Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes
Vargas, Mireia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Yañez, Francisca (Instituto de Salud Carlos III)
Elias, Andrea (Instituto de Salud Carlos III)
Bernabeu, Andrea (Instituto Bernabeu)
Goya, M (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Xie, Zixuan (Instituto de Salud Carlos III)
Farràs Llobet, Alba (Hospital Universitari Vall d'Hebron)
Sánchez Martínez, M. Olga (Institut d'Investigació Biomèdica Sant Pau)
Soler, Zaida (Instituto de Salud Carlos III)
Blasquez, Carlos (Instituto de Salud Carlos III)
Valle, Leonor (Hospital Universitario Materno-Infantil de Canarias)
Olivella, Anna (Institut d'Investigació Biomèdica Sant Pau)
Muñoz, Begoña (Hospital Universitari Sant Joan de Reus (Tarragona))
Brik, Maia (Hospital Universitario de Torrejón)
Carreras Moratonas, Elena (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Manichanh, Chaysavanh (Instituto de Salud Carlos III)
Universitat Autònoma de Barcelona

Fecha:	2022
Resumen:	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. 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. 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. 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. A short cervix is associated with a lower microbial load and higher microbial richness. Microbial richness is negatively associated with gestational age at delivery. The use of a pessary for preterm birth prevention does not appear to adversely affect Lactobacillus relative abundance or microbial diversity. By contrast, cerclage with Mersilene was associated with low abundance of Lactobacillus, more threatened preterm labour episodes and poorer clinical outcomes.
Ayudas:	European Commission. Horizon 2020 812969 Ministerio de Economía y Competitividad PI15/02043
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	16S rRNA gene ; Cerclage ; Cervical length ; Community state type ; Microbial community ; Microbial diversity ; Microbial richness ; Pessary ; Vaginal bacterial load
Publicado en:	Acta Obstetricia et Gynecologica Scandinavica, Vol. 101 (september 2022) , p. 1403-1413, ISSN 1600-0412

DOI: 10.1111/aogs.14460
PMID: 36168933

11 p, 1.9 MB

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