Vaginal infections are one of the main reasons of miscarriage. This study was undertaken to determine the vaginal microbiota of patients with threatened pregnancy who subsequently had ongoing pregnancy versus those who subsequently had miscarriage at the first trimester of gestation.
This was a study of 87 pregnant women attending hospital because of a threatened pregnancy at the first trimester of gestation. The women were divided into 2 groups: 1) 33 women with threatened pregnancy who subsequently had miscarriage; 2) 54 women with threatened pregnancy who were discharged from the hospital with ongoing pregnancy. Samples of vaginal swabs were collected from all investigated women before any treatment to perform quantitative polymerase chain reaction (qPCR) for microbial species assessment and vaginal pH evaluation. Fluorescence in situ hybridization (FISH) was also used to investigate microbiota of desquamated epithelial cells of vagina from urine sediment.
Vaginal dysbiosis was detected in 12/33 (36,4%) women of the 1st group and 24/54 women (44,4%) of the 2nd group (pH>4,5). All these 36 women had moderate vaginal dysbiosis (Lactobacillus spp. 20-80%). Statistical differences between 2 groups (p<0,05) were detected in the quantity of Lactobacillus spp. (28±6,2% and 75±9,6% respectively), Gardnerella vaginalis (60±5,0 and 45±7,3% respectively), Atopobium vaginae (60±6,5% and 45±6,9% respectively), and Enterobacteriaceae (15±4.9% and 2±0,5% respectively). FISH enabled us to see Gardnerella biofilms but no statistical differences were found between 2 groups of patients (p>0,05). That was 3/33 (9,1%) in the 1st group and 12/54 (22,2%) in the 2nd group.
Threatened pregnancy was characterized with moderate vaginal dysbiosis. The number of Lactobacillus spp., Gardnerella vaginalis, Atopobium vaginae, and Enterobacteriaceae was statistically higher in women with threatened pregnancy who subsequently had miscarriage versus those who had ongoing pregnancy in the first trimester of gestation. No statistical difference was found in the number of Gardnerella biofilms between women with threatened pregnancy either with subsequent ongoing pregnancy or with miscarriage.
1. Lamont RF, Sobel JD, Akins RA, et al. The vaginal microbiome: New information about genital tract flora using molecular based techniques. BJOG : an international journal of obstetrics and gynaecology. 2011;118(5):533-549. doi:10.1111/j.1471-0528.2010.02840.x.
2. Andosova LD, Kontorshchikova KN, Kachalina OV, Belov AV, Gonova ES, Kudel'kina SIu. The characteristic of biocenosis of urogenital tract in women. Klin Lab Diagn. 2013 Jan;(1):51-3.
3. Sangkomkamhang US, Lumbiganon P, Prasertcharoensuk W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD006178. DOI: 10.1002/14651858.CD006178.pub3.
4. Ravel J, Gajer P, Abdo Z, Schneider GM, Koenig SS, McCulle SL, Karlebach S, Gorle R, Russell J, Tacket CO, Brotman RM, Davis CC, Ault K, Peralta L, Forney LJ: Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A 2011, 108(Suppl 1):4680–4687.
5. Aagaard K, Riehle K, Ma J, Segata N, Mistretta TA, Coarfa C, Raza S, Rosenbaum S, Van den Veyver I, Milosavljevic A, Gevers D, Huttenhower C, Petrosino J, Versalovic J: A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PLoS One 2012, 7:e36466.
6. Cartwright CP, Lembke BD, Ramachandran K, Body BA, Nye MB, Rivers CA, Schwebke JR.2012. Development and validation of a semi-quantitative, multitarget PCR assay for diagnosis of bacterial vaginosis. J. Clin. Microbiol.50:2321–2329.
7. Datcu R, Gesink D, Mulvad G, Montgomery-Andersen R, Rink E, Koch A, Ahrens P, Jensen JS.2013. Vaginal microbiome in women from Greenland assessed by microscopy and quantitative PCR. BMC Infect. Dis.13:480.
8. Shipitsyna E, Roos A, Datcu R, Hallen A, Fredlund H, Jensen JS, Engstrand L, Unemo M. 2013. Composition of the vaginal microbiota in women of reproductive age—sensitive and specific molecular diagnosis of bacterial vaginosis is possible? PLoS One8:e60670.
9. Romero R, Hassan SS, Gajer P, Tarca AL, Fadrosh DW, Nikita L, Galuppi M, Lamont RF, Chaemsaithong P, Miranda J, Chaiworapongsa T, Ravel J: The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women. Microbiome 2014, 2:4
10. RomeroR,HassanSS,GajerP,TarcaAL,FadroshDW,BiedaJ,etal.The vaginal microbiota of pregnant women who subsequently have spontaneous preterm labor and delivery and those with anormal delivery at term.Microbiome (2014) 2:18.doi:10.1186/2049-2618-2-18
11. Datcu R, Gesink D, Mulvad G, Montgomery-Andersen R, Rink E, Koch A, Ahrens P, Jensen JS. Bacterial vaginosis diagnosed by analysis of first-void-urine specimens.JClin Microbiol. 2014 Jan;52(1):218-25. doi: 10.1128/JCM.02347-13. Epub 2013 Nov 6. PMID: 24197876
12. Swidsinski A, Dorffel Y, Loening-Baucke V, Schilling J, Mendling W: Response of Gardnerella vaginalis biofilm to 5 days of moxi£oxacin treatment. FEMS Immunol Med Microbiol 2011, 61:41–46.
13. Machado A, Almeida C, Salgueiro D, Henriques A, Vaneechoutte M, Haesebrouck F, Vieira MJ, Rodrigues L, Azevedo NF, Cerca N. Fluorescence in situ hybridization method using peptide nucleic acid probes for rapid detection of Lactobacillus and Gardnerella spp. BMC Microbiology. 2013;13:82. doi: 10.1186/1471-2180-13-82.
14. Machado A, Castro J, Cereija T, Almeida C, Cerca N. Diagnosis of bacterial vaginosis by a new multiplex peptide nucleic acid fluorescence in situ hybridization method. Smidt H, ed. PeerJ. 2015;3:e780. doi:10.7717/peerj.780.
15. Swidsinski A, Loening-Baucke V, Mendling W, Dörffel Y, Schilling J, Halwani Z, Jiang XF, Verstraelen H, Swidsinski S. Infection through structured polymicrobial Gardnerella biofilms (StPM-GB). Histol Histopathol. 2014 May;29(5):567-87. Epub 2013 Dec 11.
16. Hardy, L., Jespers, V., Dahchour, N., Mwambarangwe, L., Musengamana, V., Vaneechoutte, M., & Crucitti, T. (2015). Unravelling the Bacterial Vaginosis-Associated Biofilm: A Multiplex Gardnerella vaginalis and Atopobium vaginae Fluorescence In Situ Hybridization Assay Using Peptide Nucleic Acid Probes. PLoS ONE, 10(8), e0136658. http://doi.org/10.1371/journal.pone.0136658
17. Van Acker H, Van Dijck P, Coenye T (2014) Molecular mechanisms of antimicrobial tolerance and resistance in bacterial and fungal biofilms. Trends Microbiol 22(6):326–333
18. Verstraelen H.,Swidsinski A. The biofilm in bacterial vaginosis: Implications for epidemiology, diagnosis and treatment. Curr. Opin. Infect. DisYear: 2013; 26: 86-89
19. Hemalatha R, Ramalaxmi BA, Swetha E, Balakrishna N, Mastromarino P. Evaluation of vaginal pH for detection of bacterial vaginosis. The Indian Journal of Medical Research. 2013;138(3):354-359.
20. Krauss-Silva L, Almada-Horta A, Alves MB, Camacho KG, Moreira MEL, Braga A. Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population. BMC Pregnancy and Childbirth. 2014;14:107. doi:10.1186/1471-2393-14-107.
21. Foroozanfard F, Tabasi Z, Mesdaghinia E, Sehat M, Mehrdad M. Cervical length versus vaginal PH in the second trimester as preterm birth predictor. Pakistan Journal of Medical Sciences. 2015;31(2):374-378. doi:10.12669/pjms.312.6310.