maintenance of healthy microbiota (Carrara, Bazotte et al 2009, Amabebe and Anumba 2018).…”

Section: Discussionmentioning

confidence: 99%

“…We posit that through TNF-α-driven systemic insulin resistance, gut dysbiosis in the RIF group causes hyperglycemia and consequently increases glycogen levels in the vaginal epithelium, which is required for the maintenance of healthy microbiota (Carrara, Bazotte et al 2009, Amabebe and Anumba 2018). Alternatively, adipose tissue-driven rise in peripheral estrogen may increase the glycogen content of vaginal epithelial cells (Lokken, Richardson et al 2019). This chimes with the finding that obesity protects against vaginal dysbiosis (Lokken, Richardson et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Distinct gut and vaginal microbiota profile in women with Recurrent Implantation Failure and Unexplained Infertility

Patel¹,

Patel

Pal³

et al. 2021

Preprint

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Background: Implantation failure limits the success rate of natural and in vitro fertilization (IVF)-assisted conceptions. Evidence suggests dysbiosis in the female reproductive tract impacts implantation failure. However, whether gut dysbiosis influences implantation failure and whether it accompanies reproductive tract dysbiosis remains unexplored. Method: We recruited 11fertile women as the controls, and a cohort of 20 women diagnosed with implantation-failure associated infertility, which included 10 women diagnosed with recurrent implantation failure (RIF), and 10 women diagnosed with unexplained infertility (UE). Using next-generation amplicon sequencing, we compared the diversity, structure, and composition of faecal and vaginal bacteria of the controls with that of the infertile cohort. While we sequenced faecal samples of all the participants (n=31), we could only sequence 8 vaginal samples in each group (n=24). Results: Compared with the controls, α-diversity of the gut bacteria, analysed by Chao 1 and Shannon indices, among the infertile groups declined (p < 0.05). β-diversity between the controls and infertile cohort, measured by both Bray-Curtis and Jaccard distances, differed significantly (p < 0.05). Taxa analysis of the gut bacteria revealed enrichment of Gram-positive bacteria, mainly of the phylum Firmicutes, in the RIF group. In contrast, Gram-negative bacteria were relatively more abundant in the UE group. Additionally, mucus-producing bacteria genera such as Prevotella and Sutterella declined in the infertile cohort (p < 0.05). Intriguingly, significant enrichment (p < 0.05) of the genus Hungatella, associated with trimethylamine N-oxide (TMAO) production, occurred in the infertile cohort. Vaginal microbiota was dominated by L. iners across the groups, with the UE group showing the highest levels. Of the three groups, the RIF group had the least diverse vaginal microbiota. Taxa analysis showed higher levels of anaerobic bacteria such as Leptotrichia, Snethia, and Prevotella in the controls. Conclusion: We posit that in the setting of the compromised gut mucosal barrier, the phyla Firmicutes generates TNF-α-driven systemic inflammation, leading to RIF, whereas an overload of Gram-negative bacteria induces IL-6-driven systemic inflammation, leading to UE. Additionally, Hungatella-induced elevation of TMAO levels causes platelet hypercoagulability, synergistically contributing to implantation failure. Finally, vaginal dysbiosis does not appear to co-occur with gut dysbiosis.

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

Abstract: Obese women had a nearly 20% lower risk of BV compared to 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.

Cited by 23 publications

References 27 publications

Association of bacterial vaginosis with periodontitis in a cross-sectional American nationwide survey

Association of bacterial vaginosis with periodontitis in a cross-sectional American nationwide survey

Association between obesity and bacterial vaginosis as assessed by Nugent score

Distinct gut and vaginal microbiota profile in women with Recurrent Implantation Failure and Unexplained Infertility

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