Association between Bacterial Vaginosis and Preterm Delivery of a Low-Birth-Weight Infant
Sharon L. Hillier, Ph.D., Robert P. Nugent, Ph.D., David A. Eschenbach, M.D., Marijane A. Krohn, Ph.D., Ronald S. Gibbs, M.D., David H. Martin, M.D., Mary Frances Cotch, Ph.D., Robert Edelman, M.D., Joseph G. Pastorek, M.D., A. Vijaya Rao, Ph.D., Donald McNellis, M.D., Joan A. Regan, M.D., J. Christopher Carey, M.D., Mark A. Klebanoff, M.D., for The Vaginal Infections and Prematurity Study Group
Background Bacterial vaginosis is believed to be a risk factorfor preterm delivery. We undertook a study of the associationbetween bacterial vaginosis and the preterm delivery of infantswith low birth weight after accounting for other known riskfactors.
Methods In this cohort study, we enrolled 10,397 pregnant womenfrom seven medical centers who had no known medical risk factorsfor preterm delivery. At 23 to 26 weeks' gestation, bacterialvaginosis was determined to be present or absent on the basisof the vaginal pH and the results of Gram's staining. The principaloutcome variable was the delivery at less than 37 weeks' gestationof an infant with a birth weight below 2500 g.
Results Bacterial vaginosis was detected in 16 percent of the10,397 women. The women with bacterial vaginosis were more likelyto be unmarried, to be black, to have low incomes, and to havepreviously delivered low-birth-weight infants. In a multivariateanalysis, the presence of bacterial vaginosis was related topreterm delivery of a low-birth-weight infant (odds ratio, 1.4;95 percent confidence interval, 1.1 to 1.8). Other risk factorsthat were significantly associated with such a delivery in thispopulation were the previous delivery of a low-birth-weightinfant (odds ratio, 6.2; 95 percent confidence interval, 4.6to 8.4), the loss of an earlier pregnancy (odds ratio, 1.7;1.3 to 2.2), primigravidity (odds ratio, 1.6; 1.1 to 1.9), smoking(odds ratio, 1.4; 1.1 to 1.7); and black race (odds ratio, 1.4;1.1 to 1.7). Among women with bacterial vaginosis, the highestrisk of preterm delivery of a low-birth-weight infant was foundamong those with both vaginal bacteroides and Mycoplasmahominis(odds ratio, 2.1; 95 percent confidence interval, 1.5 to 3.0).
Conclusions Bacterial vaginosis was associated with the pretermdelivery of low-birth-weight infants independently of otherrecognized risk factors.
Source Information
From the University of Washington, Seattle (S.L.H., D.A.E., M.A. Krohn); the National Institute of Child Health and Human Development, Bethesda, Md. (R.P.N., D.M., M.A. Klebanoff); the University of Texas, San Antonio (R.G.); Louisiana State University, New Orleans (D.H.M., J.G.P.); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (M.F.C., R.E.); the Research Triangle Institute, Research Triangle Park, N.C. (A.V.R.); Columbia University, New York (J.A.R.); and the University of Oklahoma, Oklahoma City (J.C.C.).
Address reprint requests to Dr. Hillier at University of Pittsburgh/Magee–Women's Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, 300 Halket St., Pittsburgh, PA 15213.
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