Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis

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Citations from the literature/ International Journal of Gynecology & Obstetrics 54 (1996) 81-91

in 16%of the 10,397women. The women with bacterial vaginosis were more likely to be unmarried, to be black, to have low incomes,and to have previously delivered low-birth-weight infants. In a multivariate analysis, the presenceof bacterial vaginosis was related to preterm delivery of a low-birth-weight infant (odds ratio, 1.4; 95% conftdence interval, 1.1 to 1.5). Other risk factors that were signiticantly associated with such a delivery in this population were the previous delivery of a low-birth-weight infant (odds ratio, 6.2; 95% confidence interval, 4.6 to 8.4), the loss of an earlier pregnancy (odds ratio, 1.7; 1.3 to 2.2). prim&avidity (odds ratio, 1.6; 1.1 to 1.9), smoking (odds ratio, 1.4; 1.1 to 1.7); and black race (odds ratio, 1.4; 1.1 to 1.7).Among women with bacterial vaginosis, the highest risk of preterm delivery of a low-birth-weight infant was found among those with both vaginal bacteroides and Mycoplasma hominis (odds ratio, 2.1; 95% confidence interval, 1.5 to 3.0). Conclusions. Bacterial vaginosis was associated with the preterm delivery of low-birth- weight infants independently of other recognized risk factors. Reduced hidence -Y&b-

of pretem~ delivery with metronidazole IUNI lVithb8CtC&IVnginosis

Hauth J.C.; Goldenberg R.L.; Andrews W.W.; DuBard M.B.; Copper R.L. USA NEW ENGL. J. MED. 1995 333/26 (1732-1736) Background. Pregnant women with bacterial vaginosis may be at increased risk for prcterm delivery. We investigated whether treatment with metronidaxole and erythromycin during the secondtrimester would lower the incidence of delivery before 37 weeks’ gestation. Methods. In 624 pregnant women at risk for delivering prematurely, vaginal and cervical cultures and other laboratory tests for bacterial vaginosis were performed at a mean of 22.9 weeks’ gestation. We then performed a 2: 1 double-blind randomization to treatment with metronidaxole and erythromycin (433 women) or placebo (191 women). After treatment, the vaginal and cervical tests were repeated and a secondcourse of treatment was given to women who had bacterial vaginosis at that time (a mean of 27.6 weeks’ gestation). Results: A total of 176 women (29%) delivered infants at less than 37 weeks’ gestation. Eight women were lost to follow-up. In the remaining population, I10 of the 426 women assignedto metronidazole and erythromycin (26%) delivered prematurely, as compared with 68 of the 190 assigned to placebo (360/o, p = 0.01). However, the association between the study treatment and lower rates of prematurity was observed only among the 258women who had bacterial vaginosis (rate of preterm delivery, 31%with treatment vs. 49% with placebo; p = 0.006).Of the 358 women who did not have bacterial vaginosis when initially examined, 22% of those assigned to metronidaxole and erythromycin and 25% of those assigned to placebo delivered prematurely @ = 0.55). The lower rate of pretenn delivery among the women with bacterial vaginosis who were assigned to the study treatment was observed both in women at risk because of previous preterm delivery @term delivery in the treatment group, 390/o;and in the placebo group, 57%;p = 0.02) and in women who weighed less than 50 kg before pregnancy

(preterm delivery in the treatment group, 14%; and in the placebo group, 33%; p = 0.04). Conclusions. Treatment with metronidaxole and erythromycin reduced rates of premature delivery in women with bacterial vaginosis and an increased risk for preterm delivery. FetaI hreathhtg movementsIn Iate dIahetIc pqnauey: ReIatim ship to few heart ratc pattcrm and Braxtno Hkks’ eontTaetinns Madder E.J.H.; Leiblum D.M.; Visser G.H.A. NLD EARLY HUM. DEV. 199543/3 (225-232) In type-l diabetic pregnancy, the occurrence of fetal breathing movements(FBM) was studied in relation to the fetal heart rate patterns (HRPs) A and B and to Braxton Hicks’ contractions. Simultaneous2-h recordings of fetal heart rate and body, eye and breathing movements were available for analysis (n = 44). These recordings were made in 20 fetusesof diabetic women at 32-38 weeks of gestation. Uterine activity was monitored at 36 and 38 weeks. For all recordings combined, the median incidences of FBM during HRPs A and B were 23% and 41%, respectively (IS). At low overall breathing activity (< 50% of total observation time), FBM were more numerous during HRP B than during HRP A in 83% of the recordings. However, if the overall breathing activity exceeded50% of time FBM were preferentially made during HRP A in 93% of the recordings. This relationship was most pronounced at 38 weeks. These results corroborate our previous findings in the healthy near-term fetus. They show even more clearly that the state-dependentoccurrenceof FBM dependson the fetus’ drive to breathe. During the recordings, breathing activity remained unchanged at all gestational ages studied, in contrast to the gradual decline in FBM seen in normal pregnancy. Braxton Hicks’s contractions had no effect on FBM, which differs from the specific distribution of FBM during uterine contractions as previously found in uncomplicated pregnancies. We conclude that FBM in late diabetic pregnancy are not influenced by Braxton Hicks’ contractions and that they do not show a clearcut state-dependency. The (neural) mechanism underlying FBM differs from that in normal pregnancy. Nemoh@caIcondItIonht1 thon&old pawI to pdyddarinated

childm bipbenyls and dioxim

perinatally ex-

Huisman M.; Koopman-Esseboom C.; Laming C.I.; Van der Paauw C.G.; Tuinstra L.G.M.T.; Fidlere V.; Weisglas-Kuperus N.; Sauer P.J.J.; Boersma E.R.; Touwen B.C.L. NLD EARLY HUM. DEV. 19954312(165-176) The neurological optimality of 418 Dutch children was evaluated at the age of 18 months, in order to determine whether prenatal and breast milk mediated exposure to polychlorinated biphenyls (PCBs) and dioxins affected neurological development. Half of the infants were breast-fed, the other half were formula-fed. PCB concentrations in cord and maternal plasma were used as a measureof prenatal exposure to PCBs. To measurepostnatal exposure, PCB and dioxin congenerswere determined in human milk and in formula milk. After adjusting for covariates, transplacental PCB exposure