Appreciable uncertainty regarding benefits and risks in the treatment of bacterial vaginosis to prevent preterm birth

Haahr, Thor; Ersbøll, Anne S.; Karlsen, Mona Aarenstrup; Svare, Jens; Sneider, Kirstine; Hee, Lene; Weile, Louise Katrine Kjær; Ziobrowska-Bech, Agnes; Østergaard, Claus; Jensen, Jørgen Skov; Helmig, Rikke Bek; Uldbjerg, Niels

doi:10.1111/aogs.13076

Cited by 5 publications

(3 citation statements)

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“…Finally, the results of a recent systematic review [34] do not support the treatment of BV-positive pregnant women with probiotics with the objective of reducing the risk of spontaneous preterm delivery.…”

Section: Probiotics In Pregnant Womenmentioning

confidence: 99%

Probiotics and vaginal microecology: fact or fancy?

et al. 2019

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BackgroundProbiotics are live microorganisms that, when administered in adequate amounts, should confer a health benefit to the host. Media sources tend to present probiotics as an appealing health promotion method able to prevent or treat a wide variety of clinical conditions. In obstetrics and gynaecology, Lactobacilli species are mainly used to restore the physiologic vaginal microbiota in order to treat bacterial vaginosis and vulvovaginal candidiasis (VVC) and prevent preterm birth.DiscussionSeveral RCTs investigated the potential benefits of probiotics in gynaecological and obstetrics conditions. For all potential indications, recent specific meta-analyses have been published. Considering vulvovaginal candidiasis in non-pregnant women, probiotics slightly improved the short-term clinical and mycological cure, and reduced the 1-month relapse. However, no important impact of probiotic use was observed on long-term clinical or mycological cure. Similarly, the addition of probiotics to metronidazole for the treatment of bacterial vaginosis was not shown to provide any additional benefit. In obstetrics, using probiotics during pregnancy neither decreased nor increased the risk of preterm birth before 34 weeks or before 37 weeks. Similarly, no benefits emerged for gestational diabetes, preterm premature rupture of membrane, and small and large for gestational age infants.ConclusionDespite increasing marketing of probiotics for the treatment of vulvovaginal candidiasis and prevention of preterm birth robust evidence demonstrating a beneficial effect is scarce. Moreover, there was considerable heterogeneity among the different studies in terms of route of administration, strain/s of probiotic adopted, and length of probiotic use. Before recommending the systematic use of probiotics to treat bacterial vaginosis and VVC and prevent preterm birth, high-quality research is needed. Professional medical associations should issue recommendations defining if, when, and how probiotics should be used for gynaecological disorders.

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Section: Probiotics In Pregnant Womenmentioning

confidence: 99%

Probiotics and vaginal microecology: fact or fancy?

et al. 2019

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“…(11)(12)(13) To date, convincing evidence of the linkage between vaginal infections and PL, fetal intrauterine infection, and inflammatory complications after childbirth has been published. (14)(15)(16)(17)(18)(19)(20) That study, of the reproductive health of the examined women, showed that inflammatory diseases of the body and uterine appendages occurred in 18.2% of cases. There is evidence of repeated, and often recurrent, inflammatory diseases of the external genital organs and the vagina in 36.9% of women.…”

Section: Introductionmentioning

confidence: 99%

The Results of Microbiological Investigations into Preterm Labor

Оразмурадов¹,

Kostin²,

Apresyan³

et al. 2019

IJBM

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The purpose of this study was to identify the relationship between the microbiological status of women and newborns, and the development of premature labor. Materials and Methods: The study included 227 pregnant women at gestational age between 28 and 36 weeks and 6 days. All women underwent an assessment of vaginal microcenosis and the quantitative and qualitative composition of the biotope of the cervical discharge; the newborns underwent bacteriological examination of the auricle, pharynx and anus. Results: Disturbances in the vaginal biotope were diagnosed in every second woman. We found that the shorter the gestation period, the higher the frequency of disturbances in the vaginal biotope, and the risk of premature birth at an earlier time correlates with the presence of infection in the mother. The risk of giving birth to an infected child is 4.2 times higher at birth from a mother who has disturbances in the biotope, compared to a woman with a normal biotope.

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“…Однако вместе с высокой эффективностью перорального применения антибиотиков наблюдаются вызванные ими побочные реакции: наиболее часто у беременных развиваются диспепсические явления. Преимуществом же местной терапии являются: ■ наименьшая частота возникновения побочных явлений в связи со сниженной адсорбцией препарата в системный кровоток; ■ непосредственная активность препарата в очаге инфекции; ■ возможность применения малых доз лекарственного средства [25].…”

Section: Introductionunclassified

Features of the treatment of bacterial vaginosis during pregnancy

et al. 2022

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Introduction. The prevalence of bacterial vaginosis (BV) in the population ranges from 12 to 80% and depends on the cohort of examined women. Of the total confirmed cases, 37-40% are pregnant women.Aim. To assess the effectiveness of the treatment of bacterial vaginosis (BV) in pregnant women.Materials and methods. The study included 43 women at 22 to 30 weeks' gestation, divided into two groups: the treatment group consisted of 30 pregnant women diagnosed with BV, the control group comprised 13 pregnant women with normal vaginal microbiocenosis. To determine the antimicrobial activity of vaginal epithelium, samples of vaginal discharge were examined. The treatment was carried out using clindamycin according to the following regimen: 100 mg intravaginally per day at bedtime for 3 days.Results. The study results showed that the highest activity of antimicrobial peptides (AMP) was found in the group of healthy pregnant women, which accounted for 79.1%. In pregnant women with BV, the level of antimicrobial activity significantly decreased as compared with the group of healthy pregnant women as the severity of the disease increased, amounting to 44.5% in women with mild BV, 36.4% in women with moderate BV and 33.6% in women with severe BV. The level of antimicrobial activity in the group of pregnant women with BV, who received treatment with clindamycin significantly increased by almost two times from the baseline values and amounted to 86.1% in women with mild BV, 78.5% in women with moderate BV and 76.9% in women with severe BV.Conclusion. The production of endogenous antibiotics, AMP, provides adequate protection against infectious agents. After a course of therapy with clindamycin 100 mg intravaginally at bedtime for 3 days, the AMP level normalized 2 weeks after treatment.

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Appreciable uncertainty regarding benefits and risks in the treatment of bacterial vaginosis to prevent preterm birth

Cited by 5 publications

References 5 publications

Probiotics and vaginal microecology: fact or fancy?

Probiotics and vaginal microecology: fact or fancy?

The Results of Microbiological Investigations into Preterm Labor

Features of the treatment of bacterial vaginosis during pregnancy

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