Effects of bacterial vaginosis treatment during pregnancy on maternal-fetal outcome: A systematic review and network meta-analysis

Background: Bacterial vaginosis (BV) can lead to adverse pregnancy outcomes such as preterm delivery. However, it is unclear whether BV treatment during pregnancy can reduce the incidence of adverse maternal-fetal outcomes. Methods: We performed a meticulous literature search across various databases, including PubMed, EMBASE, Web of Science, and the Cochrane Database. Utilizing meta-analysis, we delved into the relationship between diverse drug treatments, encompassing probiotics, antibiotics, and combination therapy, and their potential impact on adverse pregnancy outcomes. We also used network meta-analysis to explore the effects of different medications on the primary outcome of preterm delivery and ranked the intervention effects using P-scores. Results: Twenty-four eligible randomized controlled trials (RCTs) were included. Regardless of the type of treatment administered, the meta-analysis demonstrated that there was no decrease in the occurrence of preterm delivery following BV treatment during pregnancy (RR = 1.00, 95 % CI = 0.80-1.24, P = 0.96). But among the UK population, it was found that BV treatment during pregnancy was significantly associated with a reduced risk of preterm delivery (RR = 0.47, 95 % CI = 0.30-0.73, P < 0.001). Through network meta-analysis, oral probiotics obtained the highest P-scores (P-score = 0.86), but with a low quality evidence. This was followed by vaginal clindamycin plus clotrimazole (P-score = 0.78), and oral clindamycin (P-score = 0.58). Furthermore, it has not been discovered that BV treatment during pregnancy can decrease the likelihood of various other adverse outcomes, such as puerperal infections, miscarriages, premature rupture of membranes, low birth weight, and neonatal intensive care unit (NICU) admission rates. Conclusion: The current evidence fails to endorse the treatment of BV during pregnancy as a means to mitigate the risk of preterm delivery. Although probiotic therapies exhibit promising potential, the available data remains inadequate. Future research is necessary to further establish the safety and effectiveness of antibiotics and probiotics in the prevention or management of BV during pregnancy.