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Identification and H₂O₂ Production of Vaginal Lactobacilli from Pregnant Women at High Risk of Preterm Birth and Relation with Outcome

Department of Microbiology, Barts and The London NHS Trust,¹ Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London, Queen Mary School of Medicine and Dentistry, London,³ Division of Medicine,² Department of Pathology and Microbiology, University of Bristol, Bristol, United Kingdom⁴

Received 31 March 2003/ Returned for modification 28 May 2003/ Accepted 22 October 2003

Lactobacilli, principally the strains that are hydrogen peroxide (H₂O₂) producing, may have a protective effect against vaginal colonization by pathogenic species such as those that cause bacterial vaginosis. Previous reports have also suggested that H₂O₂-producing lactobacilli in the vagina may protect pregnant women against ascending infection of the chorioamniotic membranes and uterine cavity. We report the identification and H₂O₂ production of lactobacilli isolated from vaginal swabs collected at 20 weeks' gestation from a population of pregnant women at high risk of preterm birth. We also report the correlation between identification and H₂O₂ production in relation to the outcomes of chorioamnionitis and preterm birth. Lactobacilli were identified by partial 16S rRNA gene sequencing. H₂O₂ production by isolates was determined by a semiquantitative method. The most commonly isolated species were L. crispatus, L. gasseri, L. vaginalis and L. jensenii. Amounts of H₂O₂ produced by lactobacilli varied widely. The presence of lactobacilli producing high levels of H₂O₂ in the vagina of this population of pregnant women was associated with a reduced risk of bacterial vaginosis at 20 weeks' gestation and subsequent chorioamnionitis. L. jensenii and L. vaginalis produced the highest levels of H₂O₂. We postulate that H₂O₂-producing lactobacilli are able to reduce the incidence of ascending infections of the uterus and the subsequent production of proinflammatory molecules which are important in the pathogenesis of chorioamnionitis and preterm birth.

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