Association of vaginal dysbiosis and gestational diabetes mellitus with adverse perinatal outcomes

Abstract

Objective Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes and is an independent risk factor for vaginal dysbiosis. Understanding the vaginal microbiota in health and disease is essential to screen, detect, and manage complications of pregnancy. Therefore, the aims of the present study were to assess and compare vaginal dysbiosis in pregnancy in women with and without GDM and examine its impact on perinatal outcomes in our population. Methods The present study was a prospective cohort study recruiting pregnant women. The subjects were divided into two groups (GDM and non‐GDM) and were followed until delivery to assess fetomaternal outcomes. Vaginal samples were collected at 24–28 weeks and 34–38 weeks for Nugent scoring and determination of bacterial and fungal species. Results The study recruited 502 pregnant women, with a final assessment of 320 mother–infant pairs (GDM n = 134; non‐GDM n = 186). We found a significant association of vaginal dysbiosis with GDM and adverse perinatal outcomes. Significant differences were also seen in status of infection and its trimester‐wise changes in relation to hyperglycemia. Conclusion By defining an association of vaginal dysbiosis with GDM and its correlation with perinatal outcomes, the present study calls for exploitation of this potential association as a new target in the prevention and treatment of GDM and in alleviating their undesired maternal and infant outcomes.

Risk Factors for Recurrence of Gestational Diabetes Mellitus and Its Correlation with Maternal and Infant Prognosis

“…The possible explanation is that overweight pregnant woman is associated with high blood pressure and blood lipid levels, and further higher blood sugar [ 19 ]. In pregnant women, hyperglycaemia can cause abnormal embryonic development or even death, with a miscarriage rate of 15%–30%, and the likelihood of hypertensive disorders in pregnancy are two to four times higher than nondiabetic women, which is possibly due to the presence of severe insulin resistance and hyperinsulinemia [ 20 ]; when diabetes is associated with microangiopathy, especially in combination with renal disease, the incidence of hypertension and pre-eclampsia in pregnancy would exceed 50% [ 21 ]. Therefore, it has significant implications to control weight, and strengthen diet, and exercise intervention for pregnant women with GDM demanding for repregnancy [ 22 ].…”

High Glucose Promotes Inflammation and Weakens Placental Defenses against E. coli and S. agalactiae Infection: Protective Role of Insulin and Metformin

“…In particular, GDM women with urinary or cervicovaginal infections are in an even more vulnerable position because they have to confront two immune insults: one due to hyperglycemia and the second due to infection. Although this combined scenario is very common in the clinical practice [ 8 , 10 , 14 ], it has been scarcely studied in experimental biomedical approaches. Therefore, we decided to study the response to pathogen infection in hyperglycemic cotyledon explants by evaluating bacterial growth and invasiveness, as well as the inflammatory cytokines synthesis in response to infection.…”

“…GDM patients have higher vulvovaginal infection rates and vaginal dysbiosis rates in comparison to euglycemic women [ 8 , 10 ]. Epidemiologic evidence supports that, in diabetic and GDM pregnant women, the most frequent bacterium isolated from urogenital specimens is S. agalactiae [ 11 , 12 ], with a colonization-adjusted rate in pregnant women of 21–25% in North America and 18% worldwide [ 13 ].…”

Gestational Diabetes Mellitus and Maternal Microbiome Alterations

“…Emerging studies have reported link between the vaginal microbiome and metabolic illnesses such GDM [20,29]. Studies have demonstrated increased inflammatory cytokine expression in GDM, together with the presence of potentially pathogenic bacteria, indicating a dysbiotic profile of the vaginal microbiome [20].…”

“…Researchers have speculated on the role of the vaginal microbiota in pregnancy outcomes, which have been shown to have a negative impact on neonatal and infant health, as well as the association of the vaginal microbiome with both health and disease states, but there are few studies to validate these speculations. According to the limited scarce studies on this subject, pregnant women with hyperglycemia have a greater prevalence of vaginal infections, and both hyperglycemia and an aberrant vaginal dysbiosis are linked to poor fetomaternal outcomes [12,20,29]. Exploring the vaginal microbiome alterations of women with GDM and its relationship to adverse pregnancy outcomes could help in the early detection and treatment of dysbiotic alterations that could lead to poor maternal and neonatal outcomes.…”