Identification and H 2 O 2 Production of Vaginal Lactobacilli from Pregnant Women at High Risk of Preterm Birth and Relation with Outcome

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Abstract
Lactobacilli, principally the strains that are hydrogen peroxide (H 2 O 2 ) producing, may have a protective effect against vaginal colonization by pathogenic species such as those that cause bacterial vaginosis. Previous reports have also suggested that H 2 O 2 -producing lactobacilli in the vagina may protect pregnant women against ascending infection of the chorioamniotic membranes and uterine cavity. We report the identification and H 2 O 2 production of lactobacilli isolated from vaginal swabs collected at 20 weeks' gestation from a population of pregnant women at high risk of preterm birth. We also report the correlation between identification and H 2 O 2 production in relation to the outcomes of chorioamnionitis and preterm birth. Lactobacilli were identified by partial 16S rRNA gene sequencing. H 2 O 2 production by isolates was determined by a semiquantitative method. The most commonly isolated species were L. crispatus , L. gasseri , L. vaginalis and L. jensenii . Amounts of H 2 O 2 produced by lactobacilli varied widely. The presence of lactobacilli producing high levels of H 2 O 2 in the vagina of this population of pregnant women was associated with a reduced risk of bacterial vaginosis at 20 weeks' gestation and subsequent chorioamnionitis. L. jensenii and L. vaginalis produced the highest levels of H 2 O 2 . We postulate that H 2 O 2 -producing lactobacilli are able to reduce the incidence of ascending infections of the uterus and the subsequent production of proinflammatory molecules which are important in the pathogenesis of chorioamnionitis and preterm birth.