Prevalence of and risk factors for abnormal vaginal flora and its association with adverse pregnancy outcomes in a rural district in north-east Bangladesh

the MIST Study Team of the Projahnmo Study Group in Bangladesh

Research output: Contribution to journalArticle

Abstract

Introduction: The role of screening and treatment for abnormal vaginal flora (AVF) on adverse pregnancy outcomes remains unclear. Using data from women who participated in a population-based cluster randomized trial who were screened and treated for AVF, we report risk factors for AVF and association of persistent AVF with adverse perinatal outcomes. Material and methods: Pregnant women (n = 4221) <19 weeks of gestation provided self-administered mid-vaginal swabs; smears were Nugent-scored. AVF was treated with oral clindamycin; if AVF was present 3 weeks after treatment, persistent AVF was re-treated. We examined risk factors for AVF and the association of persistent AVF with adverse pregnancy outcomes. Results: The prevalence of AVF was 16.5%: 9.8% of women had bacterial vaginosis and 6.8% had intermediate flora. Lower economic and educational status of women were associated with increased risk of AVF. One-third of women with AVF had persistent abnormal flora; these women had a higher risk of a composite measure of adverse pregnancy outcomes from 20 to <37 weeks (preterm live birth, preterm still birth, late miscarriage) (relative risk [RR] 1.33, 95% confidence interval [CI] 1.07-1.65) and of late miscarriage alone (RR 4.15, 95% CI 2.12-8.12) compared to women without AVF. Conclusions: In this study in Sylhet District, Bangladesh, rates of AVF and persistent AVF were high and persistent AVF was associated with adverse pregnancy outcomes, with an especially high associated risk for late miscarriage. Further characterization of the microbiome and relative bacterial species density associated with persistent AVF is needed.

Original languageEnglish (US)
JournalActa Obstetricia et Gynecologica Scandinavica
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Bangladesh
Pregnancy Outcome
Spontaneous Abortion
Premature Birth
Confidence Intervals
Bacterial Vaginosis
Educational Status
Clindamycin
Microbiota
Live Birth
Pregnant Women
Economics
Pregnancy
Therapeutics
Population

Keywords

  • abnormal vagina flora
  • adverse pregnancy outcomes
  • Bangladesh
  • risk factors
  • vaginal microbiome

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Prevalence of and risk factors for abnormal vaginal flora and its association with adverse pregnancy outcomes in a rural district in north-east Bangladesh. / the MIST Study Team of the Projahnmo Study Group in Bangladesh.

In: Acta Obstetricia et Gynecologica Scandinavica, 01.01.2018.

Research output: Contribution to journalArticle

@article{698af91eda824dd09230c6a040c21644,
title = "Prevalence of and risk factors for abnormal vaginal flora and its association with adverse pregnancy outcomes in a rural district in north-east Bangladesh",
abstract = "Introduction: The role of screening and treatment for abnormal vaginal flora (AVF) on adverse pregnancy outcomes remains unclear. Using data from women who participated in a population-based cluster randomized trial who were screened and treated for AVF, we report risk factors for AVF and association of persistent AVF with adverse perinatal outcomes. Material and methods: Pregnant women (n = 4221) <19 weeks of gestation provided self-administered mid-vaginal swabs; smears were Nugent-scored. AVF was treated with oral clindamycin; if AVF was present 3 weeks after treatment, persistent AVF was re-treated. We examined risk factors for AVF and the association of persistent AVF with adverse pregnancy outcomes. Results: The prevalence of AVF was 16.5{\%}: 9.8{\%} of women had bacterial vaginosis and 6.8{\%} had intermediate flora. Lower economic and educational status of women were associated with increased risk of AVF. One-third of women with AVF had persistent abnormal flora; these women had a higher risk of a composite measure of adverse pregnancy outcomes from 20 to <37 weeks (preterm live birth, preterm still birth, late miscarriage) (relative risk [RR] 1.33, 95{\%} confidence interval [CI] 1.07-1.65) and of late miscarriage alone (RR 4.15, 95{\%} CI 2.12-8.12) compared to women without AVF. Conclusions: In this study in Sylhet District, Bangladesh, rates of AVF and persistent AVF were high and persistent AVF was associated with adverse pregnancy outcomes, with an especially high associated risk for late miscarriage. Further characterization of the microbiome and relative bacterial species density associated with persistent AVF is needed.",
keywords = "abnormal vagina flora, adverse pregnancy outcomes, Bangladesh, risk factors, vaginal microbiome",
author = "{the MIST Study Team of the Projahnmo Study Group in Bangladesh} and Abdullah Baqui and Lee, {Anne C.C.} and Koffi, {Alain K} and Rasheda Khanam and Mitra, {Dipak K.} and Dasgupta, {Sushil K.} and Jamal Uddin and Parvez Ahmed and Iftekhar Rafiqullah and Mahmoodur Rahman and Abdul Quaiyum and Koumans, {Emilia H.} and Christian, {Parul S} and Saha, {Samir K.} and Mullany, {Luke C} and Labrique, {Alain B}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/aogs.13492",
language = "English (US)",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Prevalence of and risk factors for abnormal vaginal flora and its association with adverse pregnancy outcomes in a rural district in north-east Bangladesh

AU - the MIST Study Team of the Projahnmo Study Group in Bangladesh

AU - Baqui, Abdullah

AU - Lee, Anne C.C.

AU - Koffi, Alain K

AU - Khanam, Rasheda

AU - Mitra, Dipak K.

AU - Dasgupta, Sushil K.

AU - Uddin, Jamal

AU - Ahmed, Parvez

AU - Rafiqullah, Iftekhar

AU - Rahman, Mahmoodur

AU - Quaiyum, Abdul

AU - Koumans, Emilia H.

AU - Christian, Parul S

AU - Saha, Samir K.

AU - Mullany, Luke C

AU - Labrique, Alain B

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: The role of screening and treatment for abnormal vaginal flora (AVF) on adverse pregnancy outcomes remains unclear. Using data from women who participated in a population-based cluster randomized trial who were screened and treated for AVF, we report risk factors for AVF and association of persistent AVF with adverse perinatal outcomes. Material and methods: Pregnant women (n = 4221) <19 weeks of gestation provided self-administered mid-vaginal swabs; smears were Nugent-scored. AVF was treated with oral clindamycin; if AVF was present 3 weeks after treatment, persistent AVF was re-treated. We examined risk factors for AVF and the association of persistent AVF with adverse pregnancy outcomes. Results: The prevalence of AVF was 16.5%: 9.8% of women had bacterial vaginosis and 6.8% had intermediate flora. Lower economic and educational status of women were associated with increased risk of AVF. One-third of women with AVF had persistent abnormal flora; these women had a higher risk of a composite measure of adverse pregnancy outcomes from 20 to <37 weeks (preterm live birth, preterm still birth, late miscarriage) (relative risk [RR] 1.33, 95% confidence interval [CI] 1.07-1.65) and of late miscarriage alone (RR 4.15, 95% CI 2.12-8.12) compared to women without AVF. Conclusions: In this study in Sylhet District, Bangladesh, rates of AVF and persistent AVF were high and persistent AVF was associated with adverse pregnancy outcomes, with an especially high associated risk for late miscarriage. Further characterization of the microbiome and relative bacterial species density associated with persistent AVF is needed.

AB - Introduction: The role of screening and treatment for abnormal vaginal flora (AVF) on adverse pregnancy outcomes remains unclear. Using data from women who participated in a population-based cluster randomized trial who were screened and treated for AVF, we report risk factors for AVF and association of persistent AVF with adverse perinatal outcomes. Material and methods: Pregnant women (n = 4221) <19 weeks of gestation provided self-administered mid-vaginal swabs; smears were Nugent-scored. AVF was treated with oral clindamycin; if AVF was present 3 weeks after treatment, persistent AVF was re-treated. We examined risk factors for AVF and the association of persistent AVF with adverse pregnancy outcomes. Results: The prevalence of AVF was 16.5%: 9.8% of women had bacterial vaginosis and 6.8% had intermediate flora. Lower economic and educational status of women were associated with increased risk of AVF. One-third of women with AVF had persistent abnormal flora; these women had a higher risk of a composite measure of adverse pregnancy outcomes from 20 to <37 weeks (preterm live birth, preterm still birth, late miscarriage) (relative risk [RR] 1.33, 95% confidence interval [CI] 1.07-1.65) and of late miscarriage alone (RR 4.15, 95% CI 2.12-8.12) compared to women without AVF. Conclusions: In this study in Sylhet District, Bangladesh, rates of AVF and persistent AVF were high and persistent AVF was associated with adverse pregnancy outcomes, with an especially high associated risk for late miscarriage. Further characterization of the microbiome and relative bacterial species density associated with persistent AVF is needed.

KW - abnormal vagina flora

KW - adverse pregnancy outcomes

KW - Bangladesh

KW - risk factors

KW - vaginal microbiome

UR - http://www.scopus.com/inward/record.url?scp=85056893710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056893710&partnerID=8YFLogxK

U2 - 10.1111/aogs.13492

DO - 10.1111/aogs.13492

M3 - Article

C2 - 30346023

AN - SCOPUS:85056893710

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

ER -