{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:07:49Z","timestamp":1787497669425,"version":"build-2736575974"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T00:00:00Z","timestamp":1656547200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spontaneous preterm birth (SPTB) is a major cause of neonatal morbidity and mortality worldwide and defining its risk factors is necessary to reduce its prevalence. Recent studies have pointed out that bacterial vaginosis, a disturbance in the vaginal microbiome, is associated with SPTB. It is hypothesized that vaginal hygiene practices can alter the vaginal microbiome and are therefore associated with SPTB, but there are no studies investigating this matter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>A case-control study was conducted between August 2018 and July 2021 in two affiliated university medical centers in Amsterdam, the Netherlands. We included a total of 79 women with a SPTB and compared them with 156 women with a term birth. Women with uterine anomalies, a history of cervical surgery or major congenital anomalies of the fetus were excluded. All participants filled in a questionnaire about vaginal washing with water, soap or gel, the use of intravaginal douches and vaginal steaming, both before and during pregnancy. Most women washed vaginally with water, 144 (61.3%) women before pregnancy and 135 (57.4%) women during pregnancy. A total of 43 (18.3%) washed with soap before and 36 (15.3%) during pregnancy. Before pregnancy, 40 (17.0%) women washed with vaginal gel and 27 (11.5%) during pregnancy. We found that the use of vaginal gel before pregnancy (aOR 2.29, 95% CI: 1.08\u20134.84) and even more during pregnancy, was associated with SPTB (aOR 3.45, 95% CI: 1.37\u20138.67). No association was found between washing with water or soap, intravaginal douching, or vaginal steaming and SPTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that the use of vaginal gel is associated with SPTB. Women should be informed that vaginal use of gels might not be safe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0268248","type":"journal-article","created":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T13:38:42Z","timestamp":1656596322000},"page":"e0268248","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["The association between vaginal hygiene practices and spontaneous preterm birth: A case-control study"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5983-6932","authenticated-orcid":true,"given":"Laura E.","family":"Janssen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubin J. T.","family":"Verduin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christianne J. 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An association with prematurity and postpartum complications","volume":"86","author":"DA Eschenbach","year":"1984","journal-title":"Scand J Urol Nephrol Suppl"},{"issue":"6924","key":"pone.0268248.ref006","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1136\/bmj.308.6924.295","article-title":"Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage","volume":"308","author":"PE Hay","year":"1994","journal-title":"BMJ"},{"issue":"2","key":"pone.0268248.ref007","first-page":"173","article-title":"Bacterial vaginosis in early pregnancy and pregnancy outcome","volume":"80","author":"T Kurki","year":"1992","journal-title":"Obstet Gynecol"},{"issue":"4","key":"pone.0268248.ref008","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/0002-9378(95)91360-2","article-title":"The preterm prediction study: significance of vaginal infections. 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Aslan","year":"2018","journal-title":"J Obstet Gynaecol"},{"key":"pone.0268248.ref014","first-page":"24","article-title":"Effects of feminine hygiene products on the vaginal mucosal biome","author":"B Fashemi","year":"2013","journal-title":"Microb Ecol Health Dis"},{"issue":"2","key":"pone.0268248.ref015","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2006.10.880","article-title":"Vaginal douching and risk of preterm birth among African American women","volume":"196","author":"DP Misra","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"pone.0268248.ref016","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1067\/mob.2002.122406","article-title":"Risk of preterm birth that is associated with vaginal douching","volume":"186","author":"K Fiscella","year":"2002","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"pone.0268248.ref017","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/00001648-200205000-00014","article-title":"Is vaginal douching associated with preterm delivery?","volume":"13","author":"FC Bruce","year":"2002","journal-title":"Epidemiology"},{"issue":"3","key":"pone.0268248.ref018","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.socscimed.2009.10.023","article-title":"A cross cultural study of vaginal practices and sexuality: implications for sexual health","volume":"70","author":"A Martin Hilber","year":"2010","journal-title":"Soc Sci Med"},{"issue":"7","key":"pone.0268248.ref019","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1089\/jwh.2010.2281","article-title":"Prevalence, motivations, and adverse effects of vaginal practices in Africa and Asia: findings from a multicountry household survey","volume":"20","author":"T Hull","year":"2011","journal-title":"J Womens Health (Larchmt)"},{"issue":"10","key":"pone.0268248.ref020","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.2105\/AJPH.91.10.1664","article-title":"Factors Linked to Bacterial Vaginosis in 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Matching","volume":"46","author":"RJ Baer","year":"2019","journal-title":"Sex Transm Dis"},{"issue":"1 Pt 1","key":"pone.0268248.ref024","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0002-9378(96)70382-4","article-title":"Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia","volume":"174","author":"MR Joesoef","year":"1996","journal-title":"Am J Obstet Gynecol"},{"issue":"7","key":"pone.0268248.ref025","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/00007435-199908000-00008","article-title":"Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: a case control study","volume":"26","author":"S Rajamanoharan","year":"1999","journal-title":"Sex Transm Dis"},{"issue":"1","key":"pone.0268248.ref026","doi-asserted-by":"crossref","first-page":"e0210825","DOI":"10.1371\/journal.pone.0210825","article-title":"Association between vaginal washing and vaginal bacterial concentrations","volume":"14","author":"MC Sabo","year":"2019","journal-title":"PLoS One"},{"key":"pone.0268248.ref027","unstructured":"Lactacyd. Why Lactacyd? [updated 2020. 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