title: High Atopobium vaginae and Gardnerella vaginalis vaginal loads are associated with preterm birth.
abstract: BACKGROUND
  Bacterial vaginosis is a risk factor for preterm birth. The various conventional methods for its diagnosis are laborious and not easily reproducible. Molecular quantification methods have been reported recently, but the specific risk factors they might identify remain unclear.
  
  
  METHODS
  A prospective multicenter national study included pregnant women at risk of preterm birth. A quantitative molecular tool using a specific real-time polymerase chain reaction assay and serial dilutions of a plasmid suspension quantified Atopobium vaginae, Gardnerella vaginalis, lactobacilli, Mycoplasma hominis, and the human albumin gene (for quality control).
  
  
  RESULTS
  In 813 pregnancies, high vaginal loads of either or both of A. vaginae and G. vaginalis were associated with preterm birth (hazard ratio [HR], 3.9; 95% confidence interval {CI}, 1.1-14.1; P = .031). A high vaginal load of A. vaginae was significantly associated with shortened time to delivery and therefore pregnancy length. These times were, respectively, 152.2 and 188.2 days (HR, 5.6; 95% CI, 1.5-21.3; P < .001) before 22 weeks, 149.0 and 183.2 days (HR, 2.8; 95% CI, 1.1-8.2; P = .048) before 28 weeks, and 132.6 and 170.4 days (HR, 2.2; 95% CI, 1.1-4.6; P = .033) before 32 weeks. After multivariate analysis, A. vaginae levels ≥10(8) copies/mL remained significantly associated with delivery before 22 weeks of gestation (adjusted HR, 4.7; 95% CI, .2-17.6; P = .014).
  
  
  CONCLUSIONS
  High vaginal loads of A. vaginae and G. vaginalis are associated with late miscarriage and prematurity in high-risk pregnancies. A high vaginal load of A. vaginae (DNA level ≥10(8) copies/mL) identifies a population at high risk of preterm birth. Further studies that both screen for and then treat A. vaginae are needed.
  
  
  BACKGROUND
  NCT00484653.
authors.affiliation: Department of Gynecology and Obstetrics, Gynépole, Marseille, Pr Boubli et D'Ercole, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille.
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
authors.affiliation: Department d'obstétrique et gynécologie, Centre Hospitalier Poissy Saint-Germain en Laye.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rozenberg
authors.affiliation: Service de Gynecologie Obstétrique Hôpital Fondation Saint Joseph Marseille.
authors.forename: Alain
authors.initials: A
authors.lastname: Pascal
authors.affiliation: Service de Gynecologie Obstétrique du CMCO-HUS, Schiltigheim/Strasbourg.
authors.forename: Romain
authors.initials: R
authors.lastname: Favre
authors.affiliation: Service de Gynécologie-Obstétrique, CIC, CHU Brest, Hôpital Morvan, CH de Pau.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bohec
authors.affiliation: Medical Evaluation, Department of Public Health, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: Hôpital Antoine Béclère et Kremlin-Bicêtre, Department de Gynécologie-Obstétrique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Université Paris Sud, Faculté de Medecine, Orsay.
authors.forename: Marie-Victoire
authors.initials: MV
authors.lastname: Senat
authors.affiliation: Service de Gynecologie Obstétrique du CMCO-HUS, Schiltigheim/Strasbourg.
authors.forename: Germain
authors.initials: G
authors.lastname: Aissi
authors.affiliation: Centre d'investigation Clinique, Aix-Marseille Université, AP-HM, AMU, Marseille.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lesavre
authors.affiliation: Centre d'investigation Clinique, Aix-Marseille Université, AP-HM, AMU, Marseille.
authors.forename: Julie
authors.initials: J
authors.lastname: Brunet
authors.affiliation: Department of Gynecology and Obstetrics, Gynépole, Marseille, Pr Boubli et D'Ercole, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université
authors.forename: Hélène
authors.initials: H
authors.lastname: Heckenroth
authors.affiliation: Hôpitaux Paris Sud, Hôpital Beaujon, Department of Obstetrics and Gynecology, Hôpital Bichat Beaujon, AP-HP, Université Paris VII Denis Diderot, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille.
authors.forename: Florence
authors.initials: F
authors.lastname: Fenollar
mesh_terms: D039903:Actinobacteria / Q000235:genetics / Q000302:isolation & purification*; D000328:Adult; D058491:Bacterial Load; D005260:Female; D006194:Gardnerella vaginalis / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007778:Lactobacillus / Q000235:genetics / Q000302:isolation & purification; D019535:Mycoplasma hominis / Q000235:genetics / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology*; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000382:microbiology*; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D016585:Vaginosis, Bacterial / Q000382:microbiology*
keywords: Atopobium vaginae; Gardnerella vaginalis; bacterial vaginosis; molecular biology; preterm birth