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Although the genetic and environmental factors that regulate the vaginal microbiome have yet to be fully elucidated, high-throughput sequencing has provided an unprecedented opportunity to interrogate the vaginal microbiome as a potential source of next-generation therapeutics. Accumulating data demonstrates that vaginal health during pregnancy includes commensal bacteria such as <jats:italic>Lactobacillus<\/jats:italic> that serve to reduce pH and prevent pathogenic invasion. Vaginal microbes have been studied as contributors to several conditions occurring before and during pregnancy, and an emerging topic in women\u2019s health is finding ways to alter and restore the vaginal microbiome. Among these restorations, perhaps the most significant effect could be preterm labor (PTL) prevention. Since bacterial vaginosis (BV) is known to increase risk of PTL, and vaginal and oral probiotics are effective as supplemental treatments for BV prevention, a potential therapeutic benefit exists for pregnant women at risk of PTL. A new method of restoration, vaginal microbiome transplants (VMTs) involves transfer of one women\u2019s cervicovaginal secretions to another. New studies investigating recurrent BV will determine if VMTs can safely establish a healthy <jats:italic>Lactobacillus<\/jats:italic>-dominant vaginal microbiome. In\u00a0most cases, caution must be taken in attributing a disease state and vaginal dysbiosis with a causal relationship, since the underlying reason for dysbiosis is usually unknown. This review focuses on the impact of vaginal microflora on maternal outcomes before and during pregnancy, including PTL, gestational diabetes, preeclampsia, and infertility. It then reviews the clinical evidence focused on vaginal restoration strategies, including VMTs.<\/jats:p>","DOI":"10.1515\/jpm-2020-0367","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T23:38:53Z","timestamp":1610667533000},"page":"402-411","source":"Crossref","is-referenced-by-count":25,"title":["Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review"],"prefix":"10.1515","volume":"49","author":[{"given":"Olivia","family":"Moumne","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology , College of Medicine, University of Florida , Gainesville , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Hampe","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , College of Medicine, University of Florida , Gainesville , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Montoya-Williams","sequence":"additional","affiliation":[{"name":"Department of Neonatology , Children\u2019s Hospital of Philadelphia , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany L.","family":"Carson","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Department of Medicine , University of Alabama , Birmingham , AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Neu","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics , University of Florida , Gainesville , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda","family":"Francois","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics , College of Medicine, University of Florida , Gainesville , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Rhoton-Vlasak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , College of Medicine, University of Florida , Gainesville , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5105-2458","authenticated-orcid":false,"given":"Dominick J.","family":"Lemas","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Biomedical Informatics , College of Medicine, University of Florida , Gainesville , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,1,4]]},"reference":[{"key":"2023040100375548743_j_jpm-2020-0367_ref_001_w2aab3b7c37b1b6b1ab2b1b1Aa","doi-asserted-by":"crossref","unstructured":"Anderson, DJ, Marathe, J, Pudney, J. 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