Re: preemie-l Re: causes on pre term labor

Helen1144@aol.com
Thu, 6 Jun 1996 13:27:15 -0400 

There have been over a dozen studies linking bacterial vaginosis to preterm
birth.  The infections can come from bacteria that normally inhabit the
genital, urinary and/ or digestive tract causing no apparent problems or
symptoms.  During pregnancy, alterations in a pregnant woman's immune system
( possibly to keep her body from rejecting the genetically different baby)
may also leave her open to harmful infection from  these bacteria.  The
infections that seem to induce preterm labor and/or preterm rupture of the
membranes may also cause no symptoms until labor begins or the membranes
break. 

The December 8, 1995 issue of The New England Journal of Medicine carried a
study showing a 40% increase in preterm birth from bacterial vaginosis.
(Hillier et al. Association between bacterial vaginosis and preterm delivery
of a low-birth-weight infant. vol.333, pp.1737-42)  A study from Finland
found that the risk of preterm birth was 7 times higher among otherwise
low-risk women who had bacterial vaginosis diagnosed early in pregnancy
(Kurki et al. Bacterial vaginosis and pregnancy outcome.  Obstetrics and
Gynecology 1992;80:173-7).  A study out of Denver by Dr.James McGregor of the
University of Colorado Health Sciences Center found that when pregnant women
were screened and treated early in pregnancy for lower reproductive tract
infection (using oral clindamycin) the incidence of preterm delivery was cut
in half. (McGregor et al. Prevention of premature birth by screening and
treating for common genital tract infections: results of a prospective
controlled evaluation. American Journal of  Obstetrics and Gynecology
1995;173:157-67.

According to Dr. McGregor:  "These and other studies strongly suggest, if not
mandate, that women be screened and treated for bacterial vaginosis and other
common genitourinary infections (bacteruria [bacteria in the urine],
trichomoniasis, chlamydia infection , and so forth) during pregnancy...or
possibly in preparation for pregnancy."  Dr.McGregor also believes that
systemic antibiotic treatment using oral medication rather than topical
antibiotics is necessary to eliminate microbes within the uterine tissues. (
McGregor et al. Bacterial vaginosis and preterm birth.  Letter to the editor.
 New England Journal of Medicine, May 16, 1996;334:1337-8.)

I have heard Dr. McGregor speak at conferences and find his arguments
persuasive.  Although further studies will obviously be needed, I would
advise any mother (at high or low risk) to go to an OB who is familiar with
the literature and willing to screen and treat aggressively.  Also, new
guidelines on the treatment of Group B strep have recently been issued.  I
haven't seen them yet, but will report back to you when I have.

Helen Harrison