title: First trimester bacterial vaginosis, individual microorganism levels, and risk of second trimester pregnancy loss among urban women.
abstract: OBJECTIVE
  To examine the role of first trimester bacterial vaginosis (BV) and level of BV-associated microorganisms, diagnosed using the Nugent gram stain criteria and the risk of second trimester pregnancy loss among urban women.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Urban prenatal care clinics.
  
  
  METHODS
  Women presenting for their first prenatal care visit who had completed 12 weeks gestation or less and resided within Philadelphia, Pennsylvania.
  
  
  METHODS
  Pregnancy loss.
  
  
  RESULTS
  Of 1948 women enrolled at a mean gestational age of 10 weeks (range 7.4 to 12.6 weeks), those with the highest level of BV-related vaginal flora alteration compared with women with normal vaginal flora had over a twofold increased risk of second trimester pregnancy loss after adjustment for confounders (adjusted hazard ratio [aHR] 2.49, 95% confidence interval [CI] 1.13 to 5.48). Low Lactobacillus spp. and the absence of Lactobacillus spp. were also significantly related to the risk of second trimester pregnancy loss (aHR 1.32, 95% CI 1.10-1.64; aHR 2.30, 95% CI 1.09-4.85; respectively).
  
  
  CONCLUSIONS
  Overall BV positivity was not related to second trimester pregnancy loss. Comparing the highest to lowest tertile of BV positivity in early pregnancy conferred a two-fold increased risk of second trimester pregnancy loss and low amounts or the absence of Lactobacillus spp. in the first trimester also significantly increased the risk of second trimester pregnancy loss.
authors: Department of Public Health and Obstetrics/Gynecology, Temple University, Philadelphia, PA 19122, USA. dnelson@temple.edu
authors: Deborah B
authors: DB
authors: Nelson
authors: Scarlett
authors: S
authors: Bellamy
authors: Irving
authors: I
authors: Nachamkin
authors: Roberta B
authors: RB
authors: Ness
authors: George A
authors: GA
authors: Macones
authors: Lynne
authors: L
authors: Allen-Taylor
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology / Q000382:microbiology; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000382:microbiology*; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012307:Risk Factors; D014504:Urban Health; D016585:Vaginosis, Bacterial / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*