| dc.description.abstract |
Background: The lactobacillus-rich microbiome forms a defense system against
infections. Babies are born sterile and acquire their microbiome from exposure to the
mothers’ vaginal and rectal microbiota. Bacterial vaginosis (BV), which is characterized
by a deficit of the Lactobacilli genera, may predispose women and their babies to an
increased frequency of illness.
Objective: To determine the effect of BV on HIV-infected women’s post-delivery health
as well as the morbidity and mortality of the exposed infant at birth, 6 months, and at 12
months of life.
Study Design: A retrospective cohort study was conducted using previously collected
data to investigate whether there was an association between BV-HIV-1 infected mothers
and subsequent infant morbidity and mortality over a 12-month period.
Methods: Data for this analysis were extracted from the original data set. Women
were categorized into two groups according to whether they had a positive or negative
laboratory-based diagnosis of BV using the Nugent method. The two groups were
compared for socio-demographic characteristics, prior to the pregnancy experience in
their current pregnancy outcome and at post-delivery morbidity, and for the duration of
hospital stay. BV-exposed and unexposed infants were compared in terms of morbidity
and mortality at birth, and in the periods between birth and 6 months, and between 6
and 12 months, respectively, based on prospectively collected data of the mother’s past
and present illness, and clinical examination at scheduled and unscheduled visits during
the follow-up period of the original study. The generalized estimating equation (GEE) was
used to analyze the longitudinally collected data. We used the Kaplan-Meier (KM) method
to generate the cumulative hazard curve and compared the mortality in the first year of
life between the two groups.
Results: In total, 365 patients were included in the study. Exposure to BV was
associated with an adverse maternal condition (Relative Risk [RR], 2.45; 95% confidence
interval [CI], 1.04–5.81, P = 0.04) and maternal hospital admission (RR, 1.99; 95% CI,
1.14–3.48, P = 0.02) but was not linked to any neonatal morbidity at birth. There was a
higher frequency of gastro-intestinal morbidity among BV-exposed infants. At 6 months infants of BV-exposed mothers had higher odds of bloody stool (Odds Ratio [OR], 3.08;
95% CI, 1.11–10.00, P = 0.04), dehydration (OR, 2.94; 95% CI, 1.44–6.37, P = 0.01),
vomiting (OR, 1.64; 95% CI, 1.06–2.56, P = 0.03), and mouth ulcers (OR, 12.8; 95% CI,
2.27–241.21, P = 0.02). At 12 months, exposure to BV was associated with dehydration
(OR, 1.81; 95% CI, 1.05–3.19, P = 0.03) and vomiting (OR, 1.39; 95% CI, 1.01–1.92,
P = 0.04). KM survival analysis showed non-significant higher trends of deaths among
BV-exposed infants (P = 0.65).
Conclusion: This study demonstrates differences in maternal and infant morbidity
outcomes associated with exposure to BV. Further research is required to determine
whether treatment for maternal BV mitigates maternal and infant morbidity. |
en_US |