Premature Birth Clinical Trial
Official title:
Effect of Probiotic Lactobacilli on Vaginal Flora of Pregnant Women at High Risk for Preterm Delivery
Purpose of the study is to determine the effect of probiotic lactobacilli on the vaginal flora and cytokine profile during pregnancy, and the incidence of preterm labour in women at high risk for preterm birth.
Preterm labour involves multiple causes - one of the most significant factors being a prior
history of preterm birth. Infection is another major cause of preterm labour (PTL) and is
estimated to cause up to 30% of PTL. Bacterial Vaginosis (BV) is an alteration in the
endogenous vaginal microflora preceded by a decreased presence of Lactobacilli species and
increased growth of gardnerella and other pathogens. BV is a strong risk factor for PTL, and
is associated with a 40% increased risk in some populations. Initial studies suggested that
the treatment of BV with antibiotics could decrease the incidence of PTL, but this has not
been confirmed by randomized trials. There is substantial evidence that the "normal"
lactobacillus dominated urogenital microflora play an important role in maintenance of a
healthy urinary and reproductive tract.
One hundred and sixty (160) women at high risk for PTL, based on a prior history of preterm
birth, will be approached at their first antenatal visit to participate. Recruitment of 54
patients with symptomatic or asymptomatic BV (based on Nugent Scoring). Women with documented
BV will be randomized to either treatment with lactobacilli preparation (n=27) or placebo
(n=27). Women with symptomatic BV will be treated with oral Metronidazole prior to starting
the lactobacilli or placebo. None of the subjects, researchers or clinical staff will know
which preparation each woman receives.
This study will be the first to examine the ability of lactobacilli preparations to maintain
a normal vaginal flora in pregnant women. In addition, the results will potentially serve as
the basis for a multi-centre RCT to determine efficacy of this treatment in preventing
preterm birth.
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