Is a change in the vaginal flora associated with an increased risk of preterm birth?
Is a change in the vaginal flora associated with an increased risk of preterm birth?
复制标题
DOI：
10.1016/j.ajog.2004.12.069
复制
发表时间：
2005-04-01
影响因子：
9.8
通讯作者：
Klebanoff, MA
中科院分区：
文献类型：
--
作者：
Carey, JC;Klebanoff, MA
目的：本研究的目的是确定阴道菌群的变化是否与早产风险增加相关，并确定 32 周前甲硝唑治疗是否会增加早产风险。研究设计：我们将妊娠 23 至 26 周时采集的培养物与参加阴道感染和早产研究的妇女分娩时采集的培养物进行比较，以分析阴道菌群变化与早产的关联结果：在未经调整的模型中，32 周前甲硝唑治疗与早产风险增加相关（OR 1.5，95% CI 1.05-2.1）。研究发现，分娩时大肠杆菌或肺炎克雷伯菌大量生长的变化与早产有关（OR 2.4，95%CI 1.6-3.8）。在控制种族、产次、孕前体重 < 100 磅、怀孕期间吸烟或饮酒、阴道毛滴虫、细菌性阴道病、衣原体、支原体、B 族链球菌、32 周前甲硝唑治疗、阴道 pH > 5.0 以及大肠杆菌或肺炎克雷伯菌增加后，仅孕前体重 < 100 磅（调整优势比 [AOR]） Lit分娩（AOR 2.99，95%CI 1.01-4.21）和阴道内大肠杆菌或肺炎克雷伯菌增多（AOR 2.99，95%CI 1.37-6.53）被发现与早产显着相关。结论：阴道内大肠杆菌或肺炎克雷伯菌增多是早产的独立危险因素。阴道菌群的变化可能解释了阴道克林霉素或口服甲硝唑治疗导致早产风险增加的原因。 (c) 2005 Elsevier Inc. 保留所有权利。
Objective: The purpose of this study was to determine if a change in the vaginal flora was associated with an increased risk of preterm birth, and to determine if metronidazole therapy before 32 weeks increased the risk of preterm birth.Study design: We compared cultures taken at 23 to 26 weeks of gestation with cultures taken at delivery from women enrolled in the Vaginal Infections and Preterm Birth study to analyze the association of changes in the vaginal flora with preterm birth.Results: Metronidazole therapy before 32 weeks was associated with an increased risk of preterm birth (OR 1.5, 95%CI 1.05-2.1) in an unadjusted model. A change to heavy growth of Escherichia coli or Klebsiella pneumoniae at delivery was found to be associated with preterm birth (OR 2.4, 95%CI 1.6-3.8). After controlling for race, parity, prepregnancy weight < 100 pounds, smoking or drinking during pregnancy, Trichomonas vaginalis, bacterial vaginosis, chlamydia, mycoplasmas, group B streptococcus, metronidazole therapy before 32 weeks, vaginal pH > 5.0, and an increase in E coli or K pneumoniae, only prepregnancy weight < 100 pounds (adjusted odds ratio [AOR] 2.07, 95%CI 1.01-4.21) and increased E coli or K pneumoniae in the vagina Lit delivery (AOR 2.99, 95%CI 1.37-6.53) were found to be significantly associated with preterm birth.Conclusion: An increase in E coli or K pneumoniae in the vagina is an independent risk factor for preterm birth. Changes in the vaginal flora may explain the increased risk of preterm birth seen with vaginal clindamycin or oral metronidazole therapy. (c) 2005 Elsevier Inc. All rights reserved.