Screening for and treating asymptomatic bacterial vaginosis in pregnancy

Background. BV has been associated with poor perinatal outcome. Because the infection is amenable to treatment, identification and treatment during pregnancy may reduce the risk of preterm birth and its consequences. Objectives. The objective of this review was to assess the effects of antibiotic treatment of BV in pregnancy. Search Strategy. The authors searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Selection Criteria. Randomized trials comparing one antibiotic regimen with placebo or no treatment, or comparing two or more alternative antibiotic regimens in pregnant women with BV were included. Data Collection and Analysis. Trial quality assessments and data extraction were done independently by three reviewers. Study authors were contacted for additional information. Primary Results. Five trials involving 1,504 women were included. These trials were of good quality. Antibiotic therapy was highly effective in eradicating infection during pregnancy, as judged by "test-of-cure" following therapy (odds ratio [OR], 0.22; 95 percent confidence interval [Cl], 0.17 to 0.27). The effect of treating BV during pregnancy showed a trend toward fewer births before 37 weeks' gestation (OR, 0,78; 95 percent Cl, 0.60 to 1.02). The prevention of preterm birth at less than 37 weeks' gestation was most marked in the subgroup of women with a previous preterm birth (OR, 0.37; 95 percent Cl, 0.23 to 0,60). Reviewer's Conclusions. The current evidence does not support screening and treating all pregnant women for BV to prevent preterm birth and its consequences. In women with a history of a previous preterm birth, there is some suggestion that detection and treatment of BV early in pregnancy may prevent a proportion of these women from having a further preterm birth. It is not known whether this outcome is associated with an improvement in neonatal well-being.(1).