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Meta-Analysis
. 2007 Jan 24:(1):CD000262.
doi: 10.1002/14651858.CD000262.pub3.

Antibiotics for treating bacterial vaginosis in pregnancy

H M McDonald  1 , P Brocklehurst, A Gordon
Affiliations
Meta-Analysis

Antibiotics for treating bacterial vaginosis in pregnancy

H M McDonald et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Bacterial vaginosis is an imbalance of the normal vaginal flora with an overgrowth of anaerobic bacteria and a lack of the normal lactobacillary flora. Bacterial vaginosis during pregnancy has been associated with poor perinatal outcome and, in particular, preterm birth (PTB). Identification and treatment may reduce the risk of PTB and its consequences.

Objectives: To assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2006).

Selection criteria: Randomized trials comparing antibiotic treatment with placebo or no treatment, or comparing two or more antibiotic regimens in pregnant women with bacterial vaginosis or intermediate vaginal flora.

Data collection and analysis: Two review authors assessed trials and extracted data independently. We contacted study authors for additional information.

Main results: We included fifteen trials of good quality, involving 5888 women. Antibiotic therapy was effective at eradicating bacterial vaginosis during pregnancy (Peto odds ratio (OR) 0.17, 95% confidence interval (CI) 0.15 to 0.20; 10 trials, 4357 women). Treatment did not reduce the risk of PTB before 37 weeks (Peto OR 0.91, 95% CI 0.78 to 1.06; 15 trials, 5888 women), or the risk of preterm prelabour rupture of membranes (PPROM) (Peto OR 0.88, 95% CI 0.61 to 1.28; four trials, 2579 women). However, treatment before 20 weeks' gestation may reduce the risk of preterm birth less than 37 weeks (Peto OR 0.63, 95% CI 0.48 to 0.84; five trials, 2387 women). In women with a previous PTB, treatment did not affect the risk of subsequent PTB (Peto OR 0.83, 95% CI 0.59 to 1.17, five trials of 622); however, it may decrease the risk of PPROM (Peto OR 0.14, 95% CI 0.05 to 0.38) and low birthweight (Peto OR 0.31, 95% CI 0.13 to 0.75)(two trials, 114 women). In women with abnormal vaginal flora (intermediate flora or bacterial vaginosis) treatment may reduce the risk of PTB before 37 weeks (Peto OR 0.51, 95% CI 0.32 to 0.81; two trials, 894 women). Clindamycin did not reduce the risk of PTB before 37 weeks (Peto OR 0.80, 95% CI 0.60 to 1.05; six trials, 2406 women).

Authors' conclusions: Antibiotic treatment can eradicate bacterial vaginosis in pregnancy. This review provides little evidence that screening and treating all pregnant women with asymptomatic bacterial vaginosis will prevent PTB and its consequences. However, there is some suggestion that treatment before 20 weeks' gestation may reduce the risk of PTB. This needs to be further verified by future trials.

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Update of

References

References to studies included in this review

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    2. *

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    5. *

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References to studies excluded from this review

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References to studies awaiting assessment

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    1. Kurtzman J, Chandiramani M, Briley A, Poston L, Shennan A. Quantitative fetal fibronectin screening at 24 weeks substantially discriminates the risk of recurrent preterm delivery in asymptomatic patients with prior preterm birth. American Journal of Obstetrics and Gynecology. 2008;199(6 Suppl 1):S10. - PubMed
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Additional references

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    1. Annells MF, Hart PH, Mullighan CG, Heatley SL, Robinson JS, McDonald HM. Polymorphisms in immunoregulatory genes and the risk of histologic chorioamnionitis in Caucasoid women: a case control study. BMC Pregnancy and Childbirth. 2005;5(1):4. - PMC - PubMed
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References to other published versions of this review

    1. Brocklehurst P, Hannah M, McDonald H. Interventions for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews. 1998;(Issue 4) - PubMed
    1. McDonald H, Brocklehurst P, Parsons J. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews. 2005;Issue 1 [Art. No.: CD000262. DOI: 10.1002/14651858.CD000262.pub2] - PubMed

    1. * Indicates the major publication for the study

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