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. 2025 Jun 13;5(6):e0004768.
doi: 10.1371/journal.pgph.0004768. eCollection 2025.

Factors associated with Nugent-bacterial vaginosis in pregnancy and postpartum among women in rural northwestern Bangladesh

Lena Kan  1 , Susan Tuddenham  2 , Parul Christian  1 , Allan Massie  3 , Alain B Labrique  4 , Lee Wu  1 , Hasmot Ali  5 , Mahbubur Rashid  1 , Ethan Gough  1 , Subhra Chakraborty  1 , Michael T France  6 , Jacques Ravel  6 , Keith P West Jr  1 , Daniel J Erchick  1
Affiliations

Factors associated with Nugent-bacterial vaginosis in pregnancy and postpartum among women in rural northwestern Bangladesh

Lena Kan et al. PLOS Glob Public Health. .

Abstract

Community-based longitudinal data on factors linked to bacterial vaginosis (BV) during and after pregnancy in Bangladesh are limited. Using data from a rural randomized trial of vitamin A and β-carotene supplementation, we examined factors associated with Nugent-score-assessed BV. Self-collected vaginal swabs from 1,812 participants were obtained in early pregnancy, late pregnancy, and 3 months postpartum for Nugent scoring. We analyzed associations between participant factors and Nugent-BV (scores 7-10 vs. 0-6; 4-10 vs. 0-3) at each time point. Bivariate associations were tested using chi-square and t-tests, and multivariable log-binomial regression was used to estimate adjusted prevalence ratios with 95% confidence intervals. In early pregnancy, consistent soap use during bathing (vs. never/sometimes) was associated with a decreased risk of Nugent-BV 7-10 (adjusted prevalence ratio (aPR): 0.64, 95% CI: 0.43, 0.96). In late pregnancy, Hindu religion (vs. Muslim) (aPR: 2.68, 95% CI: 1.52, 4.72) and higher gestational age (aPR: 1.18, 95% CI: 1.04, 1.35) were associated with increased risk of Nugent-BV 7-10 and 4-10. Furthermore, maternal underweight (BMI < 18.5 kg/m² vs. ≥ 18.5) (aPR: 0.62, 95% CI: 0.44, 0.87) and having ≥1 antenatal care visit (vs. none) (aPR: 0.59, 95% CI: 0.38, 0.91) were associated with reduced risk of Nugent-BV 4-10. Among multiparous individuals, a longer pregnancy interval of ≥18 months (vs. < 18 months) was protective against Nugent-BV 7-10 (aPR: 0.34, 95% CI: 0.14, 0.81). At 3-months postpartum, vitamin A supplementation (vs. placebo) was associated with a decreased risk of Nugent-BV 7-10, consistent with prior trial findings. Our findings indicate that Nugent-BV during pregnancy and postpartum is linked to modifiable factors, including hygiene, nutrition, birth spacing, and healthcare access. Rigorous randomized trials are needed to evaluate their ability to reduce BV, promote long-term vaginal health, and lower the risk of adverse pregnancy outcomes.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Susan Tuddenham receives royalties from UPTODATE and participates in research supported by in-kind donation of test kits from Hologic. Jacques Ravel receives consulting fees from Biocodex where he serves as an International Board Member, manages US Patent 18/904,823, is part of the Microbiome Committee (ISSVD, unpaid), and is the co-founder of LUCA Biologics and a scientific adviser for Ancilia Bio. Michael T France has IP licensed (JR-2020-020 Using Lactobacillus Asparagine Synthase Protein Variant to Predict Colonization Stability and as Anti-Gardnerella in Vaginal Microbiota Modulation Strategies), receives funding from the Bill and Melinda Gates Foundation to travel to the VMRC annual meeting, manages US Patents (issued US Patent 10,967,012 - Microbiome-based informed method to formulate live biotherapeutics; issued US Patent 11,037,655 - Microbiome-based informed method to formulate live biotherapeutics; issued US Patent 11,464,813 - Microbiome-based informed method to formulate live biotherapeutics; issued US Patent 11,389,491 - Microbiome-based informed method to formulate live biotherapeutics; pending WO2023168275 - Vaginal live biotherapeutic compositions and methods of use thereof). All other authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Nugent score transitions across early pregnancy, late pregnancy, and 3-months postpartum.
See this image and copyright information in PMC

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