{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"Research Square"}],"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T17:05:51Z","timestamp":1779728751223,"version":"3.53.1"},"posted":{"date-parts":[[2026,5,25]]},"group-title":"In Review","reference-count":127,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,30]]},"abstract":"<title>Abstract<\/title>\n                <p>\n                  <bold>Background<\/bold>\n                  The vaginal microbiome significantly influences gynecological and obstetric health, yet the interrelationship between host vaginal gene expression and the microbiota during pregnancy is understudied\u2014particularly in racioethnically diverse cohorts. Here, we leveraged metatranscriptomic data from 123 participants from the Multi-Omic Microbiome Study-Pregnancy Initiative (MOMS-PI) cohort to perform a novel integrated analysis of human host gene expression and vaginal microbiota composition during pregnancy. We hypothesized that host gene expression at the vaginal-mucosal interface would exhibit distinct transcriptional profiles when colonized by bacteria commonly present in bacterial vaginosis (BV), termed BV-associated vagitypes, compared to\n                  <italic>Lactobacillus<\/italic>\n                  -dominated microbiomes. Such distinct host response would provide evidence linking vaginal inflammation to microbiome composition during pregnancy in a majority Black cohort. By profiling host expression with different BV-associated vagitypes, these host-microbiome signatures could inform clinically actionable biomarkers for microbiome-focused interventions during pregnancy in historically underrepresented populations.\n                  <bold>Results<\/bold>\n                  Host transcriptomic profiles differed significantly between BV-associated and\n                  <italic>Lactobacillus<\/italic>\n                  -dominated vagitypes, with this association remaining significant when analyses were restricted to Black participants. We identified 13 consistently differentially expressed genes in women with BV-associated vagitypes\u2014vaginal microbiomes comprised of high relative abundance of either\n                  <italic>Gardnerella<\/italic>\n                  spp.,\n                  <italic>Candidatus<\/italic>\n                  Lachnocurva vaginae, or a mixture of multiple anaerobic taxa\u2014compared to women with\n                  <italic>Lactobacillus crispatus<\/italic>\n                  vagitypes. These differentially expressed genes are involved in host immune response (\n                  <italic>DKK1, H2BC21, ILRUN, S100A9<\/italic>\n                  ), oxidative stress response and inflammasome activation (\n                  <italic>CSTB<\/italic>\n                  ), transcription modulation (\n                  <italic>CLK1, PAX9<\/italic>\n                  ), vesicle trafficking (\n                  <italic>EXPH5<\/italic>\n                  ), ubiquitination (\n                  <italic>FBXO32<\/italic>\n                  ), membrane integrity (\n                  <italic>PIEZO1<\/italic>\n                  ), and ion transport (\n                  <italic>S100A16, SCNN1A, SLCO4A1<\/italic>\n                  ).\n                  <bold>Conclusion<\/bold>\n                  BV-associated vagitypes are correlated with distinct host immunomodulatory gene expression profiles during pregnancy, independent of self-reported racioethnicity. We demonstrated novel molecular insights into microbiome-host interaction during pregnancy within the context of adverse cervicovaginal health.\n                <\/p>","DOI":"10.21203\/rs.3.rs-9268667\/v1","type":"posted-content","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T16:52:48Z","timestamp":1779727968000},"source":"Crossref","is-referenced-by-count":0,"title":["Differential Host Gene Expression Associated with Non-Lactobacillus-dominant Vaginal Microbiomes During Pregnancy"],"prefix":"10.21203","author":[{"given":"Mallory E.","family":"Cunningham","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan T.","family":"Williams","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine M.","family":"Spaine","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Marcinkowska","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrey V.","family":"Matveyev","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Hur","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather O.","family":"Natterer","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhea B.","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Oldfield","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laahirie","family":"Edupuganti","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Massey Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly K.","family":"Jefferson","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome F. Strauss","family":"III","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Olex","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myrna G.","family":"Serrano","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Buck","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1038\/nature11234","article-title":"Structure, function and diversity of the healthy human microbiome","volume":"486","author":"Huttenhower C","year":"2012","unstructured":"Huttenhower C, Gevers D, Knight R, Abubucker S, Badger JH, Chinwalla AT, et al. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486:207\u201314. https:\/\/doi.org\/10.1038\/nature11234.","journal-title":"Nature"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3389\/fpubh.2020.00326","article-title":"Diversity of Vaginal Microbiome in Pregnancy: Deciphering the Obscurity","author":"Gupta P","year":"2020","unstructured":"Gupta P, Singh MP, Goyal K. Diversity of Vaginal Microbiome in Pregnancy: Deciphering the Obscurity. Front Public Health. 2020;8. https:\/\/doi.org\/10.3389\/fpubh.2020.00326.","journal-title":"Front Public Health"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.819958","article-title":"Healthy Vaginal Microbiota and Influence of Probiotics Across the Female Life Span","volume":"13","author":"Lehtoranta L","year":"2022","unstructured":"Lehtoranta L, Ala-Jaakkola R, Laitila A, Maukonen J. Healthy Vaginal Microbiota and Influence of Probiotics Across the Female Life Span. Front Microbiol. 2022;13. https:\/\/doi.org\/10.3389\/fmicb.2022.819958.","journal-title":"Front Microbiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3389\/fcimb.2019.00446","article-title":"Distinct Immune Responses Elicited From Cervicovaginal Epithelial Cells by Lactic Acid and Short Chain Fatty Acids Associated With Optimal and Non-optimal Vaginal Microbiota","author":"Delgado-Diaz DJ","year":"2020","unstructured":"Delgado-Diaz DJ, Tyssen D, Hayward JA, Gugasyan R, Hearps AC, Tachedjian G. Distinct Immune Responses Elicited From Cervicovaginal Epithelial Cells by Lactic Acid and Short Chain Fatty Acids Associated With Optimal and Non-optimal Vaginal Microbiota. Front Cell Infect Microbiol. 2020;9. https:\/\/doi.org\/10.3389\/fcimb.2019.00446.","journal-title":"Front Cell Infect Microbiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1128\/mBio.00460-13","article-title":"Influence of vaginal bacteria and D- and L-lactic acid isomers on vaginal extracellular matrix metalloproteinase inducer: Implications for protection against upper genital tract infections","author":"Witkin SS","year":"2013","unstructured":"Witkin SS, Mendes-Soares H, Linhares IM, Jayaram A, Ledger WJ, Forney LJ. Influence of vaginal bacteria and D- and L-lactic acid isomers on vaginal extracellular matrix metalloproteinase inducer: Implications for protection against upper genital tract infections. mBio. 2013;4. https:\/\/doi.org\/10.1128\/mBio.00460-13.","journal-title":"mBio"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1471-2180-9-116","article-title":"Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and\/or L. iners are more conducive to the occurrence of abnormal vaginal microflora","author":"Verstraelen H","year":"2009","unstructured":"Verstraelen H, Verhelst R, Claeys G, De Backer E, Temmerman M, Vaneechoutte M. Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and\/or L. iners are more conducive to the occurrence of abnormal vaginal microflora. BMC Microbiol. 2009;9. https:\/\/doi.org\/10.1186\/1471-2180-9-116.","journal-title":"BMC Microbiol"},{"key":"ref7","author":"Walensky R","year":"2021","unstructured":"Walensky R, Houry D, Jernigan D, Bunnell R, Layden J, Iademarco M, et al. Sexually Transmitted Infections Treatment Guidelines, 2021, Morbidity and Mortality Weekly Report\u2013Bacterial Vaginosis. 2021."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1097\/OLQ.0b013e318074e565","article-title":"The prevalence of bacterial vaginosis in the United States, 2001\u20132004; associations with symptoms, sexual behaviors, and reproductive health","volume":"34","author":"Koumans EH","year":"2007","unstructured":"Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, et al. The prevalence of bacterial vaginosis in the United States, 2001\u20132004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34:864\u20139. https:\/\/doi.org\/10.1097\/OLQ.0b013e318074e565.","journal-title":"Sex Transm Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1097\/OLQ.0000000000000972","article-title":"High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis","volume":"46","author":"Peebles K","year":"2019","unstructured":"Peebles K, Velloza J, Balkus JE, McClelland RS, Barnabas R V. High Global Burden and Costs of Bacterial Vaginosis: A Systematic Review and Meta-Analysis. Sex Transm Dis. 2019;46:304\u201311. https:\/\/doi.org\/10.1097\/OLQ.0000000000000972.","journal-title":"Sex Transm Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1086\/503780","article-title":"High Recurrence Rates of Bacterial Vaginosis over the Course of 12 Months after Oral Metronidazole Therapy and Factors Associated with Recurrence","author":"Bradshaw CS","year":"2006","unstructured":"Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, et al. High Recurrence Rates of Bacterial Vaginosis over the Course of 12 Months after Oral Metronidazole Therapy and Factors Associated with Recurrence. J Infect Dis. 2006;:193. https:\/\/doi.org\/https:\/\/doi.org\/10.1086\/503780.","journal-title":"J Infect Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1136\/sextrans-2014-051601","article-title":"Defining genital tract cytokine signatures of sexually transmitted infections and bacterial vaginosis in women at high risk of HIV infection: A cross-sectional study","volume":"90","author":"Masson L","year":"2014","unstructured":"Masson L, Mlisana K, Little F, Werner L, Mkhize NN, Ronacher K, et al. Defining genital tract cytokine signatures of sexually transmitted infections and bacterial vaginosis in women at high risk of HIV infection: A cross-sectional study. Sex Transm Infect. 2014;90:580\u20137. https:\/\/doi.org\/10.1136\/sextrans-2014-051601.","journal-title":"Sex Transm Infect"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1038\/s41467-019-09285-9","article-title":"Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm delivery","author":"Elovitz MA","year":"2019","unstructured":"Elovitz MA, Gajer P, Riis V, Brown AG, Humphrys MS, Holm JB, et al. Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm delivery. Nat Commun. 2019;10. https:\/\/doi.org\/10.1038\/s41467-019-09285-9.","journal-title":"Nat Commun"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1038\/s41591-019-0450-2","article-title":"The vaginal microbiome and preterm birth","volume":"25","author":"Fettweis JM","year":"2019","unstructured":"Fettweis JM, Serrano MG, Brooks JP, Edwards DJ, Girerd PH, Parikh HI, et al. The vaginal microbiome and preterm birth. Nat Med. 2019;25:1012\u201321. https:\/\/doi.org\/10.1038\/s41591-019-0450-2.","journal-title":"Nat Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.ajog.2020.10.019","article-title":"Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease","volume":"224","author":"Ravel J","year":"2021","unstructured":"Ravel J, Moreno I, Sim\u00f3n C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021;224:251\u20137. https:\/\/doi.org\/10.1016\/j.ajog.2020.10.019.","journal-title":"Am J Obstet Gynecol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1371\/journal.pone.0153045","article-title":"Bacterial vaginosis is associated with loss of gamma delta T cells in the female reproductive tract in women in the Miami Women Interagency HIV Study (WIHS): A cross sectional study","author":"Alcaide ML","year":"2016","unstructured":"Alcaide ML, Strbo N, Romero L, Jones DL, Rodriguez VJ, Arheart K, et al. Bacterial vaginosis is associated with loss of gamma delta T cells in the female reproductive tract in women in the Miami Women Interagency HIV Study (WIHS): A cross sectional study. PLoS One. 2016;11. https:\/\/doi.org\/10.1371\/journal.pone.0153045.","journal-title":"PLoS One"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1089\/aid.2015.0006","article-title":"Bacterial Vaginosis and Subclinical Markers of Genital Tract Inflammation and Mucosal Immunity","volume":"31","author":"Thurman AR","year":"2015","unstructured":"Thurman AR, Kimble T, Herold B, Mesquita PMM, Fichorova RN, Dawood HY, et al. Bacterial Vaginosis and Subclinical Markers of Genital Tract Inflammation and Mucosal Immunity. AIDS Res Hum Retroviruses. 2015;31:1139\u201352. https:\/\/doi.org\/10.1089\/aid.2015.0006.","journal-title":"AIDS Res Hum Retroviruses"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1371\/journal.pone.0050106","article-title":"Identification and Characterization of Bacterial Vaginosis-Associated Pathogens Using a Comprehensive Cervical-Vaginal Epithelial Coculture Assay","author":"Eade CR","year":"2012","unstructured":"Eade CR, Diaz C, Wood MP, Anastos K, Patterson BK, Gupta P, et al. Identification and Characterization of Bacterial Vaginosis-Associated Pathogens Using a Comprehensive Cervical-Vaginal Epithelial Coculture Assay. PLoS One. 2012;7. https:\/\/doi.org\/10.1371\/journal.pone.0050106.","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1086\/340417","article-title":"Correlation of Local Interleukin-8 with Immunoglobulin A against Gardnerella vaginalis Hemolysin and with Prolidase and Sialidase Levels in Women with Bacterial Vaginosis","volume":"11","author":"Cauci S","year":"2002","unstructured":"Cauci S, Guaschino S, Driussi S, De Santo D, Lanzafame P, Quadrifoglio F. Correlation of Local Interleukin-8 with Immunoglobulin A against Gardnerella vaginalis Hemolysin and with Prolidase and Sialidase Levels in Women with Bacterial Vaginosis. J Infect Dis. 2002;11:185\u20131620. https:\/\/doi.org\/https:\/\/doi.org\/10.1086\/340417.","journal-title":"J Infect Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/j.immuni.2015.04.019","article-title":"Cervicovaginal Bacteria Are a Major Modulator of Host Inflammatory Responses in the Female Genital Tract","volume":"42","author":"Anahtar MN","year":"2015","unstructured":"Anahtar MN, Byrne EH, Doherty KE, Bowman BA, Yamamoto HS, Soumillon M, et al. Cervicovaginal Bacteria Are a Major Modulator of Host Inflammatory Responses in the Female Genital Tract. Immunity. 2015;42:965\u201376. https:\/\/doi.org\/10.1016\/j.immuni.2015.04.019.","journal-title":"Immunity"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1136\/sextrans-2017-053506","article-title":"Inflammatory cytokine biomarkers of asymptomatic sexually transmitted infections and vaginal dysbiosis: A multicentre validation study","volume":"95","author":"Masson L","year":"2019","unstructured":"Masson L, Barnabas S, Deese J, Lennard K, Dabee S, Gamieldien H, et al. Inflammatory cytokine biomarkers of asymptomatic sexually transmitted infections and vaginal dysbiosis: A multicentre validation study. Sex Transm Infect. 2019;95:5\u201312. https:\/\/doi.org\/10.1136\/sextrans-2017-053506.","journal-title":"Sex Transm Infect"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1097\/qai.0b013e318189a7ca","author":"Rebbapragada A","year":"1988","unstructured":"Rebbapragada A, Howe K, Wachihi C, Pettengell C, Sunderji S, Huibner S, et al. Bacterial Vaginosis in HIV-Infected Women Induces Reversible Alterations in the Cervical Immune Environment. J Acquir Immune Defic Syndr (1988). 2008;49. https:\/\/doi.org\/https:\/\/doi.org\/10.1097\/qai.0b013e318189a7ca."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1093\/humrep\/gag003","article-title":"Interrelationships of interleukin-8 with interleukin-1b and neutrophils in vaginal fluid of healthy and bacterial vaginosis positive women","volume":"9","author":"Cauci S","year":"2003","unstructured":"Cauci S, Guaschino S, De Aloysio D, Driussi S, De Santo D, Penacchioni P, et al. Interrelationships of interleukin-8 with interleukin-1b and neutrophils in vaginal fluid of healthy and bacterial vaginosis positive women. Mol Hum Reprod. 2003;9:53\u20138. https:\/\/doi.org\/10.1093\/humrep\/gag003.","journal-title":"Mol Hum Reprod"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1172\/JCI184609","article-title":"Bacterial vaginosis associates with dysfunctional T cells and altered soluble immune factors in the cervicovaginal tract","author":"MacLean F","year":"2025","unstructured":"MacLean F, Tsegaye AT, Graham JB, Swarts JL, Vick SC, Potchen NB, et al. Bacterial vaginosis associates with dysfunctional T cells and altered soluble immune factors in the cervicovaginal tract. J Clin Invest. 2025;135. https:\/\/doi.org\/10.1172\/JCI184609.","journal-title":"J Clin Invest"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1913","DOI":"10.1086\/429922","article-title":"Induction of Tumor Necrosis Factor-a Secretion and Toll-Like Receptor 2 and 4 mRNA Expression by Genital Mucosal Fluids from Women with Bacterial Vaginosis","volume":"191","author":"Reza Zariffard M","year":"2005","unstructured":"Reza Zariffard M, Novak RM, Lurain N, Sha BE, Graham P, Spear GT. Induction of Tumor Necrosis Factor-a Secretion and Toll-Like Receptor 2 and 4 mRNA Expression by Genital Mucosal Fluids from Women with Bacterial Vaginosis. J Infect Dis. 2005;191:1913\u201321. https:\/\/doi.org\/https:\/\/doi.org\/10.1086\/429922.","journal-title":"J Infect Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.jri.2007.04.004","article-title":"TLR2-mediated cell stimulation in bacterial vaginosis","volume":"77","author":"Mares D","year":"2008","unstructured":"Mares D, Simoes JA, Novak RM, Spear GT. TLR2-mediated cell stimulation in bacterial vaginosis. J Reprod Immunol. 2008;77:91\u20139. https:\/\/doi.org\/10.1016\/j.jri.2007.04.004.","journal-title":"J Reprod Immunol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1038\/mi.2015.86","article-title":"Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier","volume":"9","author":"Borgdorff H","year":"2016","unstructured":"Borgdorff H, Gautam R, Armstrong SD, Xia D, Ndayisaba GF, Van Teijlingen NH, et al. Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier. Mucosal Immunol. 2016;9:621\u201333. https:\/\/doi.org\/10.1038\/mi.2015.86.","journal-title":"Mucosal Immunol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1111\/j.1600-0897.2004.00203.x","article-title":"Relationship between cervical mucus interleukin-8 concentrations and vaginal bacteria in pregnancy","volume":"52","author":"Sakai M","year":"2004","unstructured":"Sakai M, Ishiyama A, Tabata M, Sasaki Y, Yoneda S, Shiozaki A, et al. Relationship between cervical mucus interleukin-8 concentrations and vaginal bacteria in pregnancy. American Journal of Reproductive Immunology. 2004;52:106\u201312. https:\/\/doi.org\/10.1111\/j.1600-0897.2004.00203.x.","journal-title":"American Journal of Reproductive Immunology"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-022-01317-9","article-title":"Gardnerella vaginalis alters cervicovaginal epithelial cell function through microbe-specific immune responses","author":"Anton L","year":"2022","unstructured":"Anton L, Ferguson B, Friedman ES, Gerson KD, Brown AG, Elovitz MA. Gardnerella vaginalis alters cervicovaginal epithelial cell function through microbe-specific immune responses. Microbiome. 2022;10. https:\/\/doi.org\/10.1186\/s40168-022-01317-9.","journal-title":"Microbiome"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/IM9.0000000000000007","article-title":"Multi-omic Microbiome Profiles in the Female Reproductive Tract in Early Pregnancy","volume":"1","author":"Jean S","year":"2019","unstructured":"Jean S, Huang B, Parikh HI, Edwards DJ, Brooks JP, Kumar NG, et al. Multi-omic Microbiome Profiles in the Female Reproductive Tract in Early Pregnancy. Infectious Microbes and Diseases. 2019;1:49\u201360. https:\/\/doi.org\/10.1097\/IM9.0000000000000007.","journal-title":"Infectious Microbes and Diseases"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1038\/s41598-022-12424-w","article-title":"HIV-associated vaginal microbiome and inflammation predict spontaneous preterm birth in Zambia","author":"Price JT","year":"2022","unstructured":"Price JT, Vwalika B, France M, Ravel J, Ma B, Mwape H, et al. HIV-associated vaginal microbiome and inflammation predict spontaneous preterm birth in Zambia. Sci Rep. 2022;12. https:\/\/doi.org\/10.1038\/s41598-022-12424-w.","journal-title":"Sci Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/j.micinf.2008.01.004","article-title":"Atopobium vaginae triggers an innate immune response in an in vitro model of bacterial vaginosis","volume":"10","author":"Libby EK","year":"2008","unstructured":"Libby EK, Pascal KE, Mordechai E, Adelson ME, Trama JP. Atopobium vaginae triggers an innate immune response in an in vitro model of bacterial vaginosis. Microbes Infect. 2008;10:439\u201346. https:\/\/doi.org\/10.1016\/j.micinf.2008.01.004.","journal-title":"Microbes Infect"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1371\/journal.pone.0128557","article-title":"Gene expression profiling of human vaginal cells in vitro discriminates compounds with pro-inflammatory and mucosa-altering properties: Novel biomarkers for preclinical testing of HIV microbicide candidates","author":"Zalenskaya IA","year":"2015","unstructured":"Zalenskaya IA, Joseph T, Bavarva J, Yousefieh N, Jackson SS, Fashemi T, et al. Gene expression profiling of human vaginal cells in vitro discriminates compounds with pro-inflammatory and mucosa-altering properties: Novel biomarkers for preclinical testing of HIV microbicide candidates. 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