Association between body mass index and the risk of bacterial vaginosis: a systematic review and meta-analysis

Abstract

Introduction: Bacterial vaginosis, resulting from vaginal microbiota imbalance and lactobacilli depletion, is the leading cause of abnormally appearing discharge in reproductive-aged women. Bacterial vaginosis is also associated with risk for sexually transmitted infections, preterm birth, and pelvic inflammatory disease. This meta-analysis assessed the association between the risk of bacterial vaginosis (BV) and body mass index (BMI).

Methods: We systematically searched electronic databases using terms for weight, vaginosis, obesity, and BMI. We also reviewed gray literature, reference lists, and trials registries and sought the advice of experts. We calculated the overall odds ratios (OR) and the 95% confidence intervals (CI) using fixed-effect model for homogenous data and random-effects models for heterogenous data.

Results: Eight observational studies (n = 22 190) were included, with quality assessment scores ranging from 7 to 9. Compared with normal-weight women (BMI 18.5-24.9), underweight women (BMI <18.5) had significantly higher prevalence of bacterial vaginosis (OR: 1.23; 95% CI: 1.12-1.36; P < 0.001). No significant associations were found for overweight (OR: 1.19; 95% CI: 0.95-1.48; P = 0.13) or obesity (OR: 1.29; 95% CI: 0.91-1.82; P = 0.15).

Conclusion: Our findings suggest a significant association between underweight status and an increased likelihood of being diagnosed with bacterial vaginosis. However, causality cannot be established due to the observational nature of the included studies. Further prospective research is needed to confirm this relationship.

Keywords: bacterial vaginosis; body mass index; microbiota; overweight; risk factor; underweight.

Figure 1.

PRISMA flow diagram showing the study selection process.

Figure 2.

Forest plot comparing bacterial vaginosis in underweight women versus women with normal BMI. Data is presented as odds ratios (OR) with 95% confidence intervals (CI).

Figure 3.

(A): Forest plot comparing bacterial vaginosis in overweight women versus women with normal BMI. (B): Leave-one-out test by removing the study by Brookheart et al (2019). Data is presented as odds ratios (OR) with 95% confidence intervals (CI).

Figure 4.

Forest plot comparing bacterial vaginosis in obese women versus women with normal BMI. (B): Leave-one-out test by removing the study by Brookheart et al (2019). Data is presented as odds ratios (OR) with 95% confidence intervals (CI).