Interventions for treating bacterial vaginosis in pregnancy.
BACKGROUND
Bacterial vaginosis has been associated with poor perinatal outcome. Since the infections are amenable to treatment, identification during pregnancy and treatment may reduce the risk of preterm birth and its consequences.


OBJECTIVE
The objective of this review was to assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register.


METHODS
Randomised trials comparing one antibiotic regimen with placebo or no treatment, or which compare two or more alternative antibiotic regimens in pregnant women with bacterial vaginosis.


METHODS
Trial quality assessments and data extraction were done independently by three reviewers. Study authors were contacted for additional information.


RESULTS
Five trials involving 1504 women were included. These trials were of good quality. Antibiotic therapy was highly effective at eradicating infection during pregnancy as judged by 'test-of-cure' following therapy (odds ratio 0.22, 95% confidence interval 0.17 to 0.27). The effect of treating bacterial vaginosis during pregnancy showed a trend to less births before 37 weeks gestation (odds ratio 0.78, 95% confidence interval 0.60 to 1.02). The prevention of preterm birth less than 37 weeks gestation was most marked in the subgroup of women with a previous preterm birth (odds ratio 0.37, 95% confidence interval 0.23 to 0. 60).


CONCLUSIONS
The current evidence does not support screening and treating all pregnant women for bacterial vaginosis to prevent preterm birth and its consequences. For women with a history of a previous preterm birth there is some suggestion that detection and treatment of bacterial vaginosis early in pregnancy may prevent a proportion of these women having a further preterm birth. It is not known whether this is associated with an improvement in neonatal well-being.
Brocklehurst
P
P
National Perinatal Epidemiology Unit, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF. peter.brocklehurst@perinat.ox.ac.uk
Hannah
M
M
McDonald
H
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D016585:Vaginosis, Bacterial / Q000188:drug therapy*
D000900:Anti-Bacterial Agents