What is Causing the Increase in Preterm Birth?


By Nicole Kerr, ND, LAc


very year, an estimated 15 million babies worldwide are born preterm (before 37 completed weeks of gesta- tion), and this number is rising, according to the World Health Organization (WHO). The WHO ranked USA 6th for greatest number of preterm births (PTB) in 2010, and in 2017 March of Dimes graded our nation as a “C” on their premature birth report card. In 2018, the USA had 1 in 10 babies as preterm births.


E Intrauterine infection and infl amma-


tion may account for up to 40% of PTB, but in many instances, the cause might be subclinical and diffi cult to detect. Preterm birth known risk factors include multiple pregnancies, smoking and substance abuse, history of PTB, maternal emotional stress during pregnancy, and limited pre- natal and antenatal care. Preventing PTB starts with preconception care and healthy pregnancy practices.


Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for ~1 million deaths per year worldwide, and can lead to lifelong developmental and physical disabilities. New information on PTB and the female reproductive micro- biome’s potential impact on PTB rates is worth a much closer look.


Maternal Reproductive Microbiome When fi guring out how we as hu-


mans interact with the “friendly” bacteria, viruses, fungi, and other organisms in our


body, the microbiome is where it’s at. All humans have unique, though similar, microbiomes throughout the body, with the gut microbiome being the most well researched. Disruption and variations to these microbiomes have shown to infl u- ence health on many levels including preterm birth rates.


The maternal reproductive microbi- ome, includes the vaginal microbiome (VBM), cervicovaginal, endometrial, and uterine microbiome; although oral and gut microbiomes also impact reproductive and pregnancy health. Changes to repro- ductive microbiomes greatly infl uence conception and pregnancy outcomes. Female reproductive microbiomes change throughout a lifetime and even between trimesters in pregnancy, shifting to less diversity with a predominance of Lactoba- cillus species, the most common probiotic or “friendly” bacteria, in late pregnancy.


A healthy VBM includes predominant- ly Lactobacillus species (90-95%), Atopo- bium, Dialister, Gardnerella, Megasphaera, Prevotella, Peptoniphilus, and Leptotrichia. Endometrial microbiome of <90% Lacto- bacillus species and >10% other bacteria is associated with reduced implantation as well as reduced rates of pregnancy, ongo- ing pregnancy and live births.


VBM variations in Lactobacillus species among women of different races and ethnicity follow PTB trends of those groups too. Lactobacillus crispatus is signifi cantly higher among white non-


Hispanic women than non-Hispanic black and Hispanic women. Non-Hispanic black and Hispanic women have signifi cantly higher rates of diversity group bacteria. It was concluded that high vaginal diversity is associated with an increased risk of PTB and bacterial vaginosis. This follows the PTB trend, where PTB in non-Hispanic black women is higher compared to that of non-Hispanic white women.


Dysbiosis and Preterm Birth


Dysbiosis is the disruption of normal microbiome organisms. Vaginal microbiome can become imbalanced through exog- enous/environmental factors such as drug use, behavioral practices, sexual activities, diet, hygiene practices, and stress; and endogenous/host factors including genetic background, age, hormonal status, vaginal pH, ethnicity, and immune system status.


Conception and pregnancy are de- pendent on balanced microbiomes in the mother’s body. VBM dysbiosis has been associated with decreased pregnancy rates in IVF patients, especially when Gardner- ella vaginalis and Atopobium vaginae are elevated. Notice both of these bacteria are listed as healthy VBM, but quantity of mi- crobes matters. The 2019 Journal of Gyne- cology Obstetrics and Human Reproduction stated, “recent meta-analysis concluded that women with an abnormal vaginal micro- biota are roughly 1.4 times less likely to have a successful early pregnancy develop- ment after IVF treatment when compared to women with normal microbiota.”


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