High sialidase levels increase preterm birth risk among women who are bacterial vaginosis-positive in early gestation.

OBJECTIVE: The purpose of this study was to assess whether vaginal sialidases level in early pregnancy is associated with preterm birth among women who are bacterial vaginosis-positive. STUDY DESIGN: Of the 1806 women who were enrolled at < 20 weeks of gestation, 800 of the women were bacterial vaginosis-positive (Nugent score, 7-10); 707 of the women had birth outcome data; 109 of the women who were bacterial vaginosis-positive had an adverse preterm outcome, which included 53 spontaneous preterm births (19 births were early at 20-34 weeks, and 34 births were late at 34-37 weeks), and 14 of the women had late miscarriages (12-20 weeks). Sialidase levels were compared with 352 control subjects (term normal birthweight infants). RESULTS: Sialidase levels at ≥ 5, ≥ 10, and ≥ 14 nmol (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.01-2.41; OR, 2.14; 95% CI, 1.25-3.64; OR, 3.17; 95% CI, 1.64-6.10, respectively) was associated significantly with all adverse preterm outcomes. The ≥ 10 nmol and ≥ 14 nmol cut-points were associated strongly with early spontaneous preterm births (OR, 3.79; 95% CI, 1.42-10.10 and OR, 5.36; 95% CI, 1.77-16.23, respectively) and late miscarriages (OR, 4.87; 95% CI, 1.61-14.65; OR, 8.33; 95% CI, 2.57-26.9, respectively). CONCLUSION: Elevated sialidase level that is measured at 12 weeks of gestation is associated strongly with early spontaneous preterm births and late miscarriage.

Postpartum physical symptoms in new mothers: their relationship to functional limitations and emotional well-being.

BACKGROUND: Postpartum physical health problems are common and have been understudied. The purpose of this investigation was to explore the associations among reported physical symptoms, functional limitations, and emotional well-being of postpartum women. METHODS: The study included data from interviews conducted at 9 to 12 months postpartum from 1,323 women who had received prenatal care at nine community health centers located in Philadelphia, Pennsylvania, United States, between February 2000 and November 2002. Emotional well-being was assessed with the Center for Epidemiological Studies Depression Scale and perceived emotional health. Functional limitations measures were related to child care, daily activities (housework and shopping), and employment. A summary measure of postpartum morbidity burden was constructed from a checklist of potential health problems typically associated with the postpartum period, such as backaches, abdominal pain, and dyspareunia. RESULTS: More than two-thirds (69%) of the women reported experiencing at least one physical health problem since childbirth. Forty-five percent reported at least one problem of moderate or major (as opposed to minor) severity and 20 percent reported at least one problem of major severity. The presence, severity, and cumulative morbidity burden associated with postpartum health problems were consistently correlated with reports of one or more functional limitations and measures of emotional well-being including depressive symptomatology. CONCLUSIONS: Although physical problems typically associated with the postpartum period are often regarded as transient or comparatively minor, they are strongly related both to women's functional impairment and to poor emotional health. Careful assessment of the physical, functional, and emotional health status of women in the year after childbirth may improve the quality of postpartum care.

Evaluation of semen detection in vaginal secretions: comparison of four methods.

PROBLEM: To determine the best method to detect semen in human vaginal secretions. METHOD OF STUDY: Vaginal secretions from 302 pregnant women at mean 11.8 weeks' gestation were analyzed. Semen detection was assessed with: (i) measurement of total prostate-specific antigen (PSA), (ii) acid phosphatase activity, (iii) microscopic measurement of spermatozoa on Gram stain, and (iv) self-reported sexual intercourse in the past 2 days. Sensitivity and specificity were calculated for each technique in comparison with PSA levels. RESULTS: A total of 119 (39.4%) women had a detectable PSA. Compared with measurable PSA, the sensitivity and specificity for other methods were: acid phosphatase (26.9%, 98.4%), Gram stain (36.1%, 98.4%), and self-report of intercourse in the past 48 hr (41.9%, 88.8%). CONCLUSION: Compared with PSA levels, commonly used assays for recent semen exposure are inaccurate. This inaccuracy may affect the results of studies, which measure vaginal immune factors like cytokines or retrieve DNA from vaginal specimens.

Among pregnant women with bacterial vaginosis, the hydrolytic enzymes sialidase and prolidase are positively associated with interleukin-1beta.

OBJECTIVE: The objective of the study was to explore the mechanisms of local innate immunity induction and modulation in pregnant women with bacterial vaginosis (BV). STUDY DESIGN: A total of 200 singleton pregnant women in early gestation (12 +/- 4 weeks) with BV (Nugent 7-10) without concurrent vaginal infections with Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and yeast. Concentrations of vaginal interleukin (IL)-1beta and IL-8, the number of neutrophils, and the levels of sialidase and prolidase hydrolytic enzymes were determined in vaginal fluid. RESULTS: Concentrations of vaginal IL-1beta had a strong positive correlation with levels of sialidase (P < .001) and prolidase (P < .001). Conversely, such enzymes were negatively correlated with the ratio of IL-8/IL-1beta (both P < .001) and were not significantly associated with concentrations of IL-8. Notably, the number of vaginal neutrophils had a negative correlation with sialidase (P = .007). CONCLUSION: The strong induction of IL-1beta in BV-positive women appears to be associated with the production of the hydrolytic enzymes sialidase and prolidase by BV-associated bacteria. However, these 2 enzymes may inhibit the expected amplification of the proinflammatory IL-1beta cascade as evaluated by the down-regulation of the IL-8/IL-1beta ratio. A blunted response to IL-1beta signals may cause the poor rise of neutrophils, which is peculiar to BV. This impairment of local defense may contribute to increased susceptibility to adverse outcomes in BV-positive pregnant women.

Modulation of vaginal immune response among pregnant women with bacterial vaginosis by Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and yeast.

OBJECTIVE: This study was undertaken to examine the influence of coinfections on vaginal innate and adaptive immunity, and microbial enzyme activities of pregnant women with bacterial vaginosis (BV). STUDY DESIGN: The population consisted of 265 singleton pregnant women in early gestation (<20 weeks) with BV (Nugent 7-10) who had vaginal fluid collected for measurement of interleukin-1beta (IL-1beta) and IL-8 concentrations, number of neutrophils, immunoglobulin A against Gardnerella vaginalis (anti-Gvh IgA), and activities of microbial sialidase and prolidase. RESULTS: Among women with BV, median levels of vaginal IL-1beta (4-fold, P = .005), IL-8 (4-fold, P < .001), and neutrophils (6-fold, P = .013) were greatly increased in women with T vaginalis with respect to women without any coinfection. Yeast increased the level of IL-8 (5-fold, P < .001), but not IL-1beta (P = .239) and neutrophils (P = .060). Chlamydia trachomatis and Neisseria gonorrhoeae had no effect on vaginal cytokines. None of the coinfections influenced vaginal anti-Gvh IgA, sialidase and prolidase activities. CONCLUSION: The strong proinflammatory cytokine induction by T. vaginalis may contribute to the observed increase in preterm birth among BV positive women coinfected with T. vaginalis treated with metronidazole.

Infection as a cause of preterm birth.

In summary, there is little question that intrauterine and some extrauterine infections play important roles in the etiology of early, spontaneous, preterm labor and PROM. Disappointing are the mixed results from various treatment attempts, usually with antibiotics, to reduce the preterm birth rate. Clearly, a better understanding of the pathways leading from infection to preterm birth will be necessary to develop effective interventions to reduce infection-related preterm delivery. Research must also address the question of individual susceptibility to infections and the influence of other exposures that may moderate the association between infection and preterm birth.