Title : Maternal and fetal outcome among pregnant women with vaginal dysbiosis: A systematic review and meta-analysis
Background: Women of childbearing age are commonly affected by bacterial vaginosis (BV). Maternal-fetal outcomes associated with BV during pregnancy can be fatal for both the mother and the newborn. In this review, we aim to identify maternal and fetal outcomes in pregnant women with BV encountered globally, to highlight their prevalence, and to identify maternal fetal outcomes associated with BV.
Methods: For the period from inception until December 2022, we searched in the databases Embase, PubMed, Web of Science, and Global Index Medicus. We searched without a restriction on time or geographical location, published articles that examined maternal-fetal outcomes in pregnant women with BV. A random-effects model was used to perform the meta-analysis. Using subgroup analysis, sources of heterogeneity were investigated, while publication bias was assessed through funnel plots and Egger tests.
Results: We found 26 articles that met the inclusion criteria out of the 8983 articles retrieved from the databases. We recorded 22 maternal outcomes and 22 fetal outcomes among pregnant women with BV worldwide. Our study determined the prevalence of maternal-fetal outcomes reported in three or more studies. Among fetal outcomes, preterm birth (PTB) occurred at the highest prevalence (17.9% [95%CI= 13-23.3], followed by mechanical ventilation (15.2% [95%CI= 0-45.9]), low birth weight (LBW) (14.2% [95%CI= 9.1-20.1]) and neonatal intensive care unit admissions (11.2 % [95%CI= 0-53.5])). BV was associated with PTB (OR = 1.76, 95% CI = [1.32- 2.35]), LBW (OR= 1.73, 95% CI = [1.41- 2.12]), and birth asphyxia (OR = 2.90, 95% CI = [1.13- 7.46]). The highest prevalence of maternal outcomes was (13.2% [95%CI= 6.1-22.3]) for premature rupture of membranes (PROM). There was an association between BV and the following maternal outcomes: intrauterine infection OR = 2.26, 95% CI = [1.44- 3.56], miscarriage OR = 2.34, 95% CI = [1.18- 4.64], and PROM OR = 2.59, 95% CI = [1.39 - 4.82]. Maternal and fetal outcomes were most prevalent in women whose BV was diagnosed using Amsel criteria (37.2% [95%CI= 23-52.6]) and in third trimester (29.6% [95%CI= 21.2-38.8]). Although reported in fewer than three studies, some maternal-fetal outcomes are highly prevalent, such as respiratory distress (76.67% [95%CI= 57.72 - 90.07]), dyspareunia (68.33% [95%CI= 55.04 - 79.74]), and malodorous discharge (85.00% [95%CI= 73.43 - 92.90]).
Conclusion: BV has been associated with several adverse maternal-fetal outcomes around the world. While BV is a common vaginal infection, the types of maternal-fetal outcomes from pregnant women with BV vary from country to country and continent to continent.