{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:11:12Z","timestamp":1782835872322,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004410","name":"T\u00fcrkiye Bilimsel ve Teknolojik Ara\u015ft\u0131rma Kurumu","doi-asserted-by":"publisher","award":["119S463"],"award-info":[{"award-number":["119S463"]}],"id":[{"id":"10.13039\/501100004410","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2025,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n \n A short cervix is a known risk factor for preterm birth, and imbalances in the vaginal microbiome, such as low relative abundance of\n Lactobacillus<\/jats:italic>\n , may be associated with an increased risk of preterm birth. The aim of this study was to evaluate differences in the vaginal microbiome between women with a short cervix and those with normal cervical length in the second trimester. Additionally, we aimed to assess longitudinal changes in microbial diversity during pregnancy, as well as the impact of vaginal progesterone treatment on vaginal microenvironment in women with a short cervix.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a prospective, longitudinal study conducted at Koc University Hospital between January 2020 and May 2023, in women with a singleton pregnancy with a short cervical length (\u2264\u200925\u2009mm) in the second trimester (20\u2009+\u20090 to 24\u2009+\u20096\u2009weeks' gestation). After diagnosis of short cervix, administration of 200\u2009mg vaginal progesterone daily was initiated. The control group comprised women with a normal cervical length (>\u200925\u2009mm) in the second trimester, matched for age and body mass index (BMI). Cervicovaginal swabs were collected from the posterior fornix at three gestational\u2010age ranges: in the first trimester (11\u2009+\u20090 to 13\u2009+\u20096\u2009weeks), the second trimester (20\u2009+\u20090 to 24\u2009+\u20096\u2009weeks) and the third trimester (28\u2009+\u20090 to 34\u2009+\u20096\u2009weeks), and cervical length was measured following sample collection. DNA was extracted and the 16S rRNA bacterial gene was sequenced to analyze and compare the vaginal microbiome between women with a short cervix and controls. We also assessed the microbiome longitudinally in each group, across the first, second and third trimesters. In the short\u2010cervix group, we also compared the microbiome before initiation of progesterone treatment in the second trimester and 4\u2009weeks after its initiation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 490 pregnant women who underwent first\u2010trimester screening during the study period and had vaginal swabs collected, short cervical length was detected in 31 at the second\u2010trimester scan. These women formed the study group. A further 27 women, with a normal cervical length, were matched for BMI and age and assigned to the control group. During the second trimester, women with a short cervix exhibited greater species diversity compared with the control group; this was suggested by the higher Shannon index (0.45\n vs<\/jats:italic>\n 0.33;\n P<\/jats:italic>\n \u2009=\u20090.135), which reflects species richness and evenness, and further demonstrated by the higher Chao index (20.2\n vs<\/jats:italic>\n 13.8;\n P<\/jats:italic>\n \u2009=\u20090.018), which estimates species richness. In the second trimester,\n Lactobacillus<\/jats:italic>\n was less abundant in women with a short cervix than in the control group, although the difference did not reach significance (86.8%\n vs<\/jats:italic>\n 95.5%;\n P<\/jats:italic>\n \u2009=\u20090.091). At the phylum level, in women with a short cervix compared to those with normal cervical length, the relative abundance of Firmicutes, to which the genus\n Lactobacillus<\/jats:italic>\n belongs, was significantly lower (90.7%\n vs<\/jats:italic>\n 97.6%;\n P<\/jats:italic>\n \u2009=\u20090.041), while the relative abundances of both Bacteroidota (1.73%\n vs<\/jats:italic>\n 0.4%;\n P<\/jats:italic>\n \u2009=\u20090.004) and Proteobacteria (0.2%\n vs<\/jats:italic>\n 0.01%;\n P<\/jats:italic>\n \u2009=\u20090.007) were higher. In the second trimester, the relative abundance of\n Lactobacillus gasseri<\/jats:italic>\n was significantly lower in women with a short cervix compared to controls (4.7%\n vs<\/jats:italic>\n 13.8%;\n P<\/jats:italic>\n \u2009=\u20090.023). In the longitudinal analysis of the vaginal microbiome, there were no significant differences among the trimesters in the control group. In contrast, in those with a short cervix, there was a notable decrease in the amount of\n Lactobacillus crispatus<\/jats:italic>\n , from 55.0% in the first trimester to 36.1% in the second trimester (\n P<\/jats:italic>\n \u2009=\u20090.052). In women with a short cervix, there was no significant difference in bacterial diversity after\n vs<\/jats:italic>\n before progesterone treatment (Chao index, 22.6\n vs<\/jats:italic>\n 20.5;\n P<\/jats:italic>\n \u2009=\u20090.609).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n These findings highlight the significant alterations in the vaginal microbiome of pregnant women with a short cervix in comparison to those with normal cervical length, particularly in terms of higher species diversity and distinct community composition. The study also shows that vaginal progesterone treatment in women with a short cervix does not alter the vaginal microbiome, suggesting that it is a safe and effective intervention without disrupting the vaginal microbial balance. Understanding the relationship between cervical length and the vaginal microbiome is essential for developing strategies to reduce the risk of preterm birth in high\u2010risk populations. \u00a9 2025 The Author(s).\n Ultrasound in Obstetrics & Gynecology<\/jats:italic>\n published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/uog.29269","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T08:24:56Z","timestamp":1750926296000},"page":"217-225","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Alterations in vaginal microbiome in women with short cervix: longitudinal study of microbial diversity and impact of vaginal progesterone treatment"],"prefix":"10.1002","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0774-4294","authenticated-orcid":false,"given":"E.","family":"Celik","sequence":"first","affiliation":[{"name":"School of Medicine, Department of Obstetrics and Gynecology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3364-514X","authenticated-orcid":false,"given":"G.","family":"Ozcan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology University of Illinois at Chicago Chicago IL USA"},{"name":"Ko\u00e7 University \u0130\u015fBank Research Center for \u0130nfectious Diseases (KUISCID) Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3703-1882","authenticated-orcid":false,"given":"C.","family":"Vatansever","sequence":"additional","affiliation":[{"name":"Ko\u00e7 University \u0130\u015fBank Research Center for \u0130nfectious Diseases (KUISCID) Istanbul T\u00fcrkiye"},{"name":"School of Medicine, Department of Medical Microbiology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Paerhati","sequence":"additional","affiliation":[{"name":"Koc University, College of Engineering Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6325-1910","authenticated-orcid":false,"given":"L.","family":"Uygur","sequence":"additional","affiliation":[{"name":"Zeynep Kamil Women and Children Diseases Training and Research Hospital Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3485-5843","authenticated-orcid":false,"given":"C.","family":"Unal","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Obstetrics and Gynecology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1632-1170","authenticated-orcid":false,"given":"S.","family":"Guler Cekic","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Obstetrics and Gynecology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2000-3818","authenticated-orcid":false,"given":"M. A.","family":"Ozten","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Obstetrics and Gynecology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2297-2113","authenticated-orcid":false,"given":"A.","family":"G\u00fcrsoy","sequence":"additional","affiliation":[{"name":"Koc University, College of Engineering Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4202-4049","authenticated-orcid":false,"given":"\u00d6.","family":"Keskin","sequence":"additional","affiliation":[{"name":"Koc University, College of Engineering Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6702-1584","authenticated-orcid":false,"given":"M.","family":"Turgal","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Obstetrics and Gynecology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6084-4067","authenticated-orcid":false,"given":"T.","family":"Gursoy","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Intensive Care Unit and Neonatology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9387-2526","authenticated-orcid":false,"given":"F.","family":"Can","sequence":"additional","affiliation":[{"name":"Ko\u00e7 University \u0130\u015fBank Research Center for \u0130nfectious Diseases (KUISCID) Istanbul T\u00fcrkiye"},{"name":"School of Medicine, Department of Medical Microbiology Koc University Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.08.062554"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15722"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.01120.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(89)90409-2"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2004.04.002"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.054"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1300661"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200102000-00010"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.4014\/jmb.1908.08016"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16519"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-26058-5"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.576"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26020"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.01541-09"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gks1219"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-020-00934-6"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-022-28620-1"},{"key":"e_1_2_7_19_1","article-title":"Is preterm birth an infectious disease? Implications for risk identification and prevention","volume":"56","author":"Klein NJ","year":"2018","journal-title":"Clin Chem Lab Med"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-018-0502-8"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1705899114"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1502875112"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5333"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.12.003"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.11.1283"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15092173"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2164-11-488"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-016-0223-9"},{"key":"e_1_2_7_29_1","doi-asserted-by":"crossref","unstructured":"Amorim\u2010FilhoAG MartinsRCR FrancoLAM et al.Effect of the Arabin pessary and natural progesterone on the vaginal microbiome. Published online January 20 2023.10.21203\/rs.3.rs\u20102493078\/v1","DOI":"10.21203\/rs.3.rs-2493078\/v1"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.792787"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-06595-9"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9113621"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-12007-9"}],"container-title":["Ultrasound in Obstetrics & Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.29269","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.29269","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.29269","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T02:46:58Z","timestamp":1775789218000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.29269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/uog.29269"],"URL":"https:\/\/doi.org\/10.1002\/uog.29269","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]},"assertion":[{"value":"2024-08-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}