Insights Into Bacterial Vaginosis During Pregnancy and Its Relationship with Preterm Birth: A Comprehensive Study in Shahid Akbarabadi Hospital, Tehran, Iran

Rahimi, Parisa; Dashtbin, Shirin; Kashanian, Maryam; Mirkalantari, ُShiva; Eshraghi, Nooshin; Masjedian Jazi, Faramarz

doi:10.30699/ijmm.19.1.50

year 19, Issue 1 (January - February 2025) Iran J Med Microbiol 2025, 19(1): 50-61 | Back to browse issues page

‎ 10.30699/ijmm.19.1.50

Mendeley

Zotero

RefWorks

Rahimi P, Dashtbin S, Kashanian M, Mirkalantari ُ, Eshraghi N, Masjedian Jazi F. Insights Into Bacterial Vaginosis During Pregnancy and Its Relationship with Preterm Birth: A Comprehensive Study in Shahid Akbarabadi Hospital, Tehran, Iran. Iran J Med Microbiol 2025; 19 (1) :50-61
URL: http://ijmm.ir/article-1-2529-en.html

Insights Into Bacterial Vaginosis During Pregnancy and Its Relationship with Preterm Birth: A Comprehensive Study in Shahid Akbarabadi Hospital, Tehran, Iran

Parisa Rahimi¹

, Shirin Dashtbin¹

, Maryam Kashanian²

, ُShiva Mirkalantari¹

, Nooshin Eshraghi³

, Faramarz Masjedian Jazi⁴

1- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran & Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
2- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3- Department of Obestrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
4- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran & Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran , masjedian.f@iums.ac.ir

Abstract: (337 Views)

Background and Aim: Bacterial Vaginosis (BV) is a common condition affecting women of reproductive age, including pregnant women. It involves a disruption of the microbial balance in the vaginal environment, which can lead to undesirable outcomes such as preterm birth. This study aimed to assess the incidence of BV and its relationship with preterm delivery among pregnant women visiting Shahid Akbarabadi Hospital in Tehran, Iran.
Materials and Methods: A cohort study was conducted between September 2022 and April 2023, involving pregnant women who underwent vaginal swab sampling for BV. Diagnosis of BV was made using Amsel's criteria. Real-time PCR was employed to detect the presence of Gardnerella vaginalis, Atopobium vaginae, Prevotella bivia, and Lactobacillus crispatus. Statistical analyses were performed using GraphPad Prism 8.4.3.
Results: Out of the 55 pregnant women who participated in the study, 20 were found to be positive for BV. In our study of pregnant women, we found that the prevalence of bacterial vaginosis is 36.36% based on the Amsel criteria.
Conclusion: Our results highlight significant correlations between the levels of G. vaginalis, A. vaginae, P. bivia, and L. crispatus and the clinical signs and symptoms of bacterial vaginosis in this population. However, no significant differences were observed in the levels of studied bacteria in the lower genital tract of patients who experienced preterm delivery compared to those who delivered at term.

Keywords: Bacterial Vaginosis, Preterm Birth, Dysbiosis, Risk Factor, Pregnant Women

Full-Text [PDF 860 kb] (123 Downloads) | | Full-Text (HTML) (41 Views)

Type of Study: Original Research Article | Subject: Medical Bacteriology
Received: 2024/12/12 | Accepted: 2025/03/15 | ePublished: 2025/03/30

References

1. Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Front Reprod Health. 2023;5:1100029. [DOI:10.3389/frph.2023.1100029] [PMID] [PMCID]

2. Bradshaw CS, Vodstrcil LA, Hocking JS, Law M, Pirotta M, Garland SM, et al. Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use. Clin Infect Dis. 2013;56(6):777-86. [DOI:10.1093/cid/cis1030] [PMID]

3. Reiter S, Kellogg Spadt S. Bacterial vaginosis: a primer for clinicians. Postgrad Med. 2019;131(1):8-18. [DOI:10.1080/00325481.2019.1546534] [PMID]

4. Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021;224(3):251-7. [DOI:10.1016/j.ajog.2020.10.019] [PMID]

5. Coudray MS, Madhivanan P. Bacterial vaginosis-A brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol. 2020;245:143-8. [DOI:10.1016/j.ejogrb.2019.12.035] [PMID] [PMCID]

6. Abou Chacra L, Fenollar F, Diop K. Bacterial Vaginosis: What Do We Currently Know?. Front Cell Infect Microbiol. 2021;11:672429. [DOI:10.3389/fcimb.2021.672429] [PMID] [PMCID]

7. Alves P, Castro J, Sousa C, Cereija TB, Cerca N. Gardnerella vaginalis outcompetes 29 other bacterial species isolated from patients with bacterial vaginosis, using in an in vitro biofilm formation model. J Infect Dis. 2014;210(4):593-6. [DOI:10.1093/infdis/jiu131] [PMID]

8. Schellenberg JJ, Paramel Jayaprakash T, Withana Gamage N, Patterson MH, Vaneechoutte M, Hill JE. Gardnerella vaginalis Subgroups Defined by cpn60 Sequencing and Sialidase Activity in Isolates from Canada, Belgium and Kenya. PLoS One. 2016;11(1):e0146510. [DOI:10.1371/journal.pone.0146510] [PMID] [PMCID]

9. Castro J, França A, Bradwell KR, Serrano MG, Jefferson KK, Cerca N. Comparative transcriptomic analysis of Gardnerella vaginalis biofilms vs. planktonic cultures using RNA-seq. NPJ Biofilms Microbiomes. 2017;3:3. [DOI:10.1038/s41522-017-0012-7] [PMID] [PMCID]

10. Muzny CA, Taylor CM, Swords WE, Tamhane A, Chattopadhyay D, Cerca N, et al. An Updated Conceptual Model on the Pathogenesis of Bacterial Vaginosis. J Infect Dis. 2019;220(9):1399-405. [DOI:10.1093/infdis/jiz342] [PMID] [PMCID]

11. Muzny CA, Blanchard E, Taylor CM, Aaron KJ, Talluri R, Griswold ME, et al. Identification of Key Bacteria Involved in the Induction of Incident Bacterial Vaginosis: A Prospective Study. J Infect Dis. 2018;218(6):966-78. [DOI:10.1093/infdis/jiy243] [PMID] [PMCID]

12. Gilbert NM, Lewis WG, Li G, Sojka DK, Lubin JB, Lewis AL. Gardnerella vaginalis and Prevotella bivia Trigger Distinct and Overlapping Phenotypes in a Mouse Model of Bacterial Vaginosis. J Infect Dis. 2019;220(7):1099-108. [DOI:10.1093/infdis/jiy704] [PMID] [PMCID]

13. Chen X, Lu Y, Chen T, Li R. The Female Vaginal Microbiome in Health and Bacterial Vaginosis. Front Cell Infect Microbiol. 2021;11:631972. [DOI:10.3389/fcimb.2021.631972] [PMID] [PMCID]

14. Griggs KM, Hrelic DA, Williams N, McEwen-Campbell M, Cypher R. Preterm Labor and Birth: A Clinical Review. MCN Am J Matern Child Nurs. 2020;45(6):328-37. [DOI:10.1097/NMC.0000000000000656] [PMID]

15. Fettweis JM, Serrano MG, Brooks JP, Edwards DJ, Girerd PH, Parikh HI, et al. The vaginal microbiome and preterm birth. Nat Med. 2019;25(6):1012-21. [DOI:10.1038/s41591-019-0450-2] [PMID] [PMCID]

16. Liu X, Cao Y, Xie X, Qin X, He X, Shi C, et al. Association between vaginal microbiota and risk of early pregnancy miscarriage. Comp Immunol Microbiol Infect Dis. 2021;77:101669. [DOI:10.1016/j.cimid.2021.101669] [PMID]

17. Menard JP, Mazouni C, Salem-Cherif I, Fenollar F, Raoult D, Boubli L, et al. High vaginal concentrations of Atopobium vaginae and Gardnerella vaginalis in women undergoing preterm labor. Obstet Gynecol. 2010;115(1):134-40. [DOI:10.1097/AOG.0b013e3181c391d7] [PMID]

18. Jayaram PM, Mohan MK, Konje J. Bacterial vaginosis in pregnancy - a storm in the cup of tea. Eur J Obstet Gynecol Reprod Biol. 2020;253:220-4. [DOI:10.1016/j.ejogrb.2020.08.009] [PMID]

19. Elovitz MA, Gajer P, Riis V, Brown AG, Humphrys MS, Holm JB, et al. Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm delivery. Nat Commun. 2019;10(1):1305. [DOI:10.1038/s41467-019-09285-9] [PMID] [PMCID]

20. Delaney ML, Onderdonk AB, Microbiology, Group PS. Nugent score related to vaginal culture in pregnant women. Obstet Gynecol. 2001;98(1):79-84. [DOI:10.1016/S0029-7844(01)01402-8] [DOI:10.1097/00006250-200107000-00015] [PMID]

21. Colonna C, Steelman M. Amsel Criteria. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/sites/books/NBK542319/]

22. Cheng X, Hong X, Khayatnezhad M, Ullah F. Genetic diversity and comparative study of genomic DNA extraction protocols in Tamarix L. species. Caryologia. 2021;74(2):131-9. [DOI:10.36253/caryologia-1056]

23. Bakhshi A, Delouyi ZS, Taheri S, Alivandi A, Mohammadzadeh N, Dabiri H. Comparative study of lactobacilli and bifidobacteria in vaginal tract of individual with bacterial vaginosis and healthy control by quantitative PCR. Rev Res Med Microbiol. 2019;30(3):148-54. [DOI:10.1097/MRM.0000000000000186]

24. da Fonseca EB, Damião R, Moreira DA. Preterm birth prevention. Best Pract Res Clin Obstet Gynaecol. 2020;69:40-9. [DOI:10.1016/j.bpobgyn.2020.09.003] [PMID]

25. Witkin SS. The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection-related preterm birth. BJOG: Int J Obstet Gynaecol. 2015;122(2):213-8. [DOI:10.1111/1471-0528.13115] [PMID]

26. France MT, Fu L, Rutt L, Yang H, Humphrys MS, Narina S, et al. Insight into the ecology of vaginal bacteria through integrative analyses of metagenomic and metatranscriptomic data. Genome Biol. 2022;23(1):66. [DOI:10.1186/s13059-022-02635-9] [PMID] [PMCID]

27. Verstraelen H, Verhelst R. Bacterial vaginosis: an update on diagnosis and treatment. Expert Rev Anti Infect Ther. 2009;7(9):1109-24. [DOI:10.1586/eri.09.87] [PMID]

28. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29(2):297-301. [DOI:10.1128/jcm.29.2.297-301.1991] [PMID] [PMCID]

29. Mengistie Z, Woldeamanuel Y, Asrat D, Yigeremu M. Comparison of clinical and gram stain diagnosis methods of bacterial vaginosis among pregnant women in ethiopia. J Clin Diagn Res. 2013;7(12):2701-3. [DOI:10.7860/JCDR/2013/5872.3736] [PMID] [PMCID]

30. Bhujel R, Mishra SK, Yadav SK, Bista KD, Parajuli K. Comparative study of Amsel's criteria and Nugent scoring for diagnosis of bacterial vaginosis in a tertiary care hospital, Nepal. BMC Infect Dis. 2021;21(1):825. [DOI:10.1186/s12879-021-06562-1] [PMID] [PMCID]

31. Roohbakhsh E, Mojtahedi A, Khavari-Nezhad RA, Amirmozafari N. Za0Using the PCR method for detection of bacterial vaginosis in women suspected of vaginosis in Guilan province. Iran J Obstet Gynecol Infertil. 2019;21(12):29-36.

32. Mengistie Z, Woldeamanuel Y, Asrat D, Adera A. Prevalence of bacterial vaginosis among pregnant women attending antenatal care in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. BMC Res Notes. 2014;7:822. [DOI:10.1186/1756-0500-7-822] [PMID] [PMCID]

33. Lata I, Pradeep Y, Sujata, Jain A. Estimation of the Incidence of Bacterial Vaginosis and other Vaginal Infections and its Consequences on Maternal/Fetal Outcome in Pregnant Women Attending an Antenatal Clinic in a Tertiary Care Hospital in North India. Indian J Community Med. 2010;35(2):285-9. [DOI:10.4103/0970-0218.66855] [PMID] [PMCID]

34. Romoren M, Velauthapillai M, Rahman M, Sundby J, Klouman E, Hjortdahl P. Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach. Bull World Health Organ. 2007;85(4):297-304. [DOI:10.2471/BLT.06.031922] [PMID] [PMCID]

35. Kurewa NE, Mapingure MP, Munjoma MW, Chirenje MZ, Rusakaniko S, Stray-Pedersen B. The burden and risk factors of Sexually Transmitted Infections and Reproductive Tract Infections among pregnant women in Zimbabwe. BMC Infect Dis. 2010;10:127. [DOI:10.1186/1471-2334-10-127] [PMID] [PMCID]

36. Amor I, Alberola A, De Salazar A, Viñuela L, Úbeda-Portugués S, Galán MI, et al. Evaluation of the Vaginal Panel Realtime PCR kit (Vircell, SL) for diagnosing vaginitis: A comparative study with routinely used diagnostics. PloS One. 2024;19(11):e0313414. [DOI:10.1371/journal.pone.0313414] [PMID] [PMCID]

37. Fredricks DN, Fiedler TL, Thomas KK, Oakley BB, Marrazzo JM. Targeted PCR for detection of vaginal bacteria associated with bacterial vaginosis. J Clin Microbiol. 2007;45(10):3270-6. [DOI:10.1128/JCM.01272-07] [PMID] [PMCID]

38. Kusters J, Reuland E, Bouter S, Koenig P, Dorigo-Zetsma J. A multiplex real-time PCR assay for routine diagnosis of bacterial vaginosis. Eur J Clin Microbiol Infect Dis. 2015;34:1779-85. [DOI:10.1007/s10096-015-2412-z] [PMID] [PMCID]

39. Adesiji Y, Taiwo S, Adekanle D, Oboro V, Fayemiwo S, Opaleye O. Bacterial vaginosis and pregnancy outcome in Osogbo, Nigeria. Res J Med Sci. 2007;1(4):195-8.

40. Lata I, Pradeep Y, Jain A. Estimation of the incidence of bacterial vaginosis and other vaginal infections and its consequences on maternal/fetal outcome in pregnant women attending an antenatal clinic in a tertiary care hospital in North India. Indian J Community Med. 2010;35(2):285-9. [DOI:10.4103/0970-0218.66855] [PMID] [PMCID]

41. Mengistie Z, Woldeamanuel Y, Asrat D, Adera A. Prevalence of bacterial vaginosis among pregnant women attending antenatal care in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. BMC Res Notes. 2014;7:1-5. [DOI:10.1186/1756-0500-7-822] [PMID] [PMCID]

42. Roohbakhsh E, Mojtahedi A, Roohbakhsh Z, Khavari-Nejad RA, Amirmozafari N. Identification of gardnerella vaginalis and atopobium vaginae in women with bacterial vaginosis in Northern Iran. Infect Dis Clin Pract. 2019;27(2):81-4. [DOI:10.1097/IPC.0000000000000691]

43. Livani S, Nosrat SB, Alhosseini MN, Sheykholeslami AS, Vakili MA, Ghaemi EA. The role of Gardnerella vaginalis, Autopobium vaginae and Mobiloncus spp in preterm delivery: A case-control study. Iran J Obstet Gynecol Infertil. 2023;26(6):50-9.

44. Lim KH, Brooks H, McDougal R, Burton J, Devenish C, De Silva T. Is there a correlation between bacterial vaginosis and preterm labour in women in the Otago region of New Zealand?. Aust N Z J Obstet Gynaecol. 2010;50(3):226-9. [DOI:10.1111/j.1479-828X.2010.01149.x] [PMID]

45. Hočevar K, Maver A, Vidmar Šimic M, Hodžić A, Haslberger A, Premru Seršen T, et al. Vaginal Microbiome Signature Is Associated With Spontaneous Preterm Delivery. Front Med. 2019;6:201. [DOI:10.3389/fmed.2019.00201] [PMID] [PMCID]

46. Prodan-Barbulescu C, Bratosin F, Folescu R, Boeriu E, Popa ZL, Citu C, et al. Analysis of Vaginal Microbiota Variations in the Third Trimester of Pregnancy and Their Correlation with Preterm Birth: A Case-Control Study. Microorganisms. 2024;12(2):417. [DOI:10.3390/microorganisms12020417] [PMID] [PMCID]

47. Nguyen QHV, Le HN, Ton Nu VA, Nguyen ND, Le MT. Lower genital tract infections in preterm premature rupture of membranes and preterm labor: a case-control study from Vietnam. J Infect Dev Ctries. 2021;15(6):805-11. [DOI:10.3855/jidc.13244] [PMID]

48. Mohanty T, Doke PP, Khuroo SR. Effect of bacterial vaginosis on preterm birth: a meta-analysis. Arch Gynecol Obstet. 2023;308(4):1247-55. [DOI:10.1007/s00404-022-06817-5] [PMID]

49. Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N Engl J Med. 1995;333(26):1737-42. [DOI:10.1056/NEJM199512283332604] [PMID]

50. Shimaoka M, Yo Y, Doh K, Kotani Y, Suzuki A, Tsuji I, et al. Association between preterm delivery and bacterial vaginosis with or without treatment. Sci Rep. 2019;9(1):509. [DOI:10.1038/s41598-018-36964-2] [PMID] [PMCID]

51. Daskalakis G, Psarris A, Koutras A, Fasoulakis Z, Prokopakis I, Varthaliti A, et al. Maternal infection and preterm birth: from molecular basis to clinical implications. Children. 2023;10(5):907. [DOI:10.3390/children10050907] [PMID] [PMCID]

52. Esmaeili ED, Kalankesh LR, Zeinalzadeh AH, Ghaffari A, Dastgiri S. Development, Validation, and Cross Cultural Adoption of Persian Version of Behavioral Risk Factor Tool. Med J Islam Repub Iran. 2024;38:21.