Screening for bacterial vaginosis in pregnancy

Jeanne-Marie Guise, Susan M. Mahon, Mikel Aickin, Mark Helfand, Jeffrey F. Peipert, Carolyn Westhoff

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Context: Bacterial vaginosis (BV) is a strong independent risk factor for adverse pregnancy outcomes. BV is found in 9% to 23% of pregnant women. Symptoms include vaginal discharge, pruritus, or malodor, but often women with BV are asymptomatic. Objectives: To determine whether screening and treating pregnant women for BV reduces adverse pregnancy outcomes, as part of an assessment for the U.S. Preventive Services Task Force. Data Randomized clinical trials of BV treatment in pregnancy that measured pregnancy Sources: outcomes were identified from multiple searches in MEDLINE from 1966 to 1999, the Cochrane Controlled Trials Register and Library, and national experts. Study All randomized controlled trials of BV treatment in pregnancy that specifically measured Selection: pregnancy outcomes. Data The following information was abstracted: study design and blinding, diagnostic methods, Extraction: antibiotic interventions, timing of antibiotic treatment in pregnancy, criteria for treatment, comorbidities, demographic details, risk factors for preterm delivery such as previous preterm delivery, compliance, rates of spontaneous and total preterm delivery less than 37 weeks and less than 34 weeks, preterm premature rupture of membranes, low birth weight less than 2500 grams, spontaneous abortion, postpartum endometritis, and neonatal sepsis. For each study, we measured the effect of treatment by calculating the difference in the rate of a given pregnancy outcome in the control group minus the treatment group (the absolute risk reduction [ARR]). A stepwise procedure based on the profile likelihood was applied to assess heterogeneity, to pool studies when appropriate, and to calculate the mean and 90% confidence intervals (CIs) for the effect of treatment. Data Seven randomized controlled trials met inclusion criteria for the meta-analysis. We found Synthesis: no benefit to BV treatment in average-risk women for any pregnancy outcome. Results of studies of high-risk populations, women with previous preterm delivery, were statistically heterogeneous. They clustered into two groups; one showed no benefit (ARR= -0.08, 90% CI= -0.19 to 0.04), whereas the three homogeneous studies showed potential benefit of BV treatment (pooled ARR=0.22; 90% CI=0.13 to 0.31) for preterm delivery before 37 weeks. Four high-risk studies reported results for preterm delivery less than 34 weeks. The pooled estimate showed no benefit (ARR=0.04; 90% CI = -0.02 to 0.09), but variation was noted among individual studies. Two trials of high-risk women found an increase in preterm delivery less than 34 weeks in women who did not have BV but received BV treatment. Comparisons of patient populations, treatment regimens, and study designs did not explain the heterogeneity among studies. Conclusions: We found no benefit to routine BV screening and treatment. A subgroup of high-risk women may benefit from BV screening and treatment; however, there may be a subgroup for whom BV treatment could increase the occurrence of preterm delivery.

Original languageEnglish (US)
Pages (from-to)62-72
Number of pages11
JournalAmerican Journal of Preventive Medicine
Volume20
Issue number3 SUPPL.
StatePublished - 2001

Fingerprint

Bacterial Vaginosis
Pregnancy
Pregnancy Outcome
Numbers Needed To Treat
Therapeutics
Confidence Intervals
Randomized Controlled Trials
Pregnant Women
Anti-Bacterial Agents
Vaginal Discharge
Endometritis
Low Birth Weight Infant
Spontaneous Abortion
Advisory Committees
Pruritus
MEDLINE
Postpartum Period
Population

Keywords

  • Bacterial vaginosis
  • Evidence-based medicine
  • Mass screening
  • MEDLINE
  • Methods
  • Pregnancy
  • Preventive health services
  • Vaginitis

ASJC Scopus subject areas

  • Medicine(all)
  • Public Health, Environmental and Occupational Health

Cite this

Guise, J-M., Mahon, S. M., Aickin, M., Helfand, M., Peipert, J. F., & Westhoff, C. (2001). Screening for bacterial vaginosis in pregnancy. American Journal of Preventive Medicine, 20(3 SUPPL.), 62-72.

Screening for bacterial vaginosis in pregnancy. / Guise, Jeanne-Marie; Mahon, Susan M.; Aickin, Mikel; Helfand, Mark; Peipert, Jeffrey F.; Westhoff, Carolyn.

In: American Journal of Preventive Medicine, Vol. 20, No. 3 SUPPL., 2001, p. 62-72.

Research output: Contribution to journalArticle

Guise, J-M, Mahon, SM, Aickin, M, Helfand, M, Peipert, JF & Westhoff, C 2001, 'Screening for bacterial vaginosis in pregnancy', American Journal of Preventive Medicine, vol. 20, no. 3 SUPPL., pp. 62-72.
Guise J-M, Mahon SM, Aickin M, Helfand M, Peipert JF, Westhoff C. Screening for bacterial vaginosis in pregnancy. American Journal of Preventive Medicine. 2001;20(3 SUPPL.):62-72.
Guise, Jeanne-Marie ; Mahon, Susan M. ; Aickin, Mikel ; Helfand, Mark ; Peipert, Jeffrey F. ; Westhoff, Carolyn. / Screening for bacterial vaginosis in pregnancy. In: American Journal of Preventive Medicine. 2001 ; Vol. 20, No. 3 SUPPL. pp. 62-72.
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abstract = "Context: Bacterial vaginosis (BV) is a strong independent risk factor for adverse pregnancy outcomes. BV is found in 9{\%} to 23{\%} of pregnant women. Symptoms include vaginal discharge, pruritus, or malodor, but often women with BV are asymptomatic. Objectives: To determine whether screening and treating pregnant women for BV reduces adverse pregnancy outcomes, as part of an assessment for the U.S. Preventive Services Task Force. Data Randomized clinical trials of BV treatment in pregnancy that measured pregnancy Sources: outcomes were identified from multiple searches in MEDLINE from 1966 to 1999, the Cochrane Controlled Trials Register and Library, and national experts. Study All randomized controlled trials of BV treatment in pregnancy that specifically measured Selection: pregnancy outcomes. Data The following information was abstracted: study design and blinding, diagnostic methods, Extraction: antibiotic interventions, timing of antibiotic treatment in pregnancy, criteria for treatment, comorbidities, demographic details, risk factors for preterm delivery such as previous preterm delivery, compliance, rates of spontaneous and total preterm delivery less than 37 weeks and less than 34 weeks, preterm premature rupture of membranes, low birth weight less than 2500 grams, spontaneous abortion, postpartum endometritis, and neonatal sepsis. For each study, we measured the effect of treatment by calculating the difference in the rate of a given pregnancy outcome in the control group minus the treatment group (the absolute risk reduction [ARR]). A stepwise procedure based on the profile likelihood was applied to assess heterogeneity, to pool studies when appropriate, and to calculate the mean and 90{\%} confidence intervals (CIs) for the effect of treatment. Data Seven randomized controlled trials met inclusion criteria for the meta-analysis. We found Synthesis: no benefit to BV treatment in average-risk women for any pregnancy outcome. Results of studies of high-risk populations, women with previous preterm delivery, were statistically heterogeneous. They clustered into two groups; one showed no benefit (ARR= -0.08, 90{\%} CI= -0.19 to 0.04), whereas the three homogeneous studies showed potential benefit of BV treatment (pooled ARR=0.22; 90{\%} CI=0.13 to 0.31) for preterm delivery before 37 weeks. Four high-risk studies reported results for preterm delivery less than 34 weeks. The pooled estimate showed no benefit (ARR=0.04; 90{\%} CI = -0.02 to 0.09), but variation was noted among individual studies. Two trials of high-risk women found an increase in preterm delivery less than 34 weeks in women who did not have BV but received BV treatment. Comparisons of patient populations, treatment regimens, and study designs did not explain the heterogeneity among studies. Conclusions: We found no benefit to routine BV screening and treatment. A subgroup of high-risk women may benefit from BV screening and treatment; however, there may be a subgroup for whom BV treatment could increase the occurrence of preterm delivery.",
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AU - Guise, Jeanne-Marie

AU - Mahon, Susan M.

AU - Aickin, Mikel

AU - Helfand, Mark

AU - Peipert, Jeffrey F.

AU - Westhoff, Carolyn

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N2 - Context: Bacterial vaginosis (BV) is a strong independent risk factor for adverse pregnancy outcomes. BV is found in 9% to 23% of pregnant women. Symptoms include vaginal discharge, pruritus, or malodor, but often women with BV are asymptomatic. Objectives: To determine whether screening and treating pregnant women for BV reduces adverse pregnancy outcomes, as part of an assessment for the U.S. Preventive Services Task Force. Data Randomized clinical trials of BV treatment in pregnancy that measured pregnancy Sources: outcomes were identified from multiple searches in MEDLINE from 1966 to 1999, the Cochrane Controlled Trials Register and Library, and national experts. Study All randomized controlled trials of BV treatment in pregnancy that specifically measured Selection: pregnancy outcomes. Data The following information was abstracted: study design and blinding, diagnostic methods, Extraction: antibiotic interventions, timing of antibiotic treatment in pregnancy, criteria for treatment, comorbidities, demographic details, risk factors for preterm delivery such as previous preterm delivery, compliance, rates of spontaneous and total preterm delivery less than 37 weeks and less than 34 weeks, preterm premature rupture of membranes, low birth weight less than 2500 grams, spontaneous abortion, postpartum endometritis, and neonatal sepsis. For each study, we measured the effect of treatment by calculating the difference in the rate of a given pregnancy outcome in the control group minus the treatment group (the absolute risk reduction [ARR]). A stepwise procedure based on the profile likelihood was applied to assess heterogeneity, to pool studies when appropriate, and to calculate the mean and 90% confidence intervals (CIs) for the effect of treatment. Data Seven randomized controlled trials met inclusion criteria for the meta-analysis. We found Synthesis: no benefit to BV treatment in average-risk women for any pregnancy outcome. Results of studies of high-risk populations, women with previous preterm delivery, were statistically heterogeneous. They clustered into two groups; one showed no benefit (ARR= -0.08, 90% CI= -0.19 to 0.04), whereas the three homogeneous studies showed potential benefit of BV treatment (pooled ARR=0.22; 90% CI=0.13 to 0.31) for preterm delivery before 37 weeks. Four high-risk studies reported results for preterm delivery less than 34 weeks. The pooled estimate showed no benefit (ARR=0.04; 90% CI = -0.02 to 0.09), but variation was noted among individual studies. Two trials of high-risk women found an increase in preterm delivery less than 34 weeks in women who did not have BV but received BV treatment. Comparisons of patient populations, treatment regimens, and study designs did not explain the heterogeneity among studies. Conclusions: We found no benefit to routine BV screening and treatment. A subgroup of high-risk women may benefit from BV screening and treatment; however, there may be a subgroup for whom BV treatment could increase the occurrence of preterm delivery.

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