Treatment of bacterial vaginosis before 28 weeks of pregnancy to reduce the incidence of preterm labor

• Published in: International journal of gynecology and obstetrics 2019-09, Vol.146 (3), p.271-276
• Main Authors: Rebouças, Karinne F., Jr, José Eleutério, Peixoto, Raquel C., Costa, Ana Paula F., Cobucci, Ricardo N., Gonçalves, Ana K.
• Format: Article
• Language: English
• Subjects: Administration, Intravaginal; Administration, Oral; Anti-Bacterial Agents - administration & dosage; Bacterial vaginosis; Clindamycin; Clindamycin - administration & dosage; Female; Humans; Incidence; Infant, Newborn; Metronidazole; Metronidazole - administration & dosage; Obstetric Labor, Premature - epidemiology; Obstetric Labor, Premature - prevention & control; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy outcome; Preterm labor; Randomized Controlled Trials as Topic; Vaginosis, Bacterial - drug therapy
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.12829

Background Controversy exists regarding the benefits of treating bacterial vaginosis (BV) during pregnancy to reduce the incidence of preterm labor (PTL). Objectives To evaluate whether treatment of BV with vaginal clindamycin or oral metronidazole before 28 weeks of pregnancy reduces PTL incidence. Search strategy PubMed, Scopus, Web of Science, Science Direct, CENTRAL, and SciELO databases were searched until December 30, 2017. Search terms included “bacterial vaginosis” and “preterm labor.” No language restrictions were applied. Selection criteria Randomized clinical trials that evaluated treatment of BV with clindamycin or metronidazole to reduce PTL incidence. Data collection and analysis The risk of PTL was evaluated by the odds ratio (OR) and 95% confidence interval (CI). Dichotomous data from each study were combined for meta‐analysis using the Mantel‐Haenszel model. Main results Nine reports were included in the systematic review, with eight reports included in the meta‐analysis. No reduction in the incidence of PTL was found for either metronidazole (OR 0.94, 95% CI 0.71–1.25) or clindamycin (OR 1.01, 95% CI 0.75–1.36). Conclusions Use of oral metronidazole or vaginal clindamycin to treat BV before 28 weeks of pregnancy did not reduce the incidence of PTL. PROSPERO registration: CRD42018086173. Treating bacterial vaginosis with oral metronidazole or vaginal clindamycin before 28 weeks of pregnancy did not reduce the incidence of preterm labor.