{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:53:23Z","timestamp":1790790803116,"version":"4.1.0"},"reference-count":65,"publisher":"American Society for Clinical Investigation","issue":"16","license":[{"start":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T00:00:00Z","timestamp":1629676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tommy\u2019s Charity","award":["1060508"],"award-info":[{"award-number":["1060508"]}]},{"DOI":"10.13039\/501100000833","name":"Rosetrees Trust","doi-asserted-by":"crossref","award":["M303-CD1"],"award-info":[{"award-number":["M303-CD1"]}],"id":[{"id":"10.13039\/501100000833","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NIHR Doctoral Research Fellowship","award":["DRF-2013-06-171"],"award-info":[{"award-number":["DRF-2013-06-171"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,23]]},"abstract":"<jats:p>\n                    The syndrome of spontaneous preterm birth (sPTB) presents a challenge to mechanistic understanding, effective risk stratification, and clinical management. Individual associations between sPTB, self-reported ethnic ancestry, vaginal microbiota, metabolome, and innate immune response are known but not fully understood, and knowledge has yet to impact clinical practice. Here, we used multi\u2013data type integration and composite statistical models to gain insight into sPTB risk by exploring the cervicovaginal environment of an ethnically heterogenous pregnant population (\n                    <jats:italic>n =<\/jats:italic>\n                    346 women;\n                    <jats:italic>n =<\/jats:italic>\n                    60 sPTB &lt; 37 weeks\u2019 gestation, including\n                    <jats:italic>n =<\/jats:italic>\n                    27 sPTB &lt; 34 weeks). Analysis of cervicovaginal samples (10\u201315\n                    <jats:sup>+6<\/jats:sup>\n                    weeks) identified potentially novel interactions between risk of sPTB and microbiota, metabolite, and maternal host defense molecules. Statistical modeling identified a composite of metabolites (leucine, tyrosine, aspartate, lactate, betaine, acetate, and Ca\n                    <jats:sup>2+<\/jats:sup>\n                    ) associated with risk of sPTB &lt; 37 weeks (AUC 0.752). A combination of glucose, aspartate, Ca\n                    <jats:sup>2+<\/jats:sup>\n                    ,\n                    <jats:italic>Lactobacillus crispatus<\/jats:italic>\n                    , and\n                    <jats:italic>L<\/jats:italic>\n                    .\n                    <jats:italic>acidophilus<\/jats:italic>\n                    relative abundance identified risk of early sPTB &lt; 34 weeks (AUC 0.758), improved by stratification by ethnicity (AUC 0.835). Increased relative abundance of\n                    <jats:italic>L<\/jats:italic>\n                    .\n                    <jats:italic>acidophilus<\/jats:italic>\n                    appeared protective against sPTB &lt; 34 weeks. By using cervicovaginal fluid samples, we demonstrate the potential of multi\u2013data type integration for developing composite models toward understanding the contribution of the vaginal environment to risk of sPTB.\n                  <\/jats:p>","DOI":"10.1172\/jci.insight.149257","type":"journal-article","created":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T12:00:36Z","timestamp":1626177636000},"source":"Crossref","is-referenced-by-count":60,"title":["Cervicovaginal microbiota and metabolome predict preterm birth risk in an ethnically diverse cohort"],"prefix":"10.1172","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4210-0451","authenticated-orcid":true,"given":"Flavia","family":"Flaviani","sequence":"first","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"},{"name":"Translational Bioinformatics Platform, NIHR Biomedical Research Centre, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9680-354X","authenticated-orcid":true,"given":"Natasha L.","family":"Hezelgrave","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1275-7911","authenticated-orcid":true,"given":"Tokuwa","family":"Kanno","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"},{"name":"Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9138-2718","authenticated-orcid":true,"given":"Erica M.","family":"Prosdocimi","sequence":"additional","affiliation":[{"name":"Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King\u2019s College London, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1935-2941","authenticated-orcid":true,"given":"Evonne","family":"Chin-Smith","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0988-7229","authenticated-orcid":true,"given":"Alexandra E.","family":"Ridout","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djuna K.","family":"von Maydell","sequence":"additional","affiliation":[{"name":"Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikash","family":"Mistry","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2685-826X","authenticated-orcid":true,"given":"William G.","family":"Wade","sequence":"additional","affiliation":[{"name":"Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King\u2019s College London, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5273-3132","authenticated-orcid":true,"given":"Andrew H.","family":"Shennan","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Dimitrakopoulou","sequence":"additional","affiliation":[{"name":"Translational Bioinformatics Platform, NIHR Biomedical Research Centre, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7904-7933","authenticated-orcid":true,"given":"Paul T.","family":"Seed","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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