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.	徐小丽. 下生殖道感染对胎膜早破及母儿结局影响的临床分析. 合肥: 安徽医科大学, 2013.
5.	季鑫. 妊娠期细菌性阴道病与不良妊娠结局的关系. 中国药物经济学, 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 例妊娠合并细菌性阴道炎患者的临床治疗分析. 中外医学研究, 2013, 11(25): 101.
9.	邹荔. 乳酸菌阴道胶囊治疗孕妇细菌性阴道病的疗效观察. 中国妇幼保健, 2010, 25(12): 1733-1734.
10.	张力, 乔丽雅. 定君生胶囊用于妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2007, 15(9): 77-78.
11.	吴敏, 陆洋, 杨洁, 等. 观察比较乳酸杆菌活菌制剂与甲硝唑类制杂治疗妊娠合并细菌性阴道病的疗效. 广东微量元素科学, 2016, 23(2): 57-60.
12.	刘国芬. 两种方法治疗妊娠期细菌性阴道病的对比观察. 牡丹江医学院学报, 2010, 31(4): 49-50.
13.	李煜, 冯建文, 刘玲. 乳酸杆菌治疗妊娠合并细菌性阴道病临床观察. 海南医学, 2006, 17(2): 49, 18.
14.	马延琴, 康雪萍. 乳酸菌胶囊在治疗妊娠合并细菌性阴道病中的应用. 陕西医学杂志, 2008, 37(2): 253-254.
15.	崔志华, 金正一. 乳酸菌阴道胶囊治疗妊娠合并细菌性阴道病的临床研究. 中国妇幼保健, 2009, 24(18): 2571-2572.
16.	童蓉. 乳酸菌阴道胶囊治疗妊娠期细菌性阴道炎的疗效观察. 中国保健营养, 2016, 26(29): 94-95.
17.	高颖. 乳酸菌阴道胶囊治疗妊娠中晚期细菌性阴道病的临床疗效分析. 中国处方药, 2015, 13(1): 51-52.
18.	李秀红. 乳酸菌阴道胶囊治疗妊娠中晚期细菌性阴道病的效果探讨. 药物与人, 2014, 27(11): 18-19.
19.	赵虹, 李霞, 代永志. 细菌性阴道病对早产及胎膜早破的影响. 中国综合临床, 2007, 23(6): 560-562.
20.	卫爱民, 叶春萍, 哈宝书. 3 种方法治疗妊娠期细菌性阴道病及预防不良妊娠结局的效果比较. 中国妇幼保健, 2008, 23(31): 4445-4446.
21.	李贤玲. 136 例妊娠合并细菌性阴道病的临床研究. 医学信息, 2015, 28(18): 214-215.
22.	刘冬梅, 孟瑞雪, 高淑丽. 活性乳酸杆菌制剂治疗妊娠期细菌性阴道病疗效观察及其对妊娠结局的影响. 华中科技大学学报(医学版), 2006, 35(4): 555-558.
23.	陈萍英, 刘淮, 陈宁宁. 临床干预对妊娠晚期细菌性阴道病不良妊娠结局的预防效果研究. 中国妇幼保健, 2008, 23(29): 4117-4118.
24.	刘瑞. 妊娠合并细菌性阴道病不同治疗方法临床疗效及对妊娠结局的影响. 陕西医学杂志, 2017, 46(6): 726-727.
25.	孟庆英. 妊娠合并细菌性阴道病采用乳酸杆菌活菌制剂与甲硝唑类制剂治疗的临床对比. 中国医药指南, 2015, 13(25): 106-107.
26.	陈丽. 妊娠合并细菌性阴道病的临床治疗探讨. 齐齐哈尔医学院学报, 2014, 35(7): 1028-1029.
27.	吴永茂. 乳酸菌阴道胶囊治疗妊娠末期细菌性阴道炎的效果及对妊娠结局的影响. 中国乡村医药, 2015, 22(19): 21-22.
28.	徐荣萍. 乳酸菌阴道胶囊治疗孕妇细菌性阴道炎的疗效观察. 保健文汇, 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.	赵腾飞, 钟玲, 罗丹. 乳酸杆菌活菌制剂与甲硝唑类制剂治疗妊娠合并细菌性阴道病的系统评价. 中国循证医学杂志, 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. 徐小丽. 下生殖道感染对胎膜早破及母儿结局影响的临床分析. 合肥: 安徽医科大学, 2013.
5. 季鑫. 妊娠期细菌性阴道病与不良妊娠结局的关系. 中国药物经济学, 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 例妊娠合并细菌性阴道炎患者的临床治疗分析. 中外医学研究, 2013, 11(25): 101.
9. 邹荔. 乳酸菌阴道胶囊治疗孕妇细菌性阴道病的疗效观察. 中国妇幼保健, 2010, 25(12): 1733-1734.
10. 张力, 乔丽雅. 定君生胶囊用于妊娠期细菌性阴道病的临床观察. 中国优生与遗传杂志, 2007, 15(9): 77-78.
11. 吴敏, 陆洋, 杨洁, 等. 观察比较乳酸杆菌活菌制剂与甲硝唑类制杂治疗妊娠合并细菌性阴道病的疗效. 广东微量元素科学, 2016, 23(2): 57-60.
12. 刘国芬. 两种方法治疗妊娠期细菌性阴道病的对比观察. 牡丹江医学院学报, 2010, 31(4): 49-50.
13. 李煜, 冯建文, 刘玲. 乳酸杆菌治疗妊娠合并细菌性阴道病临床观察. 海南医学, 2006, 17(2): 49, 18.
14. 马延琴, 康雪萍. 乳酸菌胶囊在治疗妊娠合并细菌性阴道病中的应用. 陕西医学杂志, 2008, 37(2): 253-254.
15. 崔志华, 金正一. 乳酸菌阴道胶囊治疗妊娠合并细菌性阴道病的临床研究. 中国妇幼保健, 2009, 24(18): 2571-2572.
16. 童蓉. 乳酸菌阴道胶囊治疗妊娠期细菌性阴道炎的疗效观察. 中国保健营养, 2016, 26(29): 94-95.
17. 高颖. 乳酸菌阴道胶囊治疗妊娠中晚期细菌性阴道病的临床疗效分析. 中国处方药, 2015, 13(1): 51-52.
18. 李秀红. 乳酸菌阴道胶囊治疗妊娠中晚期细菌性阴道病的效果探讨. 药物与人, 2014, 27(11): 18-19.
19. 赵虹, 李霞, 代永志. 细菌性阴道病对早产及胎膜早破的影响. 中国综合临床, 2007, 23(6): 560-562.
20. 卫爱民, 叶春萍, 哈宝书. 3 种方法治疗妊娠期细菌性阴道病及预防不良妊娠结局的效果比较. 中国妇幼保健, 2008, 23(31): 4445-4446.
21. 李贤玲. 136 例妊娠合并细菌性阴道病的临床研究. 医学信息, 2015, 28(18): 214-215.
22. 刘冬梅, 孟瑞雪, 高淑丽. 活性乳酸杆菌制剂治疗妊娠期细菌性阴道病疗效观察及其对妊娠结局的影响. 华中科技大学学报(医学版), 2006, 35(4): 555-558.
23. 陈萍英, 刘淮, 陈宁宁. 临床干预对妊娠晚期细菌性阴道病不良妊娠结局的预防效果研究. 中国妇幼保健, 2008, 23(29): 4117-4118.
24. 刘瑞. 妊娠合并细菌性阴道病不同治疗方法临床疗效及对妊娠结局的影响. 陕西医学杂志, 2017, 46(6): 726-727.
25. 孟庆英. 妊娠合并细菌性阴道病采用乳酸杆菌活菌制剂与甲硝唑类制剂治疗的临床对比. 中国医药指南, 2015, 13(25): 106-107.
26. 陈丽. 妊娠合并细菌性阴道病的临床治疗探讨. 齐齐哈尔医学院学报, 2014, 35(7): 1028-1029.
27. 吴永茂. 乳酸菌阴道胶囊治疗妊娠末期细菌性阴道炎的效果及对妊娠结局的影响. 中国乡村医药, 2015, 22(19): 21-22.
28. 徐荣萍. 乳酸菌阴道胶囊治疗孕妇细菌性阴道炎的疗效观察. 保健文汇, 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. 赵腾飞, 钟玲, 罗丹. 乳酸杆菌活菌制剂与甲硝唑类制剂治疗妊娠合并细菌性阴道病的系统评价. 中国循证医学杂志, 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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