Elsevier

Clinics in Perinatology

Volume 37, Issue 3, September 2010, Pages 677-688
Clinics in Perinatology

Progress Toward Improved Understanding of Infection-Related Preterm Birth

https://doi.org/10.1016/j.clp.2010.06.001Get rights and content

Section snippets

BV: recent developments

BV is a pathologic state characterized by the loss of normal vaginal flora, particularly Lactobacillus species, and overgrowth of other microbes, including G vaginalis, Bacteroides sp, Mobiluncus sp, and Mycoplasma hominis. Reported prevalence rates for BV range from 10% to 40% depending on the population studied, with the vast majority of women being asymptomatic.15, 16 BV during pregnancy is an independent risk factor for preterm labor17 and is estimated to cause 90,000 excess premature

Improved identification of intrauterine infection

Intrauterine infection is believed to account for 25% to 40% of preterm births.42 However, the true prevalence of infection-associated preterm labor is likely to be grossly underestimated since these approximations rely primarily on traditional diagnostic strategies, including culture-based techniques, clinical criteria, or laboratory analysis of amniotic fluid. Standard culture-based techniques often do not identify fastidious organisms or other cultivation-resistant microbes. Also, many of

The fetal response to maternal infection

The fetus is capable of mounting an immune response following perturbations in the intrauterine environment. Elevated plasma concentrations of IL-6 and C-reactive protein (CRP) and a higher percentage of Th1 cells have all been documented in fetuses with preterm labor and preterm premature rupture of membranes (PROM).61, 62, 63, 64 However, it was not until 1998 that Gomez and colleagues64 formally described the fetal inflammatory response syndrome (FIRS) as a condition characterized by

First page preview

First page preview
Click to open first page preview
View PDF

References (88)

  • L.L. Klein et al.

    Use of microbial cultures and antibiotics in the prevention of infection-associated preterm birth

    Am J Obstet Gynecol

    (2004)
  • R.L. Goldenberg et al.

    Epidemiology and causes of preterm birth

    Lancet

    (2008)
  • W.W. Andrews

    Cervicovaginal cytokines, vaginal infection, and preterm birth

    Am J Obstet Gynecol

    (2004)
  • H.L. Gardner et al.

    Haemophilus vaginalis vaginitis: a newly defined specific infection previously classified non-specific vaginitis

    Am J Obstet Gynecol

    (1955)
  • L.M. Bodnar et al.

    Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy

    J Nutr

    (2009)
  • B.H. Yoon et al.

    Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years

    Am J Obstet Gynecol

    (2000)
  • D.J. Dudley

    Pre-term labor: an intra-uterine inflammatory response syndrome?

    J Reprod Immunol

    (1997)
  • P.J. Thompson et al.

    Fetal C-reactive protein

    Early Hum Dev

    (1993)
  • R. Gomez et al.

    The fetal inflammatory response syndrome

    Am J Obstet Gynecol

    (1998)
  • R.W. Redline

    Inflammatory responses in the placenta and umbilical cord

    Semin Fetal Neonatal Med

    (2006)
  • A.R. Mohan et al.

    Molecular and biochemical mechanisms of preterm labour

    Semin Fetal Neonatal Med

    (2004)
  • R. Romero et al.

    A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition

    Am J Obstet Gynecol

    (1998)
  • B.H. Yoon et al.

    A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia

    Am J Obstet Gynecol

    (1999)
  • B.H. Yoon et al.

    Association of oligohydramnios in women with pre-term premature rupture of membranes with an inflammatory response in fetal, amniotic, and maternal compartments

    Am J Obstet Gynecol

    (1999)
  • B.H. Yoon et al.

    An increase in fetal plasma cortisol but not dehydroepiandrosterone sulfate is followed by the onset of preterm labor in patients with pre-term premature rupture of the membranes

    Am J Obstet Gynecol

    (1998)
  • E. Di Naro et al.

    Fetal thymic involution: a sonographic marker of the fetal inflammatory response syndrome

    Am J Obstet Gynecol

    (2006)
  • J.R. Bobitt et al.

    Unrecognized amnionitis and prematurity: a preliminary report

    J Reprod Med

    (1977)
  • A. Ugwumadu et al.

    Oral clindamycin and histologic chorioamnionitis in women with abnormal vaginal flora

    Obstet Gynecol

    (2006)
  • F. Gotsch et al.

    The preterm parturition syndrome and its implications for understanding the biology, risk assessment, diagnosis, treatment and prevention of preterm birth

    J Matern Fetal Neonatal Med

    (2009)
  • W.W. Andrews et al.

    Preterm labor: emerging role of genital tract infections

    Infect Agents Dis

    (1995)
  • E.H. Koumans et al.

    Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda

    Sex Transm Dis

    (2001)
  • E.H. Koumans et al.

    The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health

    Sex Transm Dis

    (2007)
  • S.L. Hillier et al.

    Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group

    N Engl J Med

    (1995)
  • H.M. McDonald et al.

    Antibiotics for treating bacterial vaginosis in pregnancy

    Cochrane Database Syst Rev

    (2007)
  • J. Martius et al.

    The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity–a review

    Arch Gynecol Obstet

    (1990)
  • S.L. Hillier et al.

    The role of bacterial vaginosis and vaginal bacteria in amniotic fluid infection in women in preterm labor with intact fetal membranes

    Clin Infect Dis

    (1995)
  • S. Cauci et al.

    Modulation of vaginal immune response among pregnant women with bacterial vaginosis by Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and yeast

    Am J Obstet Gynecol

    (2007)
  • S.R. Hedges et al.

    Local and systemic cytokine levels in relation to changes in vaginal flora

    J Infect Dis

    (2006)
  • K. Stencel-Gabriel et al.

    Prenatal priming of cord blood T lymphocytes by microbiota in the maternal vagina

    Am J Reprod Immunol

    (2009)
  • J.R. Schwebke et al.

    Prevalence of gardnerella vaginalis in male sexual partners of women with and without bacterial vaginosis

    Sex Transm Dis

    (2008)
  • W.E. Josey et al.

    The polymicrobial hypothesis of bacterial vaginosis causation: a reassessment

    Int J STD AIDS

    (2008)
  • S.E. Gelber et al.

    Functional and phylogenetic characterization of Vaginolysin, the human-specific cytolysin from Gardnerella vaginalis

    J Bacteriol

    (2008)
  • C. Holzman et al.

    Factors linked to bacterial vaginosis in nonpregnant women

    Am J Public Health

    (2001)
  • L. Uscher-Pines et al.

    Racial differences in bacterial vaginosis among pregnant women: the relationship between demographic and behavioral predictors and individual BV-related microorganism levels

    Matern Child Health J

    (2009)

    • Cited by (8)

    • Mesenchymal stem cell-derived extracellular vesicles ameliorate inflammation-induced preterm brain injury

      2017, Brain, Behavior, and Immunity
      Citation Excerpt :

      According to the “multiple hit hypothesis”, a variety of noxious events such as fluctuations in oxygen supply caused by acute or chronic lung disease, drug exposure and inflammation may affect the developing brain and thereby result in cellular loss and maturation disturbances (Anjari et al., 2009; Brehmer et al., 2012; Cai et al., 2000; Felderhoff-Mueser et al., 2004; Kaindl et al., 2009). Predisposing factors for WMI are intrauterine and perinatal infections leading to systemic inflammation (Andrews et al., 1995; Hagberg and Mallard, 2005; Randis, 2010). In preclinical studies, lipopolysaccharide (LPS) is used in experimental models to mimic the clinical situation (Brehmer et al., 2012; Eklind et al., 2001).

    • High- but not low-grade histologic chorioamnionitis is associated with spontaneous preterm birth in a Swedish cohort

      2018, Journal of Maternal-Fetal and Neonatal Medicine

    • Hyperoxia and the Immature Brain

      2017, Developmental Neuroscience

    • The Development of Extremely Preterm Infants Born to Women Who Had Genitourinary Infections during Pregnancy

      2016, American Journal of Epidemiology

    • Can genital infections alter the results of preterm birth predictive tests?

      2014, Revista Brasileira de Ginecologia e Obstetricia

    • Interaction of Inflammation and Hyperoxia in a Rat Model of Neonatal White Matter Damage

      2012, PLoS ONE
    View all citing articles on Scopus

    The author has nothing to disclose.

    View full text
    Copyright © 2010 Elsevier Inc. All rights reserved.