The value of vaginal lactobacilli in the restoration of vaginal microbiocenosis in women in the early postpartum period, depending on the method of delivery

Abstract

BACKGROUND: Despite numerous studies of the vaginal microbiota, there is still a lack of knowledge regarding its restoring dynamics in the early postpartum period. The condition of the vaginal microflora during pregnancy plays a key role in maintaining the physiological microbiocenosis of the birth canal and creating conditions for the normal course of pregnancy, the establishment of an infant’s intestinal microbiota, and the further development of the child.

AIM: The aim of this study was to estimate the role of certain types of lactobacilli in restoring the vaginal microbiota in women in the early postpartum period, depending on the method of delivery.

MATERIALS AND METHODS: We examined 150 women at 38-41 weeks of gestation. The clinical material for the study was vaginal discharge before and after delivery. To determine the species of lactobacilli and other microorganisms in the clinical material, we used quantitative real-time PCR.

RESULTS: Before delivery, lactobacilli were found in vaginal discharge in 144 out of 150 women (96.0%), their number in the majority being more than 10⁶ GE. In the postpartum period, lactobacilli were found in 66/128 (51.5%) cases, while prevailing in women after vaginal delivery in 50/65 (76.9%) cases (4.6±1.6, p = 0.000000). Among the dominant species of lactobacilli was L. crispatus, found in vaginal discharge before delivery, which most often affects the recovery of the vaginal microbiota in the postpartum period (29 out of 61 women, 47.5%). L. iners detected in the lochia predisposes to the violation of uterine involution in the early postpartum period (p = 0.03).

CONCLUSIONS: Normal vaginal microbiota in the postpartum period is restored more quickly in women after vaginal delivery. Our study confirms that L. crispatus and L. iners play a major role in restoring the vaginal microbiota in the postpartum period.

Keywords

vaginal microbiota / lactobacilli / Lactobacillus iners / Lactobacillus crispatus / postpartum period

References

[1] Marco J, Coolen MJL, Post E, et al. Characterization of microbial communities found in the human vagina by analysis of terminal restriction fragment length polymorphisms of 16S rRNA genes. Appl Environ Microbiol. 2005;71(12):8729–8737. DOI: 10.1128/AEM.71.12.8729-8737.2005

[2] Marco J., Coolen M.J.L., Post E. et al. Characterization of microbial communities found in the human vagina by analysis of terminal restriction fragment length polymorphisms of 16S rRNA genes//Appl. Environ. Microbiol. 2005. Vol. 71. No. 12. P. 8729–8737. DOI: 10.1128/AEM.71.12.8729-8737.2005

[3] Pavlova SI, Kilic AO, Kilic SS, et al. Genetic diversity of vaginal lactobacilli from women in different countries based on 16S rRNA gene sequences. J Appl Microbiol. 2002;92(3):451–459. DOI: 10.1046/j.13652672.2002.01547.x

[4] Pavlova S.I., Kilic A.O., Kilic S.S. et al. Genetic diversity of vaginal lactobacilli from women in different countries based on 16S rRNA gene sequences//J. Appl. Microbiol. 2002. Vol. 92. No. 3. P. 451–459. DOI: 10.1046/j.13652672.2002.01547.x

[5] Giakoumelou S, Wheelhouse N, Cuschieri K, et al. The role of infection in miscarriage. Hum Reprod Update. 2016;22(1):116–133. DOI: 10.1093/humupd/dmv041

[6] Giakoumelou S., Wheelhouse N., Cuschieri K. et al. The role of infection in miscarriage//Hum. Reprod. Update. 2016. Vol. 22. No. 1. P. 116–133. DOI: 10.1093/humupd/dmv041

[7] Song Y, Kato N, Matsumiya Y, et al. Identification of and hydrogen peroxide production by fecal and vaginal lactobacilli isolated from Japanese women and newborn infants. J Clin Microbiol. 1999;37:3062–3064. DOI: 10.1128/JCM.37.9.3062-3064.1999

[8] Song Y., Kato N., Matsumiya Y. et al. Identification of and hydrogen peroxide production by fecal and vaginal lactobacilli isolated from Japanese women and newborn infants//J. Clin. Microbiol. 1999. Vol. 37. P. 3062–3064. DOI: 10.1128/JCM.37.9.3062-3064.1999

[9] Ravel J, Gajer P, Abdo Z, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA. 2011;108(Suppl 1):4680–4687. DOI: 10.1073/pnas.1002611107

[10] Ravel J., Gajer P., Abdo Z. et al. Vaginal microbiome of reproductive-age women//Proc. Natl. Acad. Sci. USA. 2011. Vol. 108. Suppl. 1. P. 4680–4687. DOI: 10.1073/pnas.1002611107

[11] Antonio MAD, Hawes SE, Hillier SL. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. J Infect Dis. 1999;180:1950–1956. DOI: 10.1086/315109

[12] Antonio M.A.D., Hawes S.E., Hillier S.L. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species//J. Infect. Dis. 1999. Vol. 180. P. 1950–1956. DOI: 10.1086/315109

[13] Rampersaud R, Planet PJ, Randis TM, et al. Inerolysin, a cholesterol-dependent cytolysin produced by Lactobacillus iners. J BacterioL. 2011;193:1034–1041. DOI: 10.1128/JB.00694-10

[14] Rampersaud R., Planet P.J., Randis T.M. et al. Inerolysin, a cholesterol-dependent cytolysin produced by Lactobacillus iners//J. Bacteriol. 2011. Vol. 193. P. 1034–1041. DOI: 10.1128/JB.00694-10

[15] Macklaim JM, Fernandes AD, Di Bella JM, et al. Comparative meta-RNA-seq of the vaginal microbiota and differential expression by Lactobacillus iners in health and dysbiosis. Microbiome. 2013;1:12. DOI: 10.1186/2049-2618-1-12

[16] Macklaim J.M., Fernandes A.D., Di Bella J.M. et al. Comparative meta-RNA-seq of the vaginal microbiota and differential expression by Lactobacillus iners in health and dysbiosis//Microbiome. 2013. Vol. 1. P. 12. DOI: 10.1186/2049-2618-1-12

[17] Dobrokhotova YE, Zatikyan NG. Sovremennye predstavleniya o mekhanizmakh razvitiya disbioza vlagalishcha. Akusherstvo, ginekologiya i reproduktsiya. 2008;(3):3–6. (In Russ.)

[18] Доброхотова Ю.Э., Затикян Н.Г. Современные представления о механизмах развития дисбиоза влагалища//Акушерство, гинекология и репродукция. 2008. № 1. C. 3–6.

[19] Martikaynen ZM. Korinebakterii zhenskikh genitaliy. [dissertation abstract]. Saint Petersburg; 1996. (In Russ.). [cited 2021 May 24]. Available from: http://earthpapers.net/preview/486600/a#?page = 9

[20] Мартикайнен З.М. Коринебактерии женских гениталий: автореф. дис. … канд. биол. наук. Санкт-Петербург, 1996. [дата обращения 24.05.2021]. Доступ по ссылке: http://earthpapers.net/preview/486600/a#?page = 9

[21] MacIntyre DA, Chandiramani M, Lee YS, et al. The vaginal microbiome during pregnancy and the postpartum period in a European population. SciRep. 2015;5:89–88. DOI: 10.1038/srep08988

[22] MacIntyre D.A., Chandiramani M., Lee Y.S. et al. The vaginal microbiome during pregnancy and the postpartum period in a European population//SciRep. 2015. Vol. 5. P. 89–88. DOI: 10.1038/srep08988

[23] Kolesaeva ZhJu. Mikrobiocenoz vlagalishha u rodil’nic posle estestvennyh rodov i operacii kesarevo sechenija. [dissertation abstract]. Saint Petersburg; 2012. (In Russ.). [cited 2021 May 24]. Available from: https://viewer.rusneb.ru/ru/000199_000009_005009137?page = 1&rotate = 0&theme = white

[24] Колесаева Ж.Ю. Микробиоценоз влагалища у родильниц после естественных родов и операции кесарево сечения: автореф. дис. … кандидат медицинских наук. Санкт-Петербург, 2012. [дата обращения 24.05.2021]. Доступ по ссылке: https://viewer.rusneb.ru/ru/000199_000009_005009137?page = 1&rotate = 0&theme = white

[25] Mel’nikova TA. Osobennosti techenija beremennosti i rodov u zhenshhin s razlichnoj stepen’ju kolonizacii nizhnego otdela reproduktivnogo trakta Ureaplasma urealiticum. [dissertation abstract]. Permian; 2020. (In Russ.). [cited 2021 May 24]. Available from: https://www.dissercat.com/content/osobennosti-techeniya-beremennosti-i-rodov-u-zhenshchin-s-razlichnoi-stepenyu-kolonizatsii

[26] Мельникова Т.А. Особенности течения беременности и родов у женщин с различной степенью колонизации нижнего отдела репродуктивного тракта Ureaplasmaurealiticum: автореф. дис. … кандидат медицинских наук. Пермь, 2020. [дата обращения 24.05.2021]. Доступ по ссылке: https://www.dissercat.com/content/osobennosti-techeniya-beremennosti-i-rodov-u-zhenshchin-s-razlichnoi-stepenyu-kolonizatsii

[27] Morozova NA, Holodnjak TI, Ovsjanik MA. Sovremennyj vzgljad na problem subinvoljucii matki. Novosti mediciny i farmacii. 2009;21(301):36–42. (In Russ.)

[28] Морозова Н.А., Холодняк Т.И., Овсяник М.А. Современный взгляд на проблему субинволюции матки//Новости медицины и фармации. 2009. T. 21. № 301. С. 36–42.

[29] Kim MJ, Romero R, Gervasi MT, et al. Widespread microbial invasion of the chorioamniotic membranes is a consequence and not a cause of intra-amniotic infection. Lab Invest. 2009;89(8):924–936. DOI: 10.1038/labinvest.2009.49

[30] Kim M.J., Romero R., Gervasi M.T. et al. Widespread microbial invasion of the chorioamniotic membranes is a consequence and not a cause of intra-amniotic infection//Lab. Invest. 2009. Vol. 89. No. 8. P. 924–936. DOI: 10.1038/labinvest.2009.49

[31] Sinyakova AA, Shipitsyna EV, Budilovskaya OV, et al. Anamnestic and microbiological predictors of miscarriage. Journal of Obstetrics and Women’s Diseases. 2019;68(2):59–70. DOI: 10.17816/JOWD68259-70

[32] Синякова А.А., Шипицына Е.В., Будиловская О.В. и др. Клинико-анамнестические и микробиологические предикторы невынашивания беременности//Журнал акушерства и женских болезней. 2019. T. 68. № 2. С. 59–70. DOI: 10.17816/JOWD68259-70

[33] Petricevic L, Domig KJ, Nierscher FJ, et al. Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery. Sci Rep. 2014;4:5136. DOI: 10.1038/srep05136.

[34] Petricevic L., Domig K.J., Nierscher F.J. et al. Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery//Sci. Rep. 2014. Vol. 4. P. 5136. DOI: 10.1038/srep05136.

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