{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:01:14Z","timestamp":1787029274884,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T00:00:00Z","timestamp":1733443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Premature rupture of membranes (PROM) and cervical incompetence (CI) are major contributors to preterm birth, a leading cause of neonatal morbidity and mortality. Background\/Objectives: Disorders of the vaginal microbiota, such as bacterial vaginosis, have been associated with an increased risk of PROM, CI, and subsequent preterm birth. Probiotics, particularly Lactobacillus strains, have been proposed as a preventive strategy to restore and maintain a healthy vaginal microbiome. This review aims to summarize the latest evidence on the role of probiotics in the prevention of PROM and CI. Methods: A comprehensive review was conducted to evaluate the effectiveness of probiotic interventions in the prevention of PROM and CI, yielding 1809 records from 2005 to 2024. Seven relevant studies were selected by searching medical databases and focusing on studies that investigated the restoration of healthy vaginal flora, the reduction of pathogenic bacteria colonization, and the modulation of immune responses by probiotics. Results: The studies analyzed suggest that probiotics may help restore healthy vaginal flora, reduce pathogenic bacterial colonization, and modulate immune responses, thereby reducing the risk of membrane rupture and cervical insufficiency. Evidence from randomized controlled trials and observational studies shows that the use of probiotics is associated with a lower incidence of PROM and preterm birth, especially in high-risk groups. Conclusions: Probiotics emerge as a potential non-invasive and cost-effective strategy to improve pregnancy outcomes in women at risk of preterm birth due to PROM. According to our research, probiotic prophylaxis of cervical insufficiency has not yet been sufficiently investigated. Despite the promising findings, further research is needed to determine standardized probiotic formulations, optimal timing, and routes of administration. Personalized probiotic therapies may represent the future of preterm birth prevention as they offer targeted interventions based on individual microbiome composition.<\/jats:p>","DOI":"10.3390\/nu16234230","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T06:18:03Z","timestamp":1733725083000},"page":"4230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Probiotics in the Prophylaxis of Premature Rupture of Membranes and Cervical Incompetence"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7526-1756","authenticated-orcid":false,"given":"Constantin-Cristian","family":"Vaduva","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 200349 Craiova, Romania"},{"name":"Clinic of Obstetrics and Gynecology, Filantropia Clinical Hospital, 200143 Craiova, Romania"},{"name":"Department of Obstetrics, Gynecology and IVF, HitMed Medical Center, 200130 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Maria","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 200349 Craiova, Romania"},{"name":"Department of Mother and Child Medicine, Emergency County Hospital, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0534","authenticated-orcid":false,"given":"Laurentiu Mihai","family":"Dira","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 200349 Craiova, Romania"},{"name":"Clinic of Obstetrics and Gynecology, Filantropia Clinical Hospital, 200143 Craiova, Romania"},{"name":"Department of Obstetrics, Gynecology and IVF, HitMed Medical Center, 200130 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7183-3144","authenticated-orcid":false,"given":"Dan","family":"Ruican","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, Filantropia Clinical Hospital, 200143 Craiova, Romania"},{"name":"Department of Obstetrics, Gynecology and IVF, HitMed Medical Center, 200130 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razvan Cosmin","family":"Pana","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 200349 Craiova, Romania"},{"name":"Department of Mother and Child Medicine, Emergency County Hospital, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,6]]},"reference":[{"key":"ref_1","unstructured":"Dayal, S., and Hong, P.L. (2024). Premature Rupture of Membranes. StatPearls, StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/GRF.0000000000000184","article-title":"Overview of Cervical Insufficiency: Diagnosis, Etiologies, and Risk Factors","volume":"59","author":"Roman","year":"2016","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00281-020-00807-y","article-title":"Pathogenesis of Preterm Birth: Bidirectional Inflammation in Mother and Fetus","volume":"42","author":"Green","year":"2020","journal-title":"Semin. Immunopathol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Tantengco, O.A.G., and Menon, R. (2022). Breaking Down the Barrier: The Role of Cervical Infection and Inflammation in Preterm Birth. Front. Glob. Womens Health, 2.","DOI":"10.3389\/fgwh.2021.777643"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"010325","DOI":"10.7189\/jogh.10.010325","article-title":"Middle-East OBGYN Graduate Education (MOGGE) Foundation Practice Guidelines: Prelabor Rupture of Membranes; Practice Guideline No. 01-O-19","volume":"10","author":"Shazly","year":"2020","journal-title":"J. Glob. Health"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Barrientos-Dur\u00e1n, A., Fuentes-L\u00f3pez, A., de Salazar, A., Plaza-D\u00edaz, J., and Garc\u00eda, F. (2020). Reviewing the Composition of Vaginal Microbiota: Inclusion of Nutrition and Probiotic Factors in the Maintenance of Eubiosis. Nutrients, 12.","DOI":"10.3390\/nu12020419"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12934-020-01464-4","article-title":"Vaginal Microbiota and the Potential of Lactobacillus Derivatives in Maintaining Vaginal Health","volume":"19","author":"Chee","year":"2020","journal-title":"Microb. Cell Factories"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.3390\/applmicrobiol3040089","article-title":"The Vaginal Microbiome during Pregnancy in Health and Disease","volume":"3","author":"Mendz","year":"2023","journal-title":"Appl. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1128\/CMR.00075-15","article-title":"The Human Microbiome during Bacterial Vaginosis","volume":"29","author":"Onderdonk","year":"2016","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_10","first-page":"257","article-title":"The Role of Microbial Communities in the Etiology of Preterm Birth","volume":"71","author":"Romero","year":"2014","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Juliana, N.C.A., Suiters, M.J.M., Al-Nasiry, S., Morr\u00e9, S.A., Peters, R.P.H., and Ambrosino, E. (2020). The Association Between Vaginal Microbiota Dysbiosis, Bacterial Vaginosis, and Aerobic Vaginitis, and Adverse Pregnancy Outcomes of Women Living in Sub-Saharan Africa: A Systematic Review. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.567885"},{"key":"ref_12","first-page":"347","article-title":"Bacterial Vaginosis\u2014Vaginal Polymicrobial Biofilms and Dysbiosis","volume":"120","author":"Swidsinski","year":"2023","journal-title":"Dtsch. \u00c4rztebl. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1111\/1574-6976.12029","article-title":"Vaginal Microbiota and Its Role in HIV Transmission and Infection","volume":"37","author":"Petrova","year":"2013","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mei, Z., and Li, D. (2022). The Role of Probiotics in Vaginal Health. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.963868"},{"key":"ref_15","unstructured":"Petrova, M.I., van den Broek, M.F.L., Balzarini, J., Vanderleyden, J., and Lebeer, S. (2015). Vaginal Microbiota and Probiotics in Preventing Preterm Birth: A Review. Front. Immunol., 6."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"608.e1","DOI":"10.1016\/j.ajog.2016.06.021","article-title":"Effect of Probiotics on Vaginal Health in Pregnancy. EFFPRO, a Randomized Controlled Trial","volume":"215","author":"Gille","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_17","first-page":"CD005941","article-title":"Probiotics for Preventing Preterm Labour","volume":"2007","author":"Othman","year":"2007","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","first-page":"1100","article-title":"Probiotics Reduce the Incidence and Death Due to NEC and Improve Feed Tolerance in Pregnancy","volume":"35","author":"Samanta","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_19","first-page":"145","article-title":"Probiotics for Pregnancy: An Investigation of Preterm Birth Risk Reduction and Infant Health","volume":"275","author":"Benor","year":"2022","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/1745-6215-12-239","article-title":"A Randomised Controlled Trial of Probiotics for the Prevention of Spontaneous Preterm Delivery Associated with Bacterial Vaginosis: Preliminary Results","volume":"12","author":"Moreira","year":"2011","journal-title":"Trials"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Vanda, R., Dastani, T., Taghavi, S.-A., Sadeghi, H., Lambert, N., and Bazarganipour, F. (2024). Pregnancy Outcomes in Pregnant Women Taking Oral Probiotic Undergoing Cerclage Compared to Placebo: Two Blinded Randomized Controlled Trial. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06496-x"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.tjog.2024.03.004","article-title":"The Role of Probiotics as Adjunct Treatment in the Prevention and Management of Gynecological Infections: An Updated Meta-Analysis of 35 RCT Studies","volume":"63","author":"Abavisani","year":"2024","journal-title":"Taiwan. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1017\/S0007114519003374","article-title":"Effect of Probiotic Supplementation in Pregnant Women: A Meta-Analysis of Randomised Controlled Trials","volume":"123","author":"Kuang","year":"2020","journal-title":"Br. J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Jarde, A., Lewis-Mikhael, A.-M., Moayyedi, P., Stearns, J.C., Collins, S.M., Beyene, J., and McDonald, S.D. (2018). Pregnancy Outcomes in Women Taking Probiotics or Prebiotics: A Systematic Review and Meta-Analysis. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-017-1629-5"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Castillo, \u00cd.M., Fern\u00e1ndez-Castillo, R., Lasserrot-Cuadrado, A., Gallo-Vallejo, J.L., Rojas-Carvajal, A.M., and Aguilar-Cordero, M.J. (2021). Reporting of Perinatal Outcomes in Probiotic Randomized Controlled Trials. A Systematic Review and Meta-Analysis. Nutrients, 13.","DOI":"10.3390\/nu13010256"},{"key":"ref_26","unstructured":"Hyman, R.W., Jiang, H., Fukushima, M., Fung, E., Rand, L., Johnson, B., Vo, K.C., Caughey, A.B., Hilton, J.F., and Davis, R.W. (2014). The Dynamics of Vaginal Microbiota During Pregnancy. PLoS ONE, 9."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Virk, M.S., Virk, M.A., He, Y., Tufail, T., Gul, M., Qayum, A., Rehman, A., Rashid, A., Ekumah, J.-N., and Han, X. (2024). The Anti-Inflammatory and Curative Exponent of Probiotics: A Comprehensive and Authentic Ingredient for the Sustained Functioning of Major Human Organs. Nutrients, 16.","DOI":"10.3390\/nu16040546"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Raheem, A., Liang, L., Zhang, G., and Cui, S. (2021). Modulatory Effects of Probiotics During Pathogenic Infections With Emphasis on Immune Regulation. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.616713"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Mazziotta, C., Tognon, M., Martini, F., Torreggiani, E., and Rotondo, J.C. (2023). Probiotics Mechanism of Action on Immune Cells and Beneficial Effects on Human Health. Cells, 12.","DOI":"10.3390\/cells12010184"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chieng, W.K., Abdul Jalal, M.I., Bedi, J.S., Zainuddin, A.A., Mokhtar, M.H., Abu, M.A., Chew, K.T., and Nur Azurah, A.G. (2022). Probiotics, a Promising Therapy to Reduce the Recurrence of Bacterial Vaginosis in Women? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.938838"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ansari, A., Son, D., Hur, Y.M., Park, S., You, Y.-A., Kim, S.M., Lee, G., Kang, S., Chung, Y., and Lim, S. (2023). Lactobacillus Probiotics Improve Vaginal Dysbiosis in Asymptomatic Women. Nutrients, 15.","DOI":"10.3390\/nu15081862"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Brown, R.G., Marchesi, J.R., Lee, Y.S., Smith, A., Lehne, B., Kindinger, L.M., Terzidou, V., Holmes, E., Nicholson, J.K., and Bennett, P.R. (2018). Vaginal Dysbiosis Increases Risk of Preterm Fetal Membrane Rupture, Neonatal Sepsis and Is Exacerbated by Erythromycin. BMC Med., 16.","DOI":"10.1186\/s12916-017-0999-x"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/j.1471-0528.2010.02840.x","article-title":"Probiotics and Preterm Birth\u2014What Is the Evidence?","volume":"118","author":"Lamont","year":"2011","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Solgi, E., Tavakoli-Far, B., Badehnoosh, B., Khavandegar, A., and Bakhtiyari, M. (2022). Vaginal and Oral Probiotics Effect in the Prevention of Preterm Delivery in Patients Visiting Kamali Hospital, Karaj, Iran in 2020. Eur. J. Obstet. Gynecol. Reprod. Biol. X, 16.","DOI":"10.1016\/j.eurox.2022.100169"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Farr, A., Kiss, H., Hagmann, M., Machal, S., Holzer, I., Kueronya, V., Husslein, P., and Petricevic, L. (2015). Role of Lactobacillus Species in the Intermediate Vaginal Flora in Early Pregnancy: A Retrospective Cohort Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0144181"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1159\/000450995","article-title":"Vaginal Probiotic Administration in the Management of Preterm Premature Rupture of Membranes","volume":"42","author":"Daskalakis","year":"2017","journal-title":"Fetal Diagn. Ther."},{"key":"ref_37","first-page":"59","article-title":"The Effects of Vaginal Probiotic Administration on Perinatal Outcomes in Patients with Premature Preterm Rupture of Membrane","volume":"3","author":"Kahvazi","year":"2022","journal-title":"Arch. Obstet. Gynaecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3527","DOI":"10.1080\/01443615.2022.2151349","article-title":"Vaginal Probiotics on the Outcomes of Premature Rupture of Membranes: A Pilot Randomised Clinical Trial","volume":"42","author":"Moraes","year":"2022","journal-title":"J. Obstet. Gynaecol. J. Inst. Obstet. Gynaecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1080\/01443615.2021.1993803","article-title":"Vaginal Probiotics as an Adjunct to Antibiotic Prophylaxis in the Management of Preterm Premature Rupture of the Membranes","volume":"42","author":"Yadav","year":"2022","journal-title":"J. Obstet. Gynaecol. J. Inst. Obstet. Gynaecol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Payne, M.S., and Bayatibojakhi, S. (2014). Exploring Preterm Birth as a Polymicrobial Disease: An Overview of the Uterine Microbiome. Front. Immunol., 5.","DOI":"10.3389\/fimmu.2014.00595"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Istrate-Ofi\u0163eru, A.-M., Mogoant\u0103, C.A., Zoril\u0103, G.-L., Ro\u015fu, G.-C., Dr\u0103gu\u015fin, R.C., Berbecaru, E.-I.-A., Zoril\u0103, M.V., Com\u0103nescu, C.M., Mogoant\u0103, S.-S., and Vaduva, C.-C. (2024). Clinical Characteristics and Local Histopathological Modulators of Endometriosis and Its Progression. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25031789"},{"key":"ref_42","first-page":"5575","article-title":"Ovarian Reserve after Treatment of Ovarian Endometriomas by Ethanolic Sclerotherapy Compared to Surgical Treatment","volume":"27","author":"Vaduva","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Gruber, T.M., Ortlieb, L., Henrich, W., and Mechsner, S. (2024). Women with Endometriosis\u2014Who Is at Risk for Complications Associated with Pregnancy and Childbirth? A Retrospective Case\u2013Control Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020414"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1038\/s41467-017-00901-0","article-title":"The Microbiota Continuum along the Female Reproductive Tract and Its Relation to Uterine-Related Diseases","volume":"8","author":"Chen","year":"2017","journal-title":"Nat. Commun."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ata, B., Yildiz, S., Turkgeldi, E., Brocal, V.P., Dinleyici, E.C., Moya, A., and Urman, B. (2019). The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3\/4 Endometriosis and Healthy Controls. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-39700-6"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e30495","DOI":"10.1016\/j.heliyon.2024.e30495","article-title":"From Whole Genomes to Probiotic Candidates: A Study of Potential Lactobacilli Strains Selection for Vaginitis Treatment","volume":"10","author":"Lyu","year":"2024","journal-title":"Heliyon"},{"key":"ref_47","first-page":"434","article-title":"Probiotics\u2014A helpful additional therapy for bacterial vaginosis","volume":"6","author":"Bodean","year":"2013","journal-title":"J Med Life."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Moreno, A., and Aguilera, M. (2021). Vaginal Probiotics for Reproductive Health and Related Dysbiosis: Systematic Review and Meta-Analysis. J. Clin. Med., 10.","DOI":"10.20944\/preprints202103.0424.v1"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Romeo, M., D\u2019Urso, F., Ciccarese, G., Di Gaudio, F., and Broccolo, F. (2024). Exploring Oral and Vaginal Probiotic Solutions for Women\u2019s Health from Puberty to Menopause: A Narrative Review. Microorganisms, 12.","DOI":"10.3390\/microorganisms12081614"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"63","DOI":"10.14740\/jcgo571","article-title":"Prenatal Probiotics: The Way Forward in Prevention of Preterm Birth","volume":"8","author":"Dhanasekar","year":"2019","journal-title":"J. Clin. Gynecol. Obstet."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Melinte-Popescu, A.-S., Popa, R.-F., Harabor, V., Nechita, A., Harabor, A., Adam, A.-M., Vasilache, I.-A., Melinte-Popescu, M., Vaduva, C., and Socolov, D. (2023). Managing Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder. Medicina, 59.","DOI":"10.3390\/medicina59040715"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Ko, H., Dehority, W., Maxwell, J.R., Ko, H., Dehority, W., and Maxwell, J.R. (2020). The Impact of Maternal Infection on the Neonate. Congenital Anomalies in Newborn Infants\u2014Clinical and Etiopathological Perspectives, IntechOpen.","DOI":"10.5772\/intechopen.91637"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.clp.2005.04.006","article-title":"Maternal Infection and Adverse Fetal and Neonatal Outcomes","volume":"32","author":"Goldenberg","year":"2005","journal-title":"Clin. Perinatol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1016\/j.mayocp.2017.10.004","article-title":"Microbiome at the Frontier of Personalized Medicine","volume":"92","author":"Kashyap","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"9966","DOI":"10.1073\/pnas.1705899114","article-title":"Replication and refinement of a vaginal microbial signature of preterm birth in two racially distinct cohorts of US women","volume":"114","author":"Callahan","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/23\/4230\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:49:07Z","timestamp":1760114947000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/23\/4230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,6]]},"references-count":55,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["nu16234230"],"URL":"https:\/\/doi.org\/10.3390\/nu16234230","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,6]]}}}