A collaborative translational research framework to study the association between the alteration of the vaginal microbiota and preterm birth: Preliminary results

Abstract

Preterm birth (PTB) constitutes a major health problem in our country. There is a variety of potential etiological mechanisms for spontaneous PTB, including infectious and inflammatory pathways, stress-related influences and genetic predispositions. Uncovering the multifactorial processes and the interplay of risk factors that lead to spontaneous birth is necessary to identify effective strategies for preventing PTB. Our study analyzes the possible association between the vaginal microbiota and preterm birth. We conducted a prospective cohort study on 163 pregnant women treated in Hospital Dr. Penna Bahia Blanca (October, 2017- August, 2019), to analyze the alteration of vaginal microbiota by Nugent score (dysbacteriosis/ vaginosis), the assessment of Candida spp. and other pathogenic microorganisms at weeks 24/28 of pregnancy. Follow-up until delivery, with identification and recording of PTB or premature membrane rupture (PMR) events. The average age was 26 ± 6.1. Sixty seven % of women had a vaginal microbiota alteration: 35 % dysbacteriosis-vaginosis, 27 % candidiasis, and 41 % a sexual transmitted pathogen like Chlamydia trachomatis, Mycoplasma genitalium or Trichomonas vaginalis. Mixed infections were detected in 33 % of women and 28 % were positive for HPV. Sixty nine % concluded the follow-up until delivery and 14 % presented at least one of the outcomes of interest: 7 % PTB; 6 % PMR and 1 % PTB and PMR. The frequency of PTB was higher in the presence of some types of infections, however, a higher number of cases is still required for a statistical significance analysis. These results are of clinical and public health relevance due to high rates of vaginal microbiota alteration found in the analyzed population of pregnant women. In addition, the implementation of a translational research represented a huge challenge that impacted positively on public health by improving the systematizing care processes in and between hospital units as well as on primary health care attention.