{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:44:02Z","timestamp":1791902642786,"version":"4.3.4"},"reference-count":84,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T00:00:00Z","timestamp":1574294400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"crossref","award":["R01NR014800"],"award-info":[{"award-number":["R01NR014800"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"crossref","award":["R01MD009064"],"award-info":[{"award-number":["R01MD009064"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"crossref","award":["R24ES029490"],"award-info":[{"award-number":["R24ES029490"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Office of the Director","award":["UG3OD023318\/UH3OD023318"],"award-info":[{"award-number":["UG3OD023318\/UH3OD023318"]}]},{"name":"Emory Integrated Genomics Core"},{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["UL1TR000424"],"award-info":[{"award-number":["UL1TR000424"]}]},{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["UL1TR000454"],"award-info":[{"award-number":["UL1TR000454"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>A growing body of research has investigated the human microbiota and pregnancy outcomes, especially preterm birth. Most studies of the prenatal microbiota have focused on the vagina, with fewer investigating other body sites during pregnancy. Although pregnancy involves profound hormonal, immunological and metabolic changes, few studies have investigated either shifts in microbiota composition across pregnancy at different body sites or variation in composition at any site that may be explained by maternal characteristics. The purpose of this study was to investigate: (1) the stability of the vaginal, oral, and gut microbiota from early (8\u201314 weeks) through later (24\u201330 weeks) pregnancy among African American women according to measures of socioeconomic status, accounting for prenatal antibiotic use; (2) whether measures of socioeconomic status are associated with changes in microbiota composition over pregnancy; and (3) whether exposure to prenatal antibiotics mediate any observed associations between measures of socioeconomic status and stability of the vaginal, oral, and gut microbiota across pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used paired vaginal, oral, or gut samples available for 16S rRNA gene sequencing from two time points in pregnancy (8\u201314 and 24\u201330 weeks) to compare within-woman changes in measures of alpha diversity (Shannon and Chao1) and beta-diversity (Bray\u2013Curtis dissimilarity) among pregnant African American women (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0110). Multivariable linear regression was used to examine the effect of level of education and prenatal health insurance as explanatory variables for changes in diversity, considering antibiotic exposure as a mediator, adjusting for age, obstetrical history, and weeks between sampling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For the oral and gut microbiota, there were no significant associations between measures of socioeconomic status or prenatal antibiotic use and change in Shannon or Chao1 diversity. For the vaginal microbiota, low level of education (high school or less) was associated with an increase in Shannon and Chao1 diversity over pregnancy, with minimal attenuation when controlling for prenatal antibiotic use. Conversely, for within-woman Bray\u2013Curtis dissimilarity for early compared to later pregnancy, low level of education and prenatal antibiotics were associated with greater dissimilarity for the oral and gut sites, with minimal attenuation when controlling for prenatal antibiotics, and no difference in dissimilarity for the vaginal site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Measures of maternal socioeconomic status are variably associated with changes in diversity across pregnancy for the vaginal, oral, and gut microbiota, with minimal attenuation by prenatal antibiotic exposure. Studies that evaluate stability of the microbiota across pregnancy in association with health outcomes themselves associated with socioeconomic status (such as preterm birth) should incorporate measures of socioeconomic status to avoid finding spurious relationships.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.8004","type":"journal-article","created":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T04:33:14Z","timestamp":1574310794000},"page":"e8004","source":"Crossref","is-referenced-by-count":48,"title":["Stability of the vaginal, oral, and gut microbiota across pregnancy among African American women: the effect of socioeconomic status and antibiotic exposure"],"prefix":"10.7717","volume":"7","author":[{"given":"Anne L.","family":"Dunlop","sequence":"first","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna K.","family":"Knight","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen A.","family":"Satten","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anya J.","family":"Cutler","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences, Emory College, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L.","family":"Wright","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America"},{"name":"Department of Computer Sciences, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Read","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Mulle","sequence":"additional","affiliation":[{"name":"Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki S.","family":"Hertzberg","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherie C.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia K.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth J.","family":"Corwin","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2019,11,21]]},"reference":[{"issue":"1","key":"10.7717\/peerj.8004\/ref-1","doi-asserted-by":"crossref","first-page":"S42","DOI":"10.1016\/j.ajog.2010.10.087","article-title":"73: Metagenomic-based approach to a comprehensive characterization of the vaginal microbiome signature in pregnancy","volume":"204","author":"Aagaard","year":"2011","journal-title":"American Journal of Obstetrics & Gynecology"},{"key":"10.7717\/peerj.8004\/ref-2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.siny.2011.09.001","article-title":"Intrauterine infection and preterm labor","volume":"17","author":"Agrawal","year":"2012","journal-title":"Seminars in Fetal and Neonatal Medicine"},{"issue":"5","key":"10.7717\/peerj.8004\/ref-3","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1016\/j.athoracsur.2015.11.024","article-title":"Adjust for multiple comparisons? 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