Mild bacterial infection in the vagina -which is often asymptomatic-is associated with an increased risk of late miscarriage and spontaneous preterm delivery in pregnant women. Austin Ugwumadu from St George's Hospital, London, UK, and colleagues assessed whether antibiotic treatment early in the second trimester of pregnancy might reduce these risks.
6120 women attending hospital for their first antenatal visit (who were at 12-22 weeks' gestation) were screened for bacterial vaginosis or abnormal vaginal flora (an intermediate stage between a normal environment and overt bacterial infection). Around 500 women who screened positive were randomly assigned to receive either the antibiotic clindamycin (300 mg) or placebo orally twice daily for 5 days. Spontaneous preterm delivery was defined as childbirth between 24 and 37 weeks; late miscarriage was pregnancy loss between 13 and 24 weeks. Women who received clindamycin had 10% fewer miscarriages or preterm deliveries than women given placebo.
Austin Ugwumadu comments: "The number of women with abnormal intermediate flora or bacterial vaginosis needed to treat to prevent one late miscarriage or spontaneous preterm delivery was ten. The optimum time to screen and treat is as yet unknown, and in view of our present knowledge, could well be pre-pregnancy. The characteristics of the women in our population might differ from those in other parts of the world, and thus our study needs replication in other settings."
Contact: Dr Austin Ugwumadu, Department of Obstetrics & Gynaecology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK;
T) 44-208-672-1255;
F) 44-208-725-0078;
E) augwumad@sghms.ac.uk
Journal
The Lancet