title: Subtle perturbations of genital microflora alter mucosal immunity among low-risk pregnant women.
abstract: OBJECTIVE
  Alteration in the vaginal flora has been associated with adverse pregnancy outcomes. The objective of this study was to examine the impact of changes in individual microflora on genital immunity among low-risk pregnant women in early pregnancy.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Large, tertiary care, academic hospital clinic.
  
  
  METHODS
  Low-risk women were enrolled prior to 14 weeks' gestation.
  
  
  METHODS
  Women were included if they had no medical or previous obstetrical complications, were non-smokers, had no sexually transmitted infections and no intercourse in the last 48 hours. Consenting women underwent speculum examination for collection of vaginal culture and Dacron swabs for cytokine analysis. Semi-quantitative vaginal cultures were performed in a reference laboratory.
  
  
  METHODS
  Concentrations of immune mediators were compared in the presence of various organisms. Concentrations were converted to multiples of the median to standardize the values of each mediator. Regression analyses were performed to control for race.
  
  
  RESULTS
  We enrolled 47 women. The frequencies of genital microorganisms were: H(2)O(2) -producing lactobacilli (70%), Ureaplasma urealyticum (66%), Gardnerella vaginalis (45%), anaerobic non-pigmented Gram-negative rods (ANPGNR, 40%), anaerobic pigmented Gram-negative rods (APGNR, 17%). After adjusting for race and body mass index, interleukin-1β, interferon-γ, tumor necrosis factor-α and granulocyte macrophage-colony stimulating factor were increased in the presence of G. vaginalis, ANPGNR, and APGNR. There was no consistent impact on the other markers of immune activation.
  
  
  CONCLUSIONS
  The presence of individual species impacts genital immunity among low-risk pregnant women. Perturbations in genital immunity could partially explain heterogeneity in adverse pregnancy outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI, USA. banderson@wihri.org
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Anderson
authors.forename: Susan
authors.initials: S
authors.lastname: Cu-Uvin
authors.forename: Christina A
authors.initials: CA
authors.lastname: Raker
authors.forename: Christine
authors.initials: C
authors.lastname: Fitzsimmons
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hillier
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism*; D016983:Enterococcus; D005260:Female; D006194:Gardnerella vaginalis; D016965:Gram-Negative Anaerobic Straight, Curved, and Helical Rods; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000378:metabolism; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D053583:Interleukin-1beta / Q000378:metabolism; D007778:Lactobacillus; D009092:Mucous Membrane / Q000276:immunology* / Q000382:microbiology*; D011247:Pregnancy; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D016990:Ureaplasma urealyticum; D014621:Vagina / Q000276:immunology* / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000276:immunology / Q000382:microbiology
chemical_list: D015415:Biomarkers; D016207:Cytokines; D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma; D016178:Granulocyte-Macrophage Colony-Stimulating Factor