Efficacy of living preparation of lactobacillus in treatment of bacterial vaginosis during pregnancy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Meijiao ¹ , WANG Yefeng ² , HUANG Hairong ¹ ,  LI Xiaozhen ¹

1. Department of Epidemiology, School of Public Health, Hainan Medical University, Haikou 571199, P.R.China;
2. School of Public Health and Management, NingXia Medical University, Yinchuan 750004, P.R.China;

Corresponding?author：

LI Xiaozhen, Email: 11817717@qq.com

Keywords：

Living preparation of lactobacillus; Metronidazole; Bacterial vaginosis; Pregnancy; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201911112

Video：

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Objectives To systematically review the efficacy of living preparation of lactobacillus for bacterial vaginosis (BV) during pregnancy.Methods PubMed, Web of Science, Medline (OVID), CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of living preparation of lactobacillus for BV during pregnancy from inception to September 30^th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.Results A total of 21 RCTs involving 2 930 patients were included. The results of meta-analysis indicated that: living preparation of lactobacillus was superior to metronidazole in effective rate (RR=1.05, 95%CI 1.02 to 1.07, P=0.000 4), premature delivery rate (RR=0.49, 95%CI 0.32 to 0.73, P=0.000 4), premature rupture of membrane rate (RR=0.54, 95%CI 0.38 to 0.77, P=0.000 7), infant of low-birth weight rate (RR=0.45, 95%CI 0.22 to 0.94, P=0.03) and puerperal infection rate (RR=0.60, 95%CI 0.39 to 0.94, P=0.03).Conclusions The current evidence shows that, living preparation of lactobacillus is superior to metronidazole for BV during pregnancy, and the incidence of adverse pregnancy outcomes (preterm delivery, premature rupture of membranes, low birth weight, puerperal infection) after treatment is lower. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： LI Meijiao, WANG Yefeng, HUANG Hairong, LI Xiaozhen. Efficacy of living preparation of lactobacillus in treatment of bacterial vaginosis during pregnancy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(8): 950-955. doi: 10.7507/1672-2531.201911112 Copy

1.	Brabant G. Bacterial vaginosis and spontaneous preterm birth. J Gynecol Obstet Biol Reprod (Paris), 2016, 45(10): 1247-1260.
2.	Denney JM, Culhane JF. Bacterial vaginosis: a problematic infection from both a perinatal and neonatal perspective. Semin Fetal Neonatal Med, 2009, 14(4): 200-203.
3.	Hay P. Recurrent bacterial vaginosis. Curr Opin Infect Dis, 2009, 22(1): 82-86.
4.	徐小麗. 下生殖道感染對胎膜早破及母兒結局影響的臨床分析. 合肥: 安徽醫科大學, 2013.
5.	季鑫. 妊娠期細菌性陰道病與不良妊娠結局的關系. 中國藥物經濟學, 2017, 12(7): 54-56.
6.	Gómez LM, Sammel MD, Appleby DH, et al. Evidence of a gene-environment interaction that predisposes to spontaneous preterm birth a role for asymptomatic bacteria vaginosis and DNA variants in genes that control the inflammatory response. Am J Obstet Gynecol, 2010, 202(4): 386.
7.	Mastromarino P, Macchia S, Meggiorini L, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect, 2009, 15(1): 67-74.
8.	朱允英. 320 例妊娠合并細菌性陰道炎患者的臨床治療分析. 中外醫學研究, 2013, 11(25): 101.
9.	鄒荔. 乳酸菌陰道膠囊治療孕婦細菌性陰道病的療效觀察. 中國婦幼保健, 2010, 25(12): 1733-1734.
10.	張力, 喬麗雅. 定君生膠囊用于妊娠期細菌性陰道病的臨床觀察. 中國優生與遺傳雜志, 2007, 15(9): 77-78.
11.	吳敏, 陸洋, 楊潔, 等. 觀察比較乳酸桿菌活菌制劑與甲硝唑類制雜治療妊娠合并細菌性陰道病的療效. 廣東微量元素科學, 2016, 23(2): 57-60.
12.	劉國芬. 兩種方法治療妊娠期細菌性陰道病的對比觀察. 牡丹江醫學院學報, 2010, 31(4): 49-50.
13.	李煜, 馮建文, 劉玲. 乳酸桿菌治療妊娠合并細菌性陰道病臨床觀察. 海南醫學, 2006, 17(2): 49, 18.
14.	馬延琴, 康雪萍. 乳酸菌膠囊在治療妊娠合并細菌性陰道病中的應用. 陜西醫學雜志, 2008, 37(2): 253-254.
15.	崔志華, 金正一. 乳酸菌陰道膠囊治療妊娠合并細菌性陰道病的臨床研究. 中國婦幼保健, 2009, 24(18): 2571-2572.
16.	童蓉. 乳酸菌陰道膠囊治療妊娠期細菌性陰道炎的療效觀察. 中國保健營養, 2016, 26(29): 94-95.
17.	高穎. 乳酸菌陰道膠囊治療妊娠中晚期細菌性陰道病的臨床療效分析. 中國處方藥, 2015, 13(1): 51-52.
18.	李秀紅. 乳酸菌陰道膠囊治療妊娠中晚期細菌性陰道病的效果探討. 藥物與人, 2014, 27(11): 18-19.
19.	趙虹, 李霞, 代永志. 細菌性陰道病對早產及胎膜早破的影響. 中國綜合臨床, 2007, 23(6): 560-562.
20.	衛愛民, 葉春萍, 哈寶書. 3 種方法治療妊娠期細菌性陰道病及預防不良妊娠結局的效果比較. 中國婦幼保健, 2008, 23(31): 4445-4446.
21.	李賢玲. 136 例妊娠合并細菌性陰道病的臨床研究. 醫學信息, 2015, 28(18): 214-215.
22.	劉冬梅, 孟瑞雪, 高淑麗. 活性乳酸桿菌制劑治療妊娠期細菌性陰道病療效觀察及其對妊娠結局的影響. 華中科技大學學報(醫學版), 2006, 35(4): 555-558.
23.	陳萍英, 劉淮, 陳寧寧. 臨床干預對妊娠晚期細菌性陰道病不良妊娠結局的預防效果研究. 中國婦幼保健, 2008, 23(29): 4117-4118.
24.	劉瑞. 妊娠合并細菌性陰道病不同治療方法臨床療效及對妊娠結局的影響. 陜西醫學雜志, 2017, 46(6): 726-727.
25.	孟慶英. 妊娠合并細菌性陰道病采用乳酸桿菌活菌制劑與甲硝唑類制劑治療的臨床對比. 中國醫藥指南, 2015, 13(25): 106-107.
26.	陳麗. 妊娠合并細菌性陰道病的臨床治療探討. 齊齊哈爾醫學院學報, 2014, 35(7): 1028-1029.
27.	吳永茂. 乳酸菌陰道膠囊治療妊娠末期細菌性陰道炎的效果及對妊娠結局的影響. 中國鄉村醫藥, 2015, 22(19): 21-22.
28.	徐榮萍. 乳酸菌陰道膠囊治療孕婦細菌性陰道炎的療效觀察. 保健文匯, 2017, (3): 145.
29.	Mengistie Z, Woldeamanuel Y, Asrat D, et al. Prevalence of bacterial vaginosis among pregnant women attending antenatal care in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. BMC Res Notes, 2014, 7(1): 822.
30.	Sabour S, Arzanlou M, Vaez H, et al. Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: a systematic review and meta-analysis. Arch Gynecol Obstet, 2018, 297(5): 1101-1113.
31.	Oduyebo OO, Anorlu RI, Ogunsola FT. The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev, 2009, (3): CD006055.
32.	Senok AC, Verstraelen H, Temmerman M, et al. Probiotics for the treatment of bacterial vaginosis. Cochrane Database Syst Rev, 2009, (4): CD006289.
33.	Vujic G, Jajac Knez A, Despot Stefanovic V, et al. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol, 2013, 168(1): 75-79.
34.	Kindinger LM, Bennett PR, Lee YS, et al. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome, 2017, 5(1): 6.
35.	趙騰飛, 鐘玲, 羅丹. 乳酸桿菌活菌制劑與甲硝唑類制劑治療妊娠合并細菌性陰道病的系統評價. 中國循證醫學雜志, 2010, 10(11): 1338-1344.

1. Brabant G. Bacterial vaginosis and spontaneous preterm birth. J Gynecol Obstet Biol Reprod (Paris), 2016, 45(10): 1247-1260.
2. Denney JM, Culhane JF. Bacterial vaginosis: a problematic infection from both a perinatal and neonatal perspective. Semin Fetal Neonatal Med, 2009, 14(4): 200-203.
3. Hay P. Recurrent bacterial vaginosis. Curr Opin Infect Dis, 2009, 22(1): 82-86.
4. 徐小麗. 下生殖道感染對胎膜早破及母兒結局影響的臨床分析. 合肥: 安徽醫科大學, 2013.
5. 季鑫. 妊娠期細菌性陰道病與不良妊娠結局的關系. 中國藥物經濟學, 2017, 12(7): 54-56.
6. Gómez LM, Sammel MD, Appleby DH, et al. Evidence of a gene-environment interaction that predisposes to spontaneous preterm birth a role for asymptomatic bacteria vaginosis and DNA variants in genes that control the inflammatory response. Am J Obstet Gynecol, 2010, 202(4): 386.
7. Mastromarino P, Macchia S, Meggiorini L, et al. Effectiveness of Lactobacillus-containing vaginal tablets in the treatment of symptomatic bacterial vaginosis. Clin Microbiol Infect, 2009, 15(1): 67-74.
8. 朱允英. 320 例妊娠合并細菌性陰道炎患者的臨床治療分析. 中外醫學研究, 2013, 11(25): 101.
9. 鄒荔. 乳酸菌陰道膠囊治療孕婦細菌性陰道病的療效觀察. 中國婦幼保健, 2010, 25(12): 1733-1734.
10. 張力, 喬麗雅. 定君生膠囊用于妊娠期細菌性陰道病的臨床觀察. 中國優生與遺傳雜志, 2007, 15(9): 77-78.
11. 吳敏, 陸洋, 楊潔, 等. 觀察比較乳酸桿菌活菌制劑與甲硝唑類制雜治療妊娠合并細菌性陰道病的療效. 廣東微量元素科學, 2016, 23(2): 57-60.
12. 劉國芬. 兩種方法治療妊娠期細菌性陰道病的對比觀察. 牡丹江醫學院學報, 2010, 31(4): 49-50.
13. 李煜, 馮建文, 劉玲. 乳酸桿菌治療妊娠合并細菌性陰道病臨床觀察. 海南醫學, 2006, 17(2): 49, 18.
14. 馬延琴, 康雪萍. 乳酸菌膠囊在治療妊娠合并細菌性陰道病中的應用. 陜西醫學雜志, 2008, 37(2): 253-254.
15. 崔志華, 金正一. 乳酸菌陰道膠囊治療妊娠合并細菌性陰道病的臨床研究. 中國婦幼保健, 2009, 24(18): 2571-2572.
16. 童蓉. 乳酸菌陰道膠囊治療妊娠期細菌性陰道炎的療效觀察. 中國保健營養, 2016, 26(29): 94-95.
17. 高穎. 乳酸菌陰道膠囊治療妊娠中晚期細菌性陰道病的臨床療效分析. 中國處方藥, 2015, 13(1): 51-52.
18. 李秀紅. 乳酸菌陰道膠囊治療妊娠中晚期細菌性陰道病的效果探討. 藥物與人, 2014, 27(11): 18-19.
19. 趙虹, 李霞, 代永志. 細菌性陰道病對早產及胎膜早破的影響. 中國綜合臨床, 2007, 23(6): 560-562.
20. 衛愛民, 葉春萍, 哈寶書. 3 種方法治療妊娠期細菌性陰道病及預防不良妊娠結局的效果比較. 中國婦幼保健, 2008, 23(31): 4445-4446.
21. 李賢玲. 136 例妊娠合并細菌性陰道病的臨床研究. 醫學信息, 2015, 28(18): 214-215.
22. 劉冬梅, 孟瑞雪, 高淑麗. 活性乳酸桿菌制劑治療妊娠期細菌性陰道病療效觀察及其對妊娠結局的影響. 華中科技大學學報(醫學版), 2006, 35(4): 555-558.
23. 陳萍英, 劉淮, 陳寧寧. 臨床干預對妊娠晚期細菌性陰道病不良妊娠結局的預防效果研究. 中國婦幼保健, 2008, 23(29): 4117-4118.
24. 劉瑞. 妊娠合并細菌性陰道病不同治療方法臨床療效及對妊娠結局的影響. 陜西醫學雜志, 2017, 46(6): 726-727.
25. 孟慶英. 妊娠合并細菌性陰道病采用乳酸桿菌活菌制劑與甲硝唑類制劑治療的臨床對比. 中國醫藥指南, 2015, 13(25): 106-107.
26. 陳麗. 妊娠合并細菌性陰道病的臨床治療探討. 齊齊哈爾醫學院學報, 2014, 35(7): 1028-1029.
27. 吳永茂. 乳酸菌陰道膠囊治療妊娠末期細菌性陰道炎的效果及對妊娠結局的影響. 中國鄉村醫藥, 2015, 22(19): 21-22.
28. 徐榮萍. 乳酸菌陰道膠囊治療孕婦細菌性陰道炎的療效觀察. 保健文匯, 2017, (3): 145.
29. Mengistie Z, Woldeamanuel Y, Asrat D, et al. Prevalence of bacterial vaginosis among pregnant women attending antenatal care in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. BMC Res Notes, 2014, 7(1): 822.
30. Sabour S, Arzanlou M, Vaez H, et al. Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: a systematic review and meta-analysis. Arch Gynecol Obstet, 2018, 297(5): 1101-1113.
31. Oduyebo OO, Anorlu RI, Ogunsola FT. The effects of antimicrobial therapy on bacterial vaginosis in non-pregnant women. Cochrane Database Syst Rev, 2009, (3): CD006055.
32. Senok AC, Verstraelen H, Temmerman M, et al. Probiotics for the treatment of bacterial vaginosis. Cochrane Database Syst Rev, 2009, (4): CD006289.
33. Vujic G, Jajac Knez A, Despot Stefanovic V, et al. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol, 2013, 168(1): 75-79.
34. Kindinger LM, Bennett PR, Lee YS, et al. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome, 2017, 5(1): 6.
35. 趙騰飛, 鐘玲, 羅丹. 乳酸桿菌活菌制劑與甲硝唑類制劑治療妊娠合并細菌性陰道病的系統評價. 中國循證醫學雜志, 2010, 10(11): 1338-1344.

Chinese Journal of Evidence-Based Medicine

Efficacy of living preparation of lactobacillus in treatment of bacterial vaginosis during pregnancy: a meta-analysis

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