Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery

Abstract

The presence of an abnormal vaginal microflora in early pregnancy is a risk factor for preterm delivery. There is no investigation on vaginal flora dominated by lactic acid bacteria and possible association with preterm delivery. We assessed the dominant vaginal Lactobacillus species in healthy pregnant women in early pregnancy in relation to pregnancy outcome. We observed 111 low risk pregnant women with a normal vaginal microflora 11 + 0 to 14 + 0 weeks of pregnancy without subjective complaints. Vaginal smears were taken for the identification of lactobacilli using denaturing gradient gel electrophoresis (DGGE). Pregnancy outcome was recorded as term or preterm delivery (limit 36 + 6 weeks of gestation). The diversity of Lactobacillus species in term vs. preterm was the main outcome measure. L. iners alone was detected in 11 from 13 (85%) women who delivered preterm. By contrast, L. iners alone was detected in only 16 from 98 (16%) women who delivered at term (p < 0.001). Fifty six percent women that delivered at term and 8% women that delivered preterm had two or more vaginal Lactobacillus spp. at the same time. This study suggests that dominating L. iners alone detected in vaginal smears of healthy women in early pregnancy might be associated with preterm delivery.

Figure 1. Exclusion criteria and patient selection diagram.

Figure 2. Percentage of the most frequent vaginal Lactobacillus species in women with term (TD) and preterm delivery (PTD) as determined by denaturing gradient gel electrophoresis (DGGE).

Figure 3. Percentage of L. iners as only single Lactobacillus species in women with term (TD) and preterm delivery (PTD) as determined by denaturing gradient gel electrophoresis (DGGE).

Figure 4. Lactobacilli status obtained at the beginning of the study (i.e., between 11 + 0 and 14 + 0 weeks of gestation) compared to gestational age at birth.