The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection‐related preterm birth: a response to the Danish Society of Obstetrics and Gynecology guideline group's clinical recommendations

Abstract

Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Infection/inflammation is responsible for a significant percentage of preterm birth, particularly at early gestations. A recent clinical recommendation by a guidelines group of the Danish Society of Obstetrics and Gynecology advised against the use of clindamycin for the treatment of bacterial vaginosis in pregnancy to reduce the risk of spontaneous preterm birth based on lack of evidence of efficacy. We believe that the evidence for the use of clindamycin for this indication is robust and that this recommendation was reached erroneously on the basis of flawed inclusion criteria: the inclusion of an unpublished study with poorly diagnosed bacterial vaginosis and the exclusion of an important pivotal study on the use of clindamycin in early pregnancy for the prevention of preterm birth. Had these errors been corrected, the conclusions would have been different.

Prenatal and postnatal administration of prebiotics and probiotics

“…Bacterial vaginosis represents a marked state of vaginal dysbiosis, the complexity of which is still being characterized. Whether treatment of bacterial vaginosis in pregnancy decreases the risk of preterm birth remains uncertain [13]. Second, periodontal disease in pregnancy is associated with preterm labor and with low infant birth weight.…”

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

“…The major concern raised by Lamont and colleagues seems to relate to whether the intervention with clindamycin before 22 weeks' gestation would significantly reduce the incidence of sPTD (4). We agree that had the cut-off been gestational week 22, then the difference in incidence of sPTD would have been statistically significant with respect to clindamycin.…”

Treatment of bacterial vaginosis before 28 weeks of pregnancy to reduce the incidence of preterm labor

“…In this research, the authors used different inclusion criteria from those used in our study, finding only evidence of efficacy in reducing prematurity in the same randomized clinical trial cited in this systematic review. Indeed, Lamont et al . have criticized the Danish Society of Obstetrics and Gynecology guidelines on clinical recommendations to treat BV during pregnancy, reaffirming that the evidence supporting the use of oral clindamycin for this indication is robust.…”