Cervicovaginal detection of genital mycoplasmas is associated with preterm birth and low birth weight: a systematic review and multivariate meta-analysis of adverse pregnancy outcomes.
Boglárka Fehér, Isabel Pinto Amorim das Virgens, Mikolt Bakony et al.
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In 30 seconds
This systematic review and meta-analysis of observational studies assessed whether cervicovaginal detection of genital mycoplasmas is associated with adverse pregnancy outcomes. Across 156 studies, associations with preterm birth and low birthweight remained in analyses restricted to cervicovaginal samples. Ureaplasma parvum detection was associated with preterm birth (odds ratio, 1.63; confidence interval, 1.36-1.96); cervicovaginal Ureaplasma species were also associated with low birthweight. Mycoplasma hominis detection was associated with preterm birth and low birthweight. The observational evidence, with potential residual confounding, does not establish causation or support routine screening or treatment.
Key findings
- Cervicovaginal Ureaplasma parvum detection was associated with preterm birth (odds ratio, 1.63; confidence interval, 1.36-1.96).
- Cervicovaginal Ureaplasma detection was associated with low birthweight (odds ratio, 1.56; confidence interval, 1.33-1.83) and small for gestational age (odds ratio, 1.47; confidence interval, 1.19-1.80).
- Cervicovaginal Mycoplasma hominis detection was associated with preterm birth (adjusted odds ratio, 1.75; confidence interval, 1.21-2.53) and low birthweight (odds ratio, 1.81; confidence interval, 1.51-2.16).
- For Ureaplasma species, first-trimester detection showed stronger associations with preterm birth than second-trimester positivity (P=.044).
Why it matters
The findings indicate that associations with adverse pregnancy outcomes are not confined to mycoplasmas detected in amniotic fluid or placental specimens; cervicovaginal detection is also associated with several outcomes. However, detection should be considered in the context of the broader vaginal microbial environment, and these observational associations do not show that the organisms independently cause harm.
What to keep in mind
The evidence is observational and may be affected by residual confounding; the authors caution that it does not establish an isolated pathogenic effect.