Adverse pregnancy and birth outcomes associated withMycoplasma hominis, Ureaplasma urealyticumandUreaplasma parvum: a systematic review and meta-analysis

Abstract

ObjectivesMycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum (genital mycoplasmas) commonly colonise the urogenital tract in pregnant women. This systematic review aims to investigate their role in adverse pregnancy and birth outcomes, alone or in combination with bacterial vaginosis (BV).MethodsWe searched Embase, Medline and CINAHL databases from January 1971 to February 2021. Eligible studies tested for any of the three genital mycoplasmas during pregnancy and reported on the primary outcome, preterm birth (PTB) and/or secondary outcomes low birth weight (LBW), premature rupture of membranes (PROM), spontaneous abortion (SA) and/or perinatal or neonatal death (PND).Two reviewers independently screened titles and abstracts, read potentially eligible full texts and extracted data. Two reviewers independently assessed risks of bias using published checklists. Random effects meta-analysis was used to estimate summary ORs (with 95% CIs and prediction intervals). Multivariable and stratified analyses were synthesised descriptively.ResultsOf 57/1194 included studies, 39 were from high-income countries. In meta-analysis of unadjusted ORs, M. hominis was associated with PTB (OR 1.87, 95% CI 1.49 to 2.34), PROM, LBW and PND but not SA. U. urealyticum was associated with PTB (OR 1.84, 95% CI 1.34 to 2.55), PROM, LBW, SA and PND. U. parvum was associated with PTB (1.60, 95% CI 1.12 to 2.30), PROM and SA. Nine of 57 studies reported any multivariable analysis. In two studies, analyses stratified by BV status showed that M. hominis and U. parvum were more strongly associated with PTB in the presence than in the absence of BV. The most frequent source of bias was a failure to control for confounding.ConclusionsThe currently available literature does not allow conclusions about the role of mycoplasmas in adverse pregnancy and birth outcomes, alone or with coexisting BV. Future studies that consider genital mycoplasmas in the context of the vaginal microbiome are needed.PROSPERO registration numberCRD42016050962.

Mycoplasma hominis and Candidatus Mycoplasma girerdii in Trichomonas vaginalis: Peaceful Cohabitants or Contentious Roommates?

“…Complications related to preterm birth (PTB) are responsible for about 27% of neonatal mortality. Intraamniotic infections and the induced uterine inflammation are among the main causes of PTB, and Mollicutes are the most frequently reported organisms in the amniotic cavity [ 56 ]. Vaginal M. hominis infection is associated with several adverse pregnancy outcomes and postpartum complications such as spontaneous abortion, stillbirth, preterm birth, low birth weight, and perinatal mortality [ 57 ].…”

Genital tract infections, the vaginal microbiome and gestational age at birth among pregnant women in South Africa: a cohort study protocol

“…Bacterial vaginosis is the most common vaginal microbiota dysbiosis and is associated with adverse pregnancy outcomes, either alone or in combination with other sexually transmitted infections 15–17. Associations with adverse birth outcomes have also been observed for other genital mycoplasmas, M. hominis, Ureaplasma urealyticum and U. parvum 18. For individual sexually transmitted infections, bacterial vaginosis and colonisation by other genital mycoplasmas, summary ORs for the association with adverse birth outcomes in meta-analyses of univariable data are generally around 1.3–2.0 11–14 16 18 .…”

“… 15–17 Associations with adverse birth outcomes have also been observed for other genital mycoplasmas, M. hominis, Ureaplasma urealyticum and U. parvum . 18 For individual sexually transmitted infections, bacterial vaginosis and colonisation by other genital mycoplasmas, summary ORs for the association with adverse birth outcomes in meta-analyses of univariable data are generally around 1.3–2.0. 11–14 16 18 Candida spp have not been found to be associated with preterm birth, but an association with more inflammatory, symptomatic yeast infection cannot be ruled out.…”

Retrospective Analysis of Azithromycin-Resistant Ureaplasma urealyticum and Mycoplasma hominis Cervical Infection Among Pregnant Women

“…9 However, the latest meta-analysis data shows that the currently available literature does not allow conclusions about the role of mycoplasmas in adverse pregnancy outcomes, alone or coexisting with BV due to strong data bias. 10 Nevertheless, the clinical consensus is that gestational women with symptoms of threatened abortion, threatened premature delivery, or suspected intrauterine infection should undergo active intervention for cervical mycoplasma infection. 1,3,11 Given the teratogenic risk of tetracycline and quinolone antibiotics, pregnant women are almost exclusively administered macrolides to fight mycoplasma infection, of which the most commonly used varieties are azithromycin and erythromycin.…”