Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes
Por:
Vargas, M, Yanez, F, Elias, A, Bernabeu, A, Goya, M, Xie, ZX, Farras, A, Sanchez, O, Soler, Z, Blasquez, C, Valle, L, Olivella, A, Munoz, B, Brik, M, Carreras, E, Manichanh, C
Publicada:
1 dic 2022
Ahead of Print:
1 sep 2022
Resumen:
Introduction Our objective was to compare the vaginal microbiome in low-risk and high-risk pregnant women and to explore a potential association between vaginal microbiome and preterm birth. Material and methods A pilot, consecutive, longitudinal, multicenter study was conducted in pregnant women at 18-22 weeks of gestation. Participants were assigned to one of three groups: control (normal cervix), pessary (cervical length <= 25 mm) and cerclage (cervical length <= 25 mm or history of preterm birth). Analysis and comparison of vaginal microbiota as a primary outcome was performed at inclusion and at 30 weeks of gestation, along with a follow-up of pregnancy and perinatal outcomes. We assessed the vaginal microbiome of pregnant women presenting a short cervix with that of pregnant women having a normal cervix, and compared the vaginal microbiome of women with a short cervix before and after placement of a cervical pessary or a cervical cerclage. Results The microbiome of our control cohort was dominated by Lactobacillus crispatus and inners. Five community state types were identified and microbiome diversity did not change significantly over 10 weeks in controls. On the other hand, a short cervix was associated with a lower microbial load and higher microbial richness, and was not correlated with Lactobacillus relative abundance. After intervention, the cerclage group (n = 19) had a significant increase in microbial richness and a shift towards community state types driven by various bacterial species, including Lactobacillus mulieris, unidentified Bifidobacterium or Enterococcus. These changes were not significantly observed in the pessary (n = 26) and control (n = 35) groups. The cerclage group had more threatened preterm labor episodes and poorer outcomes than the control and pessary groups. Conclusions These findings indicate that a short cervix is associated with an altered vaginal microbiome community structure. The use of a cerclage for preterm birth prevention, as compared with a pessary, was associated with a microbial community harboring a relatively low abundance of Lactobacillus, with more threatened preterm labor episodes, and with poorer clinical outcomes.
Filiaciones:
Vargas, M:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Obstet, Maternal Fetal Med Unit, Passeig Vall dHebron 119-129, Barcelona 08036, Spain
Yanez, F:
Inst Salud Carlos III, Maternal & Child Hlth & Dev Network SAMID, Madrid, Spain
Elias, A:
Inst Salud Carlos III, Maternal & Child Hlth & Dev Network SAMID, Madrid, Spain
Bernabeu, A:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Obstet, Maternal Fetal Med Unit, Passeig Vall dHebron 119-129, Barcelona 08036, Spain
Inst Bernabeu, Dept Reprod Med, Alicante, Spain
Goya, M:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Obstet, Maternal Fetal Med Unit, Passeig Vall dHebron 119-129, Barcelona 08036, Spain
Hosp Univ Vall dHebron, Microbiome Lab, Cerdanyola Del Valles, Spain
Univ Autonoma Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Cerdanyola Del Valles, Spain
Xie, ZX:
Inst Salud Carlos III, Maternal & Child Hlth & Dev Network SAMID, Madrid, Spain
Farras, A:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Obstet, Maternal Fetal Med Unit, Passeig Vall dHebron 119-129, Barcelona 08036, Spain
Sanchez, O:
Hosp Univ Vall dHebron, Microbiome Lab, Cerdanyola Del Valles, Spain
Univ Autonoma Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Cerdanyola Del Valles, Spain
Hosp Univ St Pau, Women & Perinatal Hlth Res Grp, Inst Invest Biomed St Pau IIB St Pau, Barcelona, Spain
Soler, Z:
Inst Salud Carlos III, Maternal & Child Hlth & Dev Network SAMID, Madrid, Spain
Blasquez, C:
Inst Salud Carlos III, Maternal & Child Hlth & Dev Network SAMID, Madrid, Spain
Valle, L:
Hosp Univ Materno Infantil Canarias, Dept Obstet, Maternal Fetal Med Unit, Las Palmas Gran Canaria, Spain
Olivella, A:
Hosp Santa Creu & Sant Pau, Dept Obstet, Barcelona, Spain
Munoz, B:
Hosp Univ St Joan Reus, Dept Obstet & Gynecol, Reus, Spain
Brik, M:
Univ Francisco Vitoria, Hosp Univ Torrejon, Dept Obstet, Madrid, Spain
Carreras, E:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Obstet, Maternal Fetal Med Unit, Passeig Vall dHebron 119-129, Barcelona 08036, Spain
Hosp Univ Vall dHebron, Microbiome Lab, Cerdanyola Del Valles, Spain
Univ Autonoma Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Cerdanyola Del Valles, Spain
Manichanh, C:
Inst Salud Carlos III, Maternal & Child Hlth & Dev Network SAMID, Madrid, Spain
hybrid, All Open Access; Green
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