Problem: Preterm births (PTB) are a major determinant of neonatal morbidity and mortality in the U.S. Published data implicates genital tract infections, particularly Bacterial Vaginosis (BV) - an overgrowth of mixed organisms replacing normal vaginal lactobacilli, as increasing PTB. African-Americans (AA) are especially at risk, having 2-3 times the level as white women. Additionally, approximately 50% of AA women with BV are asymptomatic, and current standard of OB/GYN care does not include screening women without BV symptoms. Study hypothesis: AA women, seeking prenatal care without BV symptoms, who are screened, found BV positive (+) and treated, will have a lower incidence of PTB than unscreened asymptomatic women. Design: A prospective, quasi-experimental cross-over design was used over 30 months in 6 OB/GYN clinics. Each clinic had control and intervention protocol, where women (n=1758) seeking prenatal care before 33 weeks gestation were screened for BV and treated (intervention), followed by a comparable non-screening period (control). Participation rate was 98.4% Of the participants who have thus far delivered, and whose charts have been reviewed and validated, PTB rate among the screened group is 14% compared to 18% among the non-screened group, a relative risk of 0.8 (95% CI: 0.3-1.9). Conclusion: In this analysis, we found a potential benefit of screening and treating women asymptomatic for BV, toward reducing the risk of PTB. This study is funded by the Federal Maternal and Child Health Bureau, R50 MC 00001 04.
Learning Objectives: a) To measure the strength of association between Bacterial Vaginosis and preterm birth, and the effectiveness of a community based clinical trial; b) To examine the reliability and validity of BV assessment and the practical problems associated with these assessment in community settings
Keywords: Birth Outcomes, Prenatal Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Johns Hopkins Medical Services Corporation;
Johns Hopkins Hospital
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.