“…Table 1 summarises characteristics of the included studies, from 27 different countries, published between 1969 and 2022 with a median sample size of 347 participants (interquartile range, IQR 200–1000). Five were cross-sectional studies [ 24 , 26 – 29 ], 15 were case–control studies [ 30 – 44 ], 35 were cohort studies [ 45 – 81 ], and two were randomised clinical trials [ 82 , 83 ] (Table 1 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Within groups according to symptom status, heterogeneity was mostly low (Table 2 ). The OR for preterm birth was 1.44 (95% CI 0.92–2.26, I 2 0%) in two studies with ≥ 50% participants with symptoms [ 24 , 29 ], 0.84 (95% CI 0.45–1.58, I 2 88%, prediction interval 0.10–6.81) in seven studies with < 50% participants with symptoms [ 43 , 45 – 47 , 65 , 78 , 79 ], 1.12 (95% CI 0.94–1.35, I 2 0%, prediction interval 0.75–1.68) in four studies only with participants without self-reported or observed symptoms [ 55 , 56 , 70 , 82 , 83 ], and 1.05 (95% CI 0.87–1.26, I 2 2%, prediction interval 0.70–1.57) in 17 studies in which symptom status was not reported [ 27 , 28 , 32 , 37 , 40 , 44 , 50 , 53 , 61 , 63 , 64 , 66 , 68 , 72 , 74 – 76 ]. The prediction intervals for all groups with sufficient data included the null value.…”
Background
Vulvovaginal yeast infections in pregnancy are common and can cause extensive inflammation, which could contribute to adverse pregnancy outcomes. Symptomatic yeast infections are likely to cause more inflammation than asymptomatic. The objective of this study was to investigate associations between symptomatic and asymptomatic vulvovaginal yeast infections in pregnancy and perinatal outcomes.
Methods
We did a systematic review and searched eight databases until 01 July 2022. We included studies reporting on pregnant women with and without laboratory confirmed vulvovaginal yeast infection and preterm birth or eight other perinatal outcomes. We used random effects meta-analysis to calculate summary odds ratios (OR), 95% confidence intervals (CI) and prediction intervals for the association between yeast infection and outcomes. We described findings from studies with multivariable analyses. We assessed the risk of bias using published tools.
Results
We screened 3909 references and included 57 studies. Only 22/57 studies reported information about participant vulvovaginal symptoms. Preterm birth was an outcome in 35/57 studies (49,161 women). In 32/35 studies with available data, the summary OR from univariable analyses was 1.01 (95% CI 0.84–1.21, I2 60%, prediction interval 0.45–2.23). In analyses stratified by symptom status, we found ORs of 1.44 (95% CI 0.92–2.26) in two studies with ≥ 50% symptomatic participants, 0.84 (95% CI 0.45–1.58) in seven studies with < 50% symptomatic participants, and 1.12 (95% CI 0.94–1.35) in four studies with asymptomatic participants. In three studies with multivariable analysis, adjusted ORs were greater than one but CIs were compatible with there being no association. We did not find associations between vulvovaginal yeast infection and any secondary outcome. Most studies were at high risk of bias in at least one domain and only three studies controlled for confounding.
Conclusions
We did not find strong statistical evidence of an increased risk for preterm birth or eight other adverse perinatal outcomes, in pregnant women with either symptomatic or asymptomatic vulvovaginal yeast infection. The available evidence is insufficient to make recommendations about testing and treatment of vulvovaginal yeast infection in pregnancy. Future studies should assess vulvovaginal symptoms, yeast organism loads, concomitant vaginal or cervical infections, and microbiota using state-of-the-art diagnostics.
Systematic review registration
PROSPERO CRD42020197564
“…Table 1 summarises characteristics of the included studies, from 27 different countries, published between 1969 and 2022 with a median sample size of 347 participants (interquartile range, IQR 200–1000). Five were cross-sectional studies [ 24 , 26 – 29 ], 15 were case–control studies [ 30 – 44 ], 35 were cohort studies [ 45 – 81 ], and two were randomised clinical trials [ 82 , 83 ] (Table 1 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Within groups according to symptom status, heterogeneity was mostly low (Table 2 ). The OR for preterm birth was 1.44 (95% CI 0.92–2.26, I 2 0%) in two studies with ≥ 50% participants with symptoms [ 24 , 29 ], 0.84 (95% CI 0.45–1.58, I 2 88%, prediction interval 0.10–6.81) in seven studies with < 50% participants with symptoms [ 43 , 45 – 47 , 65 , 78 , 79 ], 1.12 (95% CI 0.94–1.35, I 2 0%, prediction interval 0.75–1.68) in four studies only with participants without self-reported or observed symptoms [ 55 , 56 , 70 , 82 , 83 ], and 1.05 (95% CI 0.87–1.26, I 2 2%, prediction interval 0.70–1.57) in 17 studies in which symptom status was not reported [ 27 , 28 , 32 , 37 , 40 , 44 , 50 , 53 , 61 , 63 , 64 , 66 , 68 , 72 , 74 – 76 ]. The prediction intervals for all groups with sufficient data included the null value.…”
Background
Vulvovaginal yeast infections in pregnancy are common and can cause extensive inflammation, which could contribute to adverse pregnancy outcomes. Symptomatic yeast infections are likely to cause more inflammation than asymptomatic. The objective of this study was to investigate associations between symptomatic and asymptomatic vulvovaginal yeast infections in pregnancy and perinatal outcomes.
Methods
We did a systematic review and searched eight databases until 01 July 2022. We included studies reporting on pregnant women with and without laboratory confirmed vulvovaginal yeast infection and preterm birth or eight other perinatal outcomes. We used random effects meta-analysis to calculate summary odds ratios (OR), 95% confidence intervals (CI) and prediction intervals for the association between yeast infection and outcomes. We described findings from studies with multivariable analyses. We assessed the risk of bias using published tools.
Results
We screened 3909 references and included 57 studies. Only 22/57 studies reported information about participant vulvovaginal symptoms. Preterm birth was an outcome in 35/57 studies (49,161 women). In 32/35 studies with available data, the summary OR from univariable analyses was 1.01 (95% CI 0.84–1.21, I2 60%, prediction interval 0.45–2.23). In analyses stratified by symptom status, we found ORs of 1.44 (95% CI 0.92–2.26) in two studies with ≥ 50% symptomatic participants, 0.84 (95% CI 0.45–1.58) in seven studies with < 50% symptomatic participants, and 1.12 (95% CI 0.94–1.35) in four studies with asymptomatic participants. In three studies with multivariable analysis, adjusted ORs were greater than one but CIs were compatible with there being no association. We did not find associations between vulvovaginal yeast infection and any secondary outcome. Most studies were at high risk of bias in at least one domain and only three studies controlled for confounding.
Conclusions
We did not find strong statistical evidence of an increased risk for preterm birth or eight other adverse perinatal outcomes, in pregnant women with either symptomatic or asymptomatic vulvovaginal yeast infection. The available evidence is insufficient to make recommendations about testing and treatment of vulvovaginal yeast infection in pregnancy. Future studies should assess vulvovaginal symptoms, yeast organism loads, concomitant vaginal or cervical infections, and microbiota using state-of-the-art diagnostics.
Systematic review registration
PROSPERO CRD42020197564
“…Prolonged PROM in turn increases the chances of chorioamnionitis complication which are associated with poor neonatal prognosis ( Verma et al, 2023 ) and long-lasting effects such as impaired neuropsychological development of offspring ( Gervasi et al, 2023 ). Several studies have shown that positive cervical secretion cultures in pregnant women with premature rupture of membranes are associated with the development of chorioamnionitis ( Saghafi et al, 2018 ; Thakur et al, 2021 ). We found that cervical secretion cultures, although easy to perform, has a low predictive efficacy and is only useful as the diagnostic modality.…”
Background: To investigate the clinical value of cervical secretion culture in pregnant women with premature rupture of membranes (PROM) in predicting maternal and fetal outcomes.Methods: We retrospectively reviewed clinical records of pregnant women who underwent obstetric examination and delivered in Fujian Maternal and Child Healthcare from December 2013 to December 2016. Pregnant women with a clear diagnosis of PROM, who underwent cervical secretion culture immediately after hospital admission were selected for the study. The primary outcome was the occurrence of chorioamnionitis. The secondary outcome was neonatal admission to the neonatal intensive care unit (NICU). Correlation between maternal and fetal outcomes and the results of the cervical secretion culture was analyzed by one-way analysis and multifactorial analysis, respectively. The predictive efficacy of cervical secretion culture was evaluated using receiver operating characteristic curve (ROC), area under the curve (AUC) and the integrated discrimination improvement (IDI).Results: A total of 7,727 pregnant women with PROM were included in the study. Of them, 1812 had positive cervical secretion cultures (635 positive for mycoplasma infection, 475 for bacterial, 637 for fungal, and 65 for chlamydial infections). Pregnant women with positive mycoplasma and bacterial cultures had higher rates of developing chorioamnionitis compared to women with negative cervical secretion cultures (9%, 12% vs. 1%, respectively). Similarly, positive mycoplasma and bacterial cultures were associated with higher rate of the preterm (before 34 weeks) labor (3%, 3% vs. 1% in women with negative cultures, respectively), and neonatal admission to the NICU (9%, 11% vs. 7%, respectively). After adjusting for various confounding factors, our analysis demonstrated that a positive cervical secretion culture for mycoplasma or bacterial pathogens remained an independent risk factor for chorioamnionitis. Cervical secretion culture outcome was less effective in predicting chorioamnionitis (AUC 0.569) compared to white blood count (WBC) (AUC 0.626) and C-reactive protein (CRP) levels (AUC 0.605). The IDI of the combined predictive model incorporating WBC, CRP, maternal fever and cervical secretion culture results was 0.0029.Conclusion: Positive cervical secretion cultures, especially for mycoplasma and bacteria, are associated with higher incidence of adverse maternal and fetal outcomes. However, the predictive value of this test is poor, and cannot be efficiently used for predicting chorioamnionitis.
“…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 ]. Additionally, Escherichia coli is the leading cause of chorioamnionitis and urinary tract infections in pregnant women [ 14 , 15 , 16 , 17 , 18 ].…”
Placentas from gestational diabetes mellitus (GDM) patients undergo significant metabolic and immunologic adaptations due to hyperglycemia, which results in an exacerbated synthesis of proinflammatory cytokines and an increased risk for infections. Insulin or metformin are clinically indicated for the treatment of GDM; however, there is limited information about the immunomodulatory activity of these drugs in the human placenta, especially in the context of maternal infections. Our objective was to study the role of insulin and metformin in the placental inflammatory response and innate defense against common etiopathological agents of pregnancy bacterial infections, such as E. coli and S. agalactiae, in a hyperglycemic environment. Term placental explants were cultivated with glucose (10 and 50 mM), insulin (50–500 nM) or metformin (125–500 µM) for 48 h, and then they were challenged with live bacteria (1 × 105 CFU/mL). We evaluated the inflammatory cytokine secretion, beta defensins production, bacterial count and bacterial tissue invasiveness after 4–8 h of infection. Our results showed that a GDM-associated hyperglycemic environment induced an inflammatory response and a decreased beta defensins synthesis unable to restrain bacterial infection. Notably, both insulin and metformin exerted anti-inflammatory effects under hyperglycemic infectious and non-infectious scenarios. Moreover, both drugs fortified placental barrier defenses, resulting in reduced E. coli counts, as well as decreased S. agalactiae and E. coli invasiveness of placental villous trees. Remarkably, the double challenge of high glucose and infection provoked a pathogen-specific attenuated placental inflammatory response in the hyperglycemic condition, mainly denoted by reduced TNF-α and IL-6 secretion after S. agalactiae infection and by IL-1β after E. coli infection. Altogether, these results suggest that metabolically uncontrolled GDM mothers develop diverse immune placental alterations, which may help to explain their increased vulnerability to bacterial pathogens.
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