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Obstetrics and Gynegology2023№8
The effect of vaginal progesterone...

The effect of vaginal progesterone on the vaginal biocenosis in pregnant women with a high risk of preterm birth

DOI
https://dx.doi.org/10.18565/aig.2023.187

Artymuk N.V., Marochko K.V., Parfenova Ya.A.

Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo, Russia
Objective: To evaluate the effect of the vaginal use of progesterone on vaginal biocenosis in pregnant women with a high risk of preterm birth.
Materials and methods: Cochrane, MEDLINE, Pubmed databases were assessed. Such keywords as progesterone, vaginal biocenosis, vaginal discharge were used for the search. The search depth was 12 years (2010–2022). A total of 69 sources were identified, 49 of them met the search criteria.
Results: The analysis of bibliographic sources showed that preterm birth remains one of the most relevant issues in modern obstetrics all over the world. In 184 countries, preterm birth rate ranges from 5% to 18% of the number of children. In Russia, more than 70,000 children are born prematurely every year. Etiology of preterm birth includes a lot of factors. About 80% of preterm birth are associated with infection of the amniotic fluid before 30 weeks gestation. The source of infection can be an inflammatory process in the uterine cavity, vagina, the presence of bacterial vaginosis. Vaginal biocenosis is one of the main components of a woman's reproductive health, and therefore the question of the effect of hormone therapy on the vaginal microbial landscape is of practical interest. This is especially important in preterm birth prevention, since vaginal progesterone is recommended for preterm birth prophylaxis in the high-risk group of patients (shortening the length of the cervix, history of preterm birth). However, the studies assessing the influence of progestins on the microbiocenosis of the vagina, are limited. It is important to continue research in this direction.
Conclusion: It is necessary to carry out further in-depth studies on the effect of progesterone on the vaginal biocenosis in pregnant women.

Authors’ contributions: Artymuk N.V. – developing the concept and design of the study, writing the text, editing; Marochko K.V. – collecting the material, writing the text; Parfenova Ya.A. – collecting the material, writing the text.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Artymuk N.V., Marochko K.V., Parfenova Ya.A. The effect of vaginal progesterone on the vaginal biocenosis in pregnant women with a high risk of preterm birth.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (8): 186-191 (in Russian)
https://dx.doi.org/10.18565/aig.2023.187

Keywords

preterm birth
vaginal progesterone
vaginal microbiocenosis
bacterial vaginosis
Full text (in Russian)

References

  1. Ходжаева З.С., Шмаков Р.Г., Адамян Л.В., Артымук Н.В., Башмакова Н.В., Беженарь В.Ф. и др. Преждевременные роды. Клинические рекомендации. М.; 2020. 43с. [Khodzhaeva Z.S., Shmakov R.G., Adamyan L.V., Artymuk N.V., Bashmakova N.V., Bezhenar' V.F. et al. Premature birth. Clinical guidelines. Moscow; 2020. 43p. (in Russian)].
  2. Liu L., Johnson H.L., Cousens S., Perin J., Scott S., Lawn J.E. et al. Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012; 379(9832): 2151-61.https://dx.doi.org/10.1016/S0140-6736(12)60560-1.
  3. Romero R., Dey S.K., Fisher S.J. Preterm labor: one syndrome, many causes. Science. 2014; 345(6198): 760-5. https://dx.doi.org/10.1126/science.1251816.
  4. Hussain T., Murtaza G., Kalhoro D.H., Kalhoro M.S., Metwally E., Chughtai M.I. et al. Relationship between gut microbiota and host-metabolism: Emphasis on hormones related to reproductive function. Anim. Nutr. 2021; 7(1): 1-10. https://dx.doi.org/10.1016/j.aninu.2020.11.005.
  5. Anderson L., Martin W., Higgins C., Nelson S.M., Norman J.E. The effect of progesterone on myometrial contractility, potassium channels, and tocolytic efficacy. Reprod. Sci. 2009; 16(11): 1052-61. https://dx.doi.org/ 10.1177/1933719109340926.
  6. Ilicic M., Zakar T., Paul J.W. The regulation of uterine function during parturition: an update and recent advances. Reprod. Sci. 2020; 27(1): 3-28. https://dx.doi.org/10.1007/s43032-019-00001-y.
  7. Tan H., Yi L., Rote N.S., Hurd W.W., Mesiano S. Progesterone receptor-A and -B have opposite effects on proinflammatory gene expression in human myometrial cells: implications for progesterone actions in human pregnancy and parturition. J. Clin. Endocrinol. Metab. 2012; 97(5): E719-30. https://dx.doi.org/10.1210/jc.2011-3251.
  8. Loudon J.A., Elliott C.L., Hills F., Bennett P.R. Progesterone represses interleukin-8 and cyclo-oxygenase-2 in human lower segment fibroblast cells and amnion epithelial cells. Biol. Reprod. 2003; 69(1): 331-7.https://dx.doi.org/10.1095/biolreprod.102.013698.
  9. Yellon S.M., Dobyns A.E., Beck H.L., Kurtzman J.T., Garfield R.E., Kirby M.A. Loss of progesterone receptor-mediated actions induce preterm cellular and structural remodeling of the cervix and premature birth. PLoS One. 2013; 8(12): e81340. https://dx.doi.org/10.1371/journal.pone.0081340.
  10. Bagga R., Arora P. Genital micro-organisms in pregnancy. Front. Public Health. 2020; 8: 225. https://dx.doi.org/10.3389/fpubh.2020.00225.
  11. Chee W.J.Y., Chew S.Y., Than L.T.L. Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microb. Cell Fact. 2020; 19(1): 203. https://dx.doi.org/10.1186/s12934-020-01464-4.
  12. Lewis A.L., Gilbert N.M. Roles of the vagina and the vaginal microbiota in urinary tract infection: evidence from clinical correlations and experimental models. GMS Infect. Dis. 2020; 8: Doc02. https://dx.doi.org/10.3205/id000046.
  13. Gupta P., Singh M.P., Goyal K. Diversity of vaginal microbiome in pregnancy: deciphering the obscurity. Front. Public Health. 2020; 8: 326.https://dx.doi.org/10.3389/fpubh.2020.00326.
  14. Bayar E., Bennett P.R., Chan D., Sykes L., MacIntyre D.A. The pregnancy microbiome and preterm birth. Semin, Immunopathol. 2020; 42(4): 487-99. https://dx.doi.org/10.1007/s00281-020-00817-w.
  15. Reid G., Younes J.A., Van der Mei H.C., Gloor G.B., Knight R., Busscher H.J. Microbiota restoration: natural and supplemented recovery of human microbial communities. Na.t. Rev. Microbiol. 2011; 9(1): 27-38. https://dx.doi.org/10.1038/nrmicro2473.
  16. Spear G.T., French A.L., Gilbert D., Zariffard M.R., Mirmonsef P., Sullivan T.H. et al. Human alpha-amylase present in lower-genital-tract mucosal fluid processes glycogen to support vaginal colonization by Lactobacillus. J. Infect. Dis. 2014; 210(7): 1019-28. https://dx.doi.org/10.1093/infdis/jiu231.
  17. Di Giulio D.B., Callahan B.J., McMurdie P.J., Costello E.K., Lyell D.J., Robaczewska A. et al. Temporal and spatial variation of the human microbiota during pregnancy. Proc. Natl. Acad. Sci. USA. 2015; 112(35): 11060-5.https://dx.doi.org/10.1073/pnas.1502875112.
  18. Freitas A.C., Chaban B., Bocking A., Rocco M., Yang S., Hill J.E. et al.; VOGUE Research Group. The vaginal microbiome of pregnant women is less rich and diverse, with lower prevalence of Mollicutes, compared to non-pregnant women. Sci. Rep. 2017; 7(1): 9212. https://dx.doi.org/10.1038/s41598-017-07790-9.
  19. Pelzer E.S., Allan J.A., Waterhouse M.A., Ross T., Beagley K.W., Knox C.L. Microorganisms within human follicular fluid: effects on IVF. PLoS One. 2013; 8(3): e59062. https://dx.doi.org/10.1371/journal.pone.0059062.
  20. Nuriel-Ohayon M., Neuman H., Koren O. Microbial changes during pregnancy, birth, and infancy. Front. Microbiol. 2016; 7: 1031. https://dx.doi.org/10.3389/fmicb.2016.01031.
  21. Chandiramani M., Bennett P.R., Brown R., Lee Y.S., MacIntyre D.A. Vaginal microbiome-pregnant host interactions determine a significant proportion of preterm labour. Fetal Matern. Med. Rev. 2014; 25(01): 73-8.https://dx.doi.org/10.1017/S0965539514000059.
  22. Merrifield C.A., Lewis M.C., Berger B., Cloarec O., Heinzmann S.S., Charton F. et al. Neonatal environment exerts a sustained influence on the development of the intestinal microbiota and metabolic phenotype. ISME J. 2016; 10(1): 145-57. https://dx.doi.org/10.1038/ismej.2015.90.
  23. Dominguez-Bello M.G., Costello E.K., Contreras M., Magris M., Hidalgo G., Fierer N. et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc. Natl. Acad. Sci. USA. 2010; 107(26): 11971-5. https://dx.doi.org/ 10.1073/pnas.1002601107.
  24. Franasiak J.M., Scott R.T. Jr. Introduction: microbiome in human reproduction. Fertil. Steril. 2015; 104(6): 1341-3. https://dx.doi.org/10.1016/j.fertnstert.2015.10.021.
  25. Kyathanahalli C., Snedden M., Hirsch E. Is human labor at term an inflammatory condition? Biol. Reprod. 2023; 108(1): 23-40. https://dx.doi.org/10.1093/biolre/ioac182.
  26. Goldenberg R.L., Culhane J.F., Iams J.D., Romero R. Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606): 75-84. https://dx.doi.org/10.1016/S0140-6736(08)60074-4.
  27. MacIntyre D.A., Chandiramani M., Lee Y.S., Kindinger L., Smith A., Angelopoulos N. et al. The vaginal microbiome during pregnancy and the postpartum period in a European population. Sci. Rep. 2015; 5: 8988.https://dx.doi.org/10.1038/srep08988.
  28. Romero R., Hassan S.S., Gajer P., Tarca A.L., Fadrosh D.W., Nikita L. et al. The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women. Microbiome. 2014; 2(1): 4.https://dx.doi.org/10.1186/2049-2618-2-4.
  29. Odogwu N.M., Onebunne C.A., Chen J., Ayeni F.A., Walther-Antonio M.R.S., Olayemi O.O. et al. Lactobacillus crispatus thrives in pregnancy hormonal milieu in a Nigerian patient cohort. Sci. Rep. 202; 11(1): 18152.https://dx.doi.org/10.1038/s41598-021-96339-y.
  30. Romero R., Hassan S.S., Gajer P., Tarca A.L., Fadrosh D.W., Bieda J. et al. The vaginal microbiota of pregnant women who subsequently have spontaneous preterm labor and delivery and those with a normal delivery at term. Microbiome. 2014; 2: 18. https://dx.doi.org/10.1186/2049-2618-2-18.
  31. Petricevic L., Domig K.J., Nierscher F.J., Sandhofer M.J., Fidesser M., Krondorfer I. et al. Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery. Sci. Rep. 2014; 4: 5136. https://dx.doi.org/10.1038/srep05136.
  32. Tamrakar R., Yamada T., Furuta I., Cho K., Morikawa M., Yamada H. et al. Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women. BMC Infect. Dis. 2007; 7: 128. https://dx.doi.org/10.1186/1471-2334-7-128.
  33. Srinivasan S., Hoffman N.G., Morgan M.T., Matsen F.A., Fiedler T.L., Hall R.W. et al. Bacterial communities in women with bacterial vaginosis: high resolution phylogenetic analyses reveal relationships of microbiota to clinical criteria. PLoS One. 2012; 7(6): e37818. https://dx.doi.org/10.1371/journal.pone.0037818.
  34. Africa C.W., Nel J., Stemmet M. Anaerobes and bacterial vaginosis in pregnancy: virulence factors contributing to vaginal colonisation. Int. J. Environ. Res. Public Health. 2014;11(7): 6979-7000. https://dx.doi.org/10.3390/ijerph110706979.
  35. Kindinger L.M., Bennett P.R., Lee Y.S., Marchesi J.R., Smith A., Cacciatore S. et al. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome. 2017; 5(1): 6. https://dx.doi.org/10.1186/s40168-016-0223-9.
  36. Hardy D.B., Janowski B.A., Corey D.R., Mendelson C.R. Progesterone receptor plays a major antiinflammatory role in human myometrial cells by antagonism of nuclear factor-kappaB activation of cyclooxygenase 2 expression. Mol. Endocrinol. 2006; 20(11): 2724-33. https://dx.doi.org/10.1210/me.2006-0112.
  37. Ratten L.K., Plummer E.L., Bradshaw C.S., Fairley C.K., Murray G.L., Garland S.M. et al. The effect of exogenous sex steroids on the vaginal microbiota: a systematic review. Front. Cell. Infect. Microbiol. 2021; 11: 732423. https://dx.doi.org/10.3389/fcimb.2021.732423.
  38. Dabee S., Barnabas S.L., Lennard K.S., Jaumdally S.Z., Gamieldien H., BalleC. et al. Defining characteristics of genital health in South African adolescent girls and young women at high risk for HIV infection. PloS One. 2019; 14(4): e0213975. https://dx.doi.org/10.1371/journal.pone.0213975.
  39. Yang L., Hao Y., Hu J., Kelly D., Li H., Brown S. et al. Differential effects of depot medroxyprogesterone acetate administration on vaginal microbiome in hispanic white and black vomen. Emerg. Microb. Infect. 2019; 8(1): 197-210. https://dx.doi.org/10.1080/22221751.2018.1563458.
  40. Achilles S.L., Austin M.N., Meyn L.A., Mhlanga F., Chirenje Z.M., Hillier S.L. Impact of contraceptive initiation on vaginal microbiota. Am. J. Obstet. Reprod. 2018; 218(6): 622.e1-622.e10. https://dx.doi.org/10.1016/j.ajog.2018.02.017.
  41. Wessels J.M., Lajoie J., Cooper M.I.J.H., Omollo K., Felker A.M., Vitali D. et al. Medroxyprogesterone acetate alters the vaginal microbiota and microenvironment in women and increases susceptibility to HIV-1 in humanized mice. Dis. Models Mech. 2019; 12(10): dmm039669.https://dx.doi.org/10.1242/dmm.039669.
  42. Воронцова А.В., Звычайный М.А. Состояние биоциноза влагалища при применении микронизированного прогестерона. Акушерство и гинекология. 2011; 7-1: 70-2. [Vorontsova A.V., Zvychainyi M.A. The vaginal biocenosis in the use of micronized progesterone. Obstetrics and Gynecology. 2011; 7-1: 70-2. (in Russian)].
  43. Carosso A., Revelli A., Gennarelli G., Canosa S., Cosma S., Borella F. et al. Controlled ovarian stimulation and progesterone supplementation affect vaginal and endometrial microbiota in IVF cycles: a pilot study. J. Assist. Reprod. Genet. 2020; 37(9): 2315-26. https://dx.doi.org/10.1007/s10815-020-01878-4.
  44. Griesinger G., Blockeel C., Sukhikh G.T., Patki A., Dhorepatil B., Yang D.Z. et al. Oral dydrogesterone versus intravaginal micronized progesterone gel for luteal phase support in IVF: a randomized clinical trial. Hum. Reprod. 2018; 33(12): 2212-21. https://dx.doi.org/10.1093/humrep/dey306.
  45. Dahl C., Stanislawski M., Iszatt N., Mandal S., Lozupone C., Clemente J.C. et al. Gut microbiome of mothers delivering prematurely shows reduced diversity and lower relative abundance of Bifidobacterium and Streptococcus. PLoS One. 2017; 12(10): e0184336. https://dx.doi.org/10.1371/journal.pone.0184336.
  46. Nuriel-Ohayon M., Neuman H., Ziv O., Belogolovski A., Barsheshet Y., Bloch N. et al. Progesterone increases bifidobacterium relative abundance during late pregnancy. Cell Rep. 2019; 27(3): 730-6.e3. https://dx.doi.org/10.1016/j.celrep.2019.03.075.
  47. García-Gómez E., González-Pedrajo B., Camacho-Arroyo I. Role of sex steroid hormones in bacterial-host interactions. Biomed. Res. Int. 2013; 2013: 928290. https://dx.doi.org/10.1155/2013/928290.
  48. Kaur H., Merchant M., Haque M.M., Mande S.S. Crosstalk between female gonadal hormones and vaginal microbiota across various phases of women's gynecological lifecycle. Front. Microbiol. 2020; 11: 551.https://dx.doi.org/10.3389/fmicb.2020.00551.
  49. Ходжаева З.С., Гусейнова Г.Э., Муравьева В.В., Донников А.Е., Мишина Н.Д., Припутневич Т.В. Характеристика микробиоты влагалища у беременных с досрочным преждевременным разрывом плодных оболочек. Акушерство и гинекология. 2019; 12: 66-74. [Khodzhaeva Z.S., Guseinova G.E., Muravyeva V.V., Donnikov A.E., Mishina N.D., Priputnevich T.V. Characteristics of the vaginal microbiota in pregnant women with preterm premature rupture of the membranes. Obstetrics and Gynecology. 2019; (12): 66-74. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.12.66-74.

Received 08.08.2023

Accepted 20.08.2023

About the Authors

Natalya V. Artymuk, Dr. Med. Sci., Professor, Head of the G.A. Ushakova Department of Obstetrics and Gynecology, Kemerovo State Medical University, Ministry of Health of Russia, +7(960)923-33-55, artymuk@gmail.com https://orcid.org/0000-0001-7014-6492, 22a Voroshilova str., Kemerovo, 650056, Russia.
Kristina V. Marochko, PhD, Associate Professor at the G.A. Ushakova Department of Obstetrics and Gynecology, Kemerovo State Medical University, Ministry of Health of Russia, +7(923)612-48-92, marochkokv@mail.ru, https://orcid.org/0000-0003-2832-6638, 22a Voroshilova str., Kemerovo, 650056, Russia.
Yana A. Parfenova, postgraduate student of the G.A. Ushakova Department of Obstetrics and Gynecology, Kemerovo State Medical University, Ministry of Health of Russia, +7(904)579-15-08, yanachka_titova@list.ru, https://orcid.org/0000-0003-2378-9078, 22a Voroshilova str., Kemerovo, 650056, Russia.
Corresponding author: Natalya V. Artymuk, artymuk@gmail.com

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