Cervical pessary and cerclage placement for preterm birth prevention and cervicovaginal microbiome changes

Elena Carreras Moratonas, Mireia Vargas, Francisca Yañez, Andrea Elias, Andrea Bernabeu, M Goya, Zixuan Xie, Alba Farràs Llobet, Zaida Soler, Carlos Blasquez, Leonor Valle, Anna Olivella, Begoña Muñoz, Maia Brik, Chaysavanh Manichanh

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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.
Idioma originalInglés
Páginas (desde-hasta)1403-1413
Número de páginas11
PublicaciónActa Obstetricia et Gynecologica Scandinavica
Volumen101
DOI
EstadoPublicada - 2022

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