Effect of vaginal probiotics containing Lactobacillus casei rhamnosus (Lcr regenerans) on vaginal dysbiotic microbiota and pregnancy outcome, prospective, randomized study.

Scientific reports. 2023;13(1):7129

Plain language summary

Preterm delivery (PTD) of babies is thought in some women to be associated with the development of vaginal infections. An imbalance in the bacteria normally present in the vagina and especially a lack of Lactobacillus species can develop into a condition known as bacterial vaginosis (BV), which is a risk factor for PTD. The use of antibiotics is the standard treatment, however concerns on its effectiveness in preventing PTB have been raised. Antibiotics not only eradicate the abnormal bacteria, but also the Lactobacillus. This randomised control trial of 129 women with BV aimed to determine the effect of vaginally applied lactobacilli on the restoration of normal bacteria in the vagina and the rate of PTD. The results showed that women who had a complete lack of Lactobacillus, the vaginal application of Lactobacillus casei rhamnosus, BV was improved and gestational age at delivery and birthweight were both significantly increased, although PTD rate was not. It was concluded that vaginally applied Lactobacillus may be of some benefit to women with BV during pregnancy. This study could be used by healthcare professionals to understand the importance of vaginal microbiota during pregnancy. However, this was a study of very small numbers of women and larger studies are needed before vaginally applied microbiota can be definitively recommended.

Abstract

The intermediate bacterial microbiota is a heterogeneous group that varies in the severity of the dysbiosis, from minor deficiency to total absence of vaginal Lactobacillus spp. We treated women with this vaginal dysbiosis in the first trimester of pregnancy using a vaginally applied lactobacilli preparation to restore the normal microbiota in order to delay the preterm delivery rate. Pregnant women with intermediate microbiota of the vagina and a Nugent score of 4 were enrolled in two groups: intermediate vaginal microbiota and a Nugent score of 4 with lactobacilli (IMLN4) and intermediate vaginal microbiota and a Nugent score of 4 without lactobacilli (IM0N4), with and without vaginal lactobacilli at baseline, respectively. Half of the women in each group received the treatment. Among women without lactobacilli (the IM0N4 group), the Nugent sore decreased by 4 points only in the women who received treatment, and gestational age at delivery and neonatal birthweight were both significantly higher in the treated subgroup than in the untreated subgroup (pā€‰=ā€‰0.047 and pā€‰=ā€‰0.016, respectively). This small study found a trend toward a benefit of treatment with vaginal lactobacilli during pregnancy.

Lifestyle medicine

Fundamental Clinical Imbalances : Digestive, absorptive and microbiological
Patient Centred Factors : Mediators/Vaginal microbiota dysbiosis
Environmental Inputs : Microorganisms
Personal Lifestyle Factors : Not applicable
Functional Laboratory Testing : Tissue biopsy
Bioactive Substances : Lactobacillus probiotic

Methodological quality

Jadad score : 3
Allocation concealment : No

Metadata