title: Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population.
abstract: BACKGROUND
  Bacterial vaginosis (BV) increases the risk of spontaneous preterm deliveries (PD) in developed countries. Its prevalence varies with ethnicity, socioeconomic conditions and gestational age. Aerobic vaginitis (AV) has also been implicated with spontaneous PD. The present study aimed to estimate the prevalence of asymptomatic BV, the accuracy of vaginal pH level to predict BV and to estimate the risk of spontaneous PD <34 and <37 weeks' gestation of BV and AV.
  
  
  METHODS
  Women attending prenatal public services in Rio de Janeiro were screened to select asymptomatic pregnant women, < 20 weeks' gestation, with no indication for elective PD and without risk factors of spontaneous PD. Vaginal smears of women with vaginal pH > = 4.5 were collected to determine the Nugent score; a sample of those smears was also classified according to a modified Donders' score. Primary outcomes were spontaneous PD < 34 and <37 weeks' gestation and abortion.
  
  
  RESULTS
  Prevalence of asymptomatic BV was estimated in 28.1% (n = 1699); 42.4% of the smears were collected before 14 weeks' gestation. After an 8-week follow up, nearly 40% of the initially BV positive women became BV negative. The prevalence of BV among white and black women was 28.1% (95% CI: 24.6%-32.0%) and 32.5% (95% CI: 28.2%-37.2%), respectively. The sensitivity of vaginal pH= > 4.5 and = > 5.0 to predict BV status was 100% and 82%, correspondingly; the 5.0 cutoff value doubled the specificity, from 41% to 84%. The incidence of < 37 weeks' spontaneous PDs among BV pregnant women with a pH= > 4.5 was 3.8%. The RR of spontaneous PD < 34 and <37 weeks among BV women with pH > =4.5, as compared with those with intermediate state, were 1.24 and 1.86, respectively (Fisher's exact test, p value = 1; 0.52, respectively, both ns). No spontaneous case of PD or abortion was associated with severe or moderate AV.
  
  
  CONCLUSIONS
  A high prevalence of asymptomatic BV was observed without statistically significant difference between black and white women. The RRs of spontaneous PD < 34 and <37 weeks among women with BV, as compared with those with intermediate state were not statistically significant but were consistent with those found in the literature.
authors.affiliation: Health Technology Assessment Unit, National School of Public Health, Oswaldo Cruz Foundation, Brazilian Health Ministry, R Leopoldo Bulhões, 1480, room 714, Manguinhos, Rio de Janeiro 21041-210, Brazil. leticiak@ensp.fiocruz.br.
authors.forename: Leticia
authors.initials: L
authors.lastname: Krauss-Silva
authors.forename: Antonio
authors.initials: A
authors.lastname: Almada-Horta
authors.forename: Mariane B
authors.initials: MB
authors.lastname: Alves
authors.forename: Karla G
authors.initials: KG
authors.lastname: Camacho
authors.forename: Maria Elizabeth L
authors.initials: ME
authors.lastname: Moreira
authors.forename: Alcione
authors.initials: A
authors.lastname: Braga
mesh_terms: D000328:Adult; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D001938:Brazil / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000191:economics / Q000208:ethnology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000208:ethnology* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013020:South America / Q000208:ethnology; D013997:Time Factors; D014621:Vagina / Q000378:metabolism* / Q000382:microbiology; D014626:Vaginal Smears; D014627:Vaginitis / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*; D016585:Vaginosis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*