Bacterial Vaginosis Early in Pregnancy a Strong Risk Factor for Preterm Delivery
Sunday, August 17th 2003
Results of a meta-analysis of 18 studies involving a total of 20,232 women show, once again, that bacterial vaginosis early in pregnancy significantly increases the risk of preterm delivery.
"Although the role of bacterial vaginosis itself in the pathogenesis of preterm labor and delivery is not well understood, the association between bacterial vaginosis and preterm delivery has been confirmed repeatedly and consistently," Dr. Harald Leitich and colleagues from the University of Vienna in Austria write in July American Journal of Obstetrics and Gynecology.
However, a lack of "detailed knowledge" about the clinical circumstances that determine the strength of the association prompted them to revisit the issue.
In the main analysis of pooled data from all 18 trials, bacterial vaginosis was significantly associated with preterm delivery at <37 weeks, with an odds ratio of 2.19. However, the investigators believe this result should be viewed only as a "crude estimate," due to "considerable and highly significant heterogeneity."
In subgroup analyses of studies sharing specific clinical characteristics, the amount of heterogeneity seen in the main analysis was strongly reduced and even stronger associations emerged, according to the team.
For example, in studies that screened for bacterial vaginosis at <16 weeks gestation and <20 weeks gestation, the odds ratios for preterm delivery were 7.55 and 4.20 respectively.
Bacterial vaginosis also significantly increased the risk of spontaneous abortion and maternal infection, with odds ratios of 9.91 and 2.53, respectively. This association "appears to have received little attention so far, but clearly deserves attention," Dr. Leitich and colleagues write.
"Strategies to screen for and treat BV in pregnancy remain controversial," the team acknowledges.
Am J Obstet Gynecol 2003;189:139-147
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