688: Atopobium vaginae reduces interval to delivery in high risk pregnancies

ObjectiveBacterial vaginosis is a risk factor for prematurity. Despite bacterial vaginosis is often asymptomatic, the diagnosis methods are heterogeneous and based on either a clinical score and/or Gram staining, that are fastidious and unreproducible. Molecular methods have been recently developed to detect vaginal flora anomalies allowing to rationally evaluate a link between them and prematurity.Study DesignProspective multicenter national study including high prematurity risk pregnant women with previous preterm delivery or late abortion and/or short cervix assessed by ultrasound. Quantitative molecular tool targeting Atopobium vaginae, Gardnerella vaginalis, Lactobacillus sp, Mycoplasma hominis, and a human gene was performed using a specific real-time polymerase chain reaction assay and serial dilutions of a plasmid suspension. Bacterial vaginal loads were assessed between 14 and 34 weeks of gestation. clinicaltrial.gov NCT00484653.Results813 patients were enrolled. High A. vaginae vaginal loads (>105/ml) was always associated with a significantly shorter interval time to delivery before 22, 28, and 32 weeks (respectively, 152.1 and 413.2 days (P=0.001), Hazard ratio (HR 6.6, 95% CI 1.9-22.5) before 22 weeks, 149.2 and 400.6 days (P=0.028), (HR 2.9, 95% CI 1.1-7.6) before 28 weeks, and 132.5 and 365.1 days (P=0.014), (HR 2.3, 95 CI %1.2-4.5) before 32 weeks.Low Lactobacilli vaginal loads (<105/ml) and high G. vaginalis loads (>105/ml) were associated with a significantly shorter interval to delivery only for delivery before 22 weeks (respectively 169.4 and 415.4 days (P=0.013), (HR 4.6, 95% CI 1.2-17.4) for Lactobacilli and for G. vaginalis, 174.1 and 412.9 days (P=0.018), (HR 3.9, 95% CI 1.2-13.5). After multivariate analysis the difference remains significant for A. vaginae at any gestationnal age and for G. vaginalis for delivery before 22 weeks.ConclusionTabled 1Nucleotide sequences of primers and probes used for quantitative real-time PCRView Large Image Figure ViewerDownload Hi-res image Download (PPT) Open table in a new tab ObjectiveBacterial vaginosis is a risk factor for prematurity. Despite bacterial vaginosis is often asymptomatic, the diagnosis methods are heterogeneous and based on either a clinical score and/or Gram staining, that are fastidious and unreproducible. Molecular methods have been recently developed to detect vaginal flora anomalies allowing to rationally evaluate a link between them and prematurity. Bacterial vaginosis is a risk factor for prematurity. Despite bacterial vaginosis is often asymptomatic, the diagnosis methods are heterogeneous and based on either a clinical score and/or Gram staining, that are fastidious and unreproducible. Molecular methods have been recently developed to detect vaginal flora anomalies allowing to rationally evaluate a link between them and prematurity. Study DesignProspective multicenter national study including high prematurity risk pregnant women with previous preterm delivery or late abortion and/or short cervix assessed by ultrasound. Quantitative molecular tool targeting Atopobium vaginae, Gardnerella vaginalis, Lactobacillus sp, Mycoplasma hominis, and a human gene was performed using a specific real-time polymerase chain reaction assay and serial dilutions of a plasmid suspension. Bacterial vaginal loads were assessed between 14 and 34 weeks of gestation. clinicaltrial.gov NCT00484653. Prospective multicenter national study including high prematurity risk pregnant women with previous preterm delivery or late abortion and/or short cervix assessed by ultrasound. Quantitative molecular tool targeting Atopobium vaginae, Gardnerella vaginalis, Lactobacillus sp, Mycoplasma hominis, and a human gene was performed using a specific real-time polymerase chain reaction assay and serial dilutions of a plasmid suspension. Bacterial vaginal loads were assessed between 14 and 34 weeks of gestation. clinicaltrial.gov NCT00484653. Results813 patients were enrolled. High A. vaginae vaginal loads (>105/ml) was always associated with a significantly shorter interval time to delivery before 22, 28, and 32 weeks (respectively, 152.1 and 413.2 days (P=0.001), Hazard ratio (HR 6.6, 95% CI 1.9-22.5) before 22 weeks, 149.2 and 400.6 days (P=0.028), (HR 2.9, 95% CI 1.1-7.6) before 28 weeks, and 132.5 and 365.1 days (P=0.014), (HR 2.3, 95 CI %1.2-4.5) before 32 weeks.Low Lactobacilli vaginal loads (<105/ml) and high G. vaginalis loads (>105/ml) were associated with a significantly shorter interval to delivery only for delivery before 22 weeks (respectively 169.4 and 415.4 days (P=0.013), (HR 4.6, 95% CI 1.2-17.4) for Lactobacilli and for G. vaginalis, 174.1 and 412.9 days (P=0.018), (HR 3.9, 95% CI 1.2-13.5). After multivariate analysis the difference remains significant for A. vaginae at any gestationnal age and for G. vaginalis for delivery before 22 weeks. 813 patients were enrolled. High A. vaginae vaginal loads (>105/ml) was always associated with a significantly shorter interval time to delivery before 22, 28, and 32 weeks (respectively, 152.1 and 413.2 days (P=0.001), Hazard ratio (HR 6.6, 95% CI 1.9-22.5) before 22 weeks, 149.2 and 400.6 days (P=0.028), (HR 2.9, 95% CI 1.1-7.6) before 28 weeks, and 132.5 and 365.1 days (P=0.014), (HR 2.3, 95 CI %1.2-4.5) before 32 weeks. Low Lactobacilli vaginal loads (<105/ml) and high G. vaginalis loads (>105/ml) were associated with a significantly shorter interval to delivery only for delivery before 22 weeks (respectively 169.4 and 415.4 days (P=0.013), (HR 4.6, 95% CI 1.2-17.4) for Lactobacilli and for G. vaginalis, 174.1 and 412.9 days (P=0.018), (HR 3.9, 95% CI 1.2-13.5). After multivariate analysis the difference remains significant for A. vaginae at any gestationnal age and for G. vaginalis for delivery before 22 weeks. ConclusionTabled 1Nucleotide sequences of primers and probes used for quantitative real-time PCR Open table in a new tab