{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:00:46Z","timestamp":1792699246320,"version":"4.5.0"},"reference-count":38,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2018,3,15]],"date-time":"2018-03-15T00:00:00Z","timestamp":1521072000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID-OAA-A-12-00005"],"award-info":[{"award-number":["AID-OAA-A-12-00005"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP49817"],"award-info":[{"award-number":["OPP49817"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"publisher","award":["252075"],"award-info":[{"award-number":["252075"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Appl Environ Microbiol"],"published-print":{"date-parts":[[2018,3,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The bacterial community found in the vagina is an important determinant of a woman's health and disease status. A healthy vaginal microbiota is associated with low species richness and a high proportion of one of a number of different\n            <jats:named-content content-type=\"genus-species\">Lactobacillus<\/jats:named-content>\n            spp. When disrupted, the resulting abnormal vaginal microbiota is associated with a number of disease states and poor pregnancy outcomes. Studies up until now have concentrated on relatively small numbers of American and European populations that may not capture the full complexity of the community or adequately predict what constitutes a healthy microbiota in all populations. In this study, we sampled and characterized the vaginal microbiota found on vaginal swabs taken postpartum from a cohort of 1,107 women in rural Malawi. We found a population dominated by\n            <jats:named-content content-type=\"genus-species\">Gardnerella vaginalis<\/jats:named-content>\n            and devoid of the most common vaginal\n            <jats:named-content content-type=\"genus-species\">Lactobacillus<\/jats:named-content>\n            species, even if the vagina was sampled over a year postpartum. This\n            <jats:named-content content-type=\"genus-species\">Lactobacillus<\/jats:named-content>\n            -deficient anaerobic community, commonly labeled community state type (CST) 4, could be subdivided into four further communities. A\n            <jats:named-content content-type=\"genus-species\">Lactobacillus iners<\/jats:named-content>\n            -dominated vaginal microbiota became more common the longer after delivery the vagina was sampled, but\n            <jats:named-content content-type=\"genus-species\">G. vaginalis<\/jats:named-content>\n            remained the dominant organism. These results outline the difficulty in all-encompassing definitions of what a healthy or abnormal postpartum vaginal microbiota is. Previous identification of community state types and associations among bacterial species, bacterial vaginosis, and adverse birth outcomes may not represent the complex heterogeneity of the microbiota present. (This study has been registered at ClinicalTrials.gov as NCT01239693.)\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>IMPORTANCE<\/jats:bold>\n            A bacterial community in the vaginal tract is dominated by a small number of\n            <jats:named-content content-type=\"genus-species\">Lactobacillus<\/jats:named-content>\n            species, and when not present there is an increased incidence of inflammatory conditions and adverse birth outcomes. A switch to a vaginal bacterial community lacking in\n            <jats:named-content content-type=\"genus-species\">Lactobacillus<\/jats:named-content>\n            species is common after pregnancy. In this study, we characterized the postpartum vaginal bacterial community of a large group of women from a resource-poor, undersampled population in rural Malawi. The majority of women were found to have a\n            <jats:named-content content-type=\"genus-species\">Lactobacillus-<\/jats:named-content>\n            deficient community, and even when sampled a year after delivery the majority of women still did not have\n            <jats:named-content content-type=\"genus-species\">Lactobacillus<\/jats:named-content>\n            present in their vaginal microbiota. The effect of becoming pregnant again for those who do not revert to a\n            <jats:named-content content-type=\"genus-species\">Lactobacillus<\/jats:named-content>\n            -dominant community is unknown, and this could suggest that not all\n            <jats:named-content content-type=\"genus-species\">Lactobacillus-<\/jats:named-content>\n            deficient community structures are adverse. A better understanding of this complex community state type is needed.\n          <\/jats:p>","DOI":"10.1128\/aem.02150-17","type":"journal-article","created":{"date-parts":[[2018,1,8]],"date-time":"2018-01-08T12:09:16Z","timestamp":1515413356000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":65,"title":["A Lactobacillus-Deficient Vaginal Microbiota Dominates Postpartum Women in Rural Malawi"],"prefix":"10.1128","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5001-1945","authenticated-orcid":false,"given":"Ronan","family":"Doyle","sequence":"first","affiliation":[{"name":"Institute of Child Health, University College London, London, United Kingdom"},{"name":"Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austridia","family":"Gondwe","sequence":"additional","affiliation":[{"name":"Department for International Health, University of Tampere School of Medicine, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue-Mei","family":"Fan","sequence":"additional","affiliation":[{"name":"Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Maleta","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Malawi College of Medicine, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Ashorn","sequence":"additional","affiliation":[{"name":"Department for International Health, University of Tampere School of Medicine, Tampere, Finland"},{"name":"Department of Paediatrics, University of Tampere School of Medicine, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Klein","sequence":"additional","affiliation":[{"name":"Institute of Child Health, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1002611107"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1086\/462427"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1502875112"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13115"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03020.x"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512283332604"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02237.x"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016349808565808"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016340500442423"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.818124"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep08988"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60820-4"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.3109\/01443615.2013.842963"},{"key":"e_1_3_3_16_2","first-page":"52","article-title":"Early postpartum endometritis: the role of bacteria, genital mycoplasmas, and Chlamydia trachomatis","volume":"73","author":"Watts DH","year":"1989","unstructured":"Watts DH, Eschenbach DA, Kenny GE. 1989. 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