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Am J Perinatol 2015; 32(12): 1119-1125
DOI: 10.1055/s-0035-1549294
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Quantitative Polymerase Chain Reaction to Assess Response to Treatment of Bacterial Vaginosis and Risk of Preterm Birth

Adi Abramovici
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Elena Lobashevsky
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Suzanne P. Cliver
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Rodney K. Edwards
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
John C. Hauth
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Joseph R. Biggio
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

28 August 2014

20 February 2015

Publication Date:
29 May 2015 (online)

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Abstract

Objective The aim of this study was to determine whether quantitative polymerase chain reaction (qPCR) bacterial load measurement is a valid method to assess response to treatment of bacterial vaginosis and risk of preterm birth in pregnant women.

Study Design Secondary analysis by utilizing stored vaginal samples obtained during a previous randomized controlled trial studying the effect of antibiotics on preterm birth (PTB). All women had risk factors for PTB: (1) positive fetal fibronectin (n = 146), (2) bacterial vaginosis (BV) and a prior PTB (n = 43), or (3) BV and a prepregnancy weight < 50 kg (n = 54). Total and several individual BV-related bacteria loads were measured using qPCR for 16S rRNA. Loads were correlated with Nugent scores (Spearman correlation coefficients). Loads were compared pre- and posttreatment with Wilcoxon rank-sum test. Individual patient differences were examined with Wilcoxon signed-rank test.

Results A total of 243 paired vaginal samples were available for analysis: 123 antibiotics and 120 placebo. Groups did not differ by risk factors for PTB. For all samples, bacterial loads were correlated with Nugent score and each of its specific bacterial components (all p < 0.01). Baseline total bacterial load did not differ by treatment group (p = 0.87). Posttreatment total bacterial load was significantly lower in the antibiotics group than the placebo group (p < 0.01). Individual patient total bacterial load decreased significantly posttreatment in the antibiotics group (p < 0.01), but not in the placebo group (p = 0.12). The rate of PTB did not differ between groups (p = 0.24). PTB relative risks calculated for BV positive versus BV negative women and women with the highest quartile total and individual bacterial loads were not statistically significant.

Conclusion qPCR correlates with Nugent score and demonstrates decreased bacterial load after antibiotic treatment. Therefore, it is a valid method of vaginal flora assessment in pregnant women who are at high risk for PTB.

Keywords

bacterial vaginosis - bacterial load - quantitative PCR - preterm birth
 

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