{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:45:14Z","timestamp":1792788314675,"version":"4.5.0"},"reference-count":49,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T00:00:00Z","timestamp":1626652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,12]]},"abstract":"\n Objective<\/jats:title>\n To assess the association between vaginal microbiome (VMB) composition and recurrent early spontaneous preterm birth (sPTB)\/preterm prelabour rupture of membranes (PPROM).<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Nested case\u2013control study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n UK tertiary referral hospital.<\/jats:p>\n <\/jats:sec>\n \n Sample<\/jats:title>\n \n High\u2010risk women with previous sPTB\/PPROM <34\n +0<\/jats:sup>\n \u2009weeks\u2019 gestation who had a recurrence (\n n<\/jats:italic>\n \u2009= 22) or delivered at \u226537\n +0<\/jats:sup>\n \u2009weeks without PPROM (\n n\u2009<\/jats:italic>\n = 87).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Vaginal swabs collected between 15 and 22\u2009weeks\u2019 gestation were analysed by 16S rRNA gene sequencing and 16S quantitative PCR.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measure<\/jats:title>\n Recurrent early sPTB\/PPROM.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 109 high\u2010risk women, 28 had anaerobic vaginal dysbiosis, with the remainder dominated by lactobacilli (\n Lactobacillus iners<\/jats:italic>\n 36\/109,\n Lactobacillus crispatus<\/jats:italic>\n 23\/109, or other 22\/109). VMB type and diversity were not associated with recurrence. Women with a recurrence, compared to those without, had a higher median vaginal bacterial load (8.64 versus 7.89 log\n 10<\/jats:sub>\n cells\/mcl, adjusted odds ratio [aOR] 1.90, 95% CI\u20091.01\u20133.56,\n P<\/jats:italic>\n \u2009= 0.047) and estimated\n Lactobacillus<\/jats:italic>\n concentration (8.59 versus 7.48 log\n 10<\/jats:sub>\n cells\/mcl, aOR\u20092.35, (95% CI\u20091.20\u20134.61,\n P\u2009<\/jats:italic>\n = 0.013). A higher recurrence risk was associated with higher median bacterial loads for each VMB type after stratification, although statistical significance was reached only for\n L. iners<\/jats:italic>\n domination (aOR 3.44, 95% CI\u20091.06\u201311.15,\n P<\/jats:italic>\n \u2009= 0.040). Women with anaerobic dysbiosis or\n L. iners<\/jats:italic>\n domination had a higher median vaginal bacterial load than women with a VMB dominated by\n L. crispatus<\/jats:italic>\n or other lactobacilli (8.54, 7.96, 7.63, and 7.53 log\n 10<\/jats:sub>\n cells\/mcl, respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Vaginal bacterial load is associated with early sPTB\/PPROM recurrence. Domination by lactobacilli other than\n L. iners<\/jats:italic>\n may protect women from developing high bacterial loads. Future PTB studies should quantify vaginal bacteria and yeasts.\n <\/jats:p>\n <\/jats:sec>\n \n Tweetable abstract<\/jats:title>\n Increased vaginal bacterial load in the second trimester may be associated with recurrent early spontaneous preterm birth.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.16816","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T13:29:40Z","timestamp":1623936580000},"page":"2061-2072","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Vaginal bacterial load in the second trimester is associated with early preterm birth recurrence: a nested case\u2013control study"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8111-5007","authenticated-orcid":false,"given":"L","family":"Goodfellow","sequence":"first","affiliation":[{"name":"Harris Wellbeing Research Centre Department of Women's and Children's Health, University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MC","family":"Verwijs","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology Institute of Infection, Veterinary, and Ecological Sciences University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2131-0406","authenticated-orcid":false,"given":"A","family":"Care","sequence":"additional","affiliation":[{"name":"Harris Wellbeing Research Centre Department of Women's and Children's Health, University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Sharp","sequence":"additional","affiliation":[{"name":"Harris Wellbeing Research Centre Department of Women's and Children's Health, University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Ivandic","sequence":"additional","affiliation":[{"name":"Harris Wellbeing Research Centre Department of Women's and Children's Health, University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Poljak","sequence":"additional","affiliation":[{"name":"Liverpool Women\u2019s NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Roberts","sequence":"additional","affiliation":[{"name":"Liverpool Women\u2019s NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8089-4021","authenticated-orcid":false,"given":"C","family":"Bronowski","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology Institute of Infection, Veterinary, and Ecological Sciences University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AC","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology Institute of Infection, Veterinary, and Ecological Sciences University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AC","family":"Darby","sequence":"additional","affiliation":[{"name":"Centre for Genomic Research University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Alfirevic","sequence":"additional","affiliation":[{"name":"Harris Wellbeing Research Centre Department of Women's and Children's Health, University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Muller\u2010Myhsok","sequence":"additional","affiliation":[{"name":"Harris Wellbeing Research Centre Department of Women's and Children's Health, University of 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