BMJ 2016;355:i5805 doi: 10.1136/bmj.
i5805 (Published 2 November 2016)
Letters
REDUCING THE RISK OF PRETERM BIRTH
Antibiotics for the prevention of infection related
preterm birth
Ronald F Lamont professor of obstetrics and gynaecology
Department of Obstetrics and Gynaecology, Odense University Hospital, University of Southern Denmark, 5000 Odense C, Denmark
Stock and Ismail discuss reducing the risk of preterm birth,
which is an important cause of neonatal mortality and
morbidity.1 But they omit the use of antibiotics to prevent
infection related preterm birth. The aetiology of preterm birth
is multifactorial, but overwhelming evidence implicates infection
or inflammation in up to 40% of cases—more so at early
gestations.
Bacterial vaginosis detected at 13-16 weeks’ gestation was
associated with a five to sevenfold higher risk of preterm birth
before 34 weeks and late miscarriage (the aetiology of which
is on a continuum with early preterm birth).2 3 Individual
prophylaxis studies have found benefits of antibiotics for the
prevention of preterm birth, but meta-analyses have not, owing
to the inclusion of large methodologically flawed studies with
negative results that failed to tackle the optimal antibiotic (in
my view, clindamycin), in the optimal patient (women with
objective evidence of bacterial vaginosis), at the optimal time
in pregnancy (earlier than 22 weeks’ gestation, before
inflammatory damage can occur).4 In a more focused systematic
review and meta-analysis clindamycin given to women with
bacterial vaginosis before 22 weeks’ gestation significantly
reduced the rate of preterm birth by 40% and late miscarriage
by 80%.5
rlamont@health.sdu.dk
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Page 1 of 1
LETTERS
Stock and Ismail also fail to take into account the finding that
screening at 10-16 weeks’ gestation and treating vulvovaginal
candidiasis, trichomoniasis, or bacterial vaginosis reduced the
rate of preterm birth and low birth weight from 22.3% and 20%
in controls to 9.7% and 8.4% (P=0.001), respectively, in those
screened and treated.6
Competing interests: None declared.
1 Stock SJ, Ismail KMK. Which intervention reduces the risk of preterm birth in women with
risk factors?BMJ 2016;355:i5206. doi:10.1136/bmj.i5206 pmid:27707727.
2 Hay PE, Lamont RF, Taylor-Robinson D, Morgan DJ, Ison C, Pearson J. Abnormal
bacterial colonisation of the genital tract and subsequent preterm delivery and late
miscarriage. BMJ 1994;308:295-8. doi:10.1136/bmj.308.6924.295 pmid:8124116.
3 Kurki T, Sivonen A, Renkonen OV, Savia E, Ylikorkala O. Bacterial vaginosis in early
pregnancy and pregnancy outcome. Obstet Gynecol 1992;80:173-7.pmid:1635726.
4 Lamont RF. Advances in the prevention of infection-related preterm birth. Front Immunol
2015;6:566. doi:10.3389/fimmu.2015.00566 pmid:26635788.
5 Lamont RF, Nhan-Chang CL, Sobel JD, Workowski K, Conde-Agudelo A, Romero R.
Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention
of spontaneous preterm birth: a systematic review and meta analysis. Am J Obstet Gynecol
2011;205:177-90. doi:10.1016/j.ajog.2011.03.047 pmid:22071048.
6 Farr A, Kiss H, Hagmann M, Marschalek J, Husslein P, Petricevic L. Routine use of an
antenatal infection screen-and-treat program to prevent preterm birth: long-term experience
at a tertiary referral center. Birth 2015;42:173-80. doi:10.1111/birt.12154 pmid:25677078.
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