Culture-based analysis of vaginal microbiota and its link to pregnancy outcomes: an observational cohort study in France

  1. Laura Lesimple
  2. Jessica Rousseau
  3. Céline Plainvert
  4. Luce Landraud
  5. Nathalie Grall
  6. François Goffinet
  7. Pierre-Yves Ancel
  8. Christophe Pannetier
  9. Claire Poyart
  10. Laurent Mandelbrot
  11. Asmaa Tazi
  12. The Inspire Consortium
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Abstract

Rationale

Increasing evidence links vaginal microbiota composition and preterm birth (PTB). However, most metagenomic studies are relatively small-sized, do not systematically adjust for confounders, and are difficult to transpose in clinical settings.

Objective

To identify, using routine vaginal microbiological cultures, signatures of preterm labor (PTL), preterm premature rupture of membranes (PPROM), and PTB.

Methods

We conducted an observational cohort study from August 2018 until June 2023 in France. Pregnant women were enrolled in three groups: control, PTL and PPROM. Demographic, clinical data, and pregnancy outcome were collected. Vaginal swabs were collected at enrollment and microbiological cultures were performed. The association between bacterial species and PTL, PPROM, and PTB was studied in univariate analyses. Adjusted odds ratio (aOR) and 95% confidence intervals (CI) were calculated in multivariable analyses adjusting for confounding variables.

Results

1,848 women were included: 1,048 in the control group, 417 with PTL, and 383 with PPROM. Among women with PTL or PPROM, 328/646 (50.8%) spontaneously delivered preterm. Vaginal samples enriched in enterobacteria and in Gardnerella spp. were signatures of PTL. Lactobacilli depletion and enterobacteria enrichment were signatures of PPROM. In multivariable analysis, lactobacilli depletion was the strongest risk factor for spontaneous PTB (aOR 2.29, 95% CI 1.52-3.48).

Conclusions

Our study corroborates previous findings demonstrating the protective role of lactobacilli during pregnancy and highlights enterobacteria as signatures of PTL and PPROM. Furthermore, it provides perspectives for the management of women at high risk of PTB using standard microbiological techniques.

Highlights

  • Vaginal microbiological analysis of 800 women with preterm labor or PPROM

  • Preterm labor signatures include enterobacteria and Gardnerella enrichment

  • PPROM signatures include lactobacilli depletion and enterobacteria enrichment

  • Lactobacilli depletion is the strongest risk factor for preterm birth

Article activity feed

  1. Version published to 10.1101/2024.09.11.612423 on bioRxiv