Unveiling the Microbial Contribution to Preterm Birth : The Role of Asymptomatic Bacteriuria obial Contribution to Preterm Birth: The Role of Asymptomatic Bacteriuria

Yossra Saleh Khudhur; Huda Saleh Khuder; Shaimaa Saleh Khudhur

doi:10.61132/obat.v3i2.1138

Authors

Yossra Saleh Khudhur Tikrit University
Huda Saleh Khuder Tikrit University
Shaimaa Saleh Khudhur Tikrit University

DOI:

https://doi.org/10.61132/obat.v3i2.1138

Keywords:

Preterm labor, asymptomatic bacteriuria, inflammation, TNF-α, hs-CRP

Abstract

Background: Preterm labor (PTL) remains a major global health concern, contributing significantly to neonatal morbidity and mortality. Asymptomatic bacteriuria (ASB), has been implicated as a predisposing factor to PTL. This research investigates association between ASB and PTL, emphasizing inflammatory mediators such as high-sensitivity C-reactive protein along with tumor necrosis factor- α. Methods: This observational case-control study was conducted at Tikrit Teaching Hospital, Iraq, involving 100 pregnant women (50 PTL cases and 50 full-term controls). Demographic, clinical, and laboratory data were collected. Urine cultures identified bacterial isolates. In addition, levels of TNF-α and hs-CRP in serum were measured using ELISA. Statistical analyses were performed using SPSS. Results: ASB was significantly associated with PTL, with 30% from PTL cases having a positive urine culture compared to 8% in controls (p = 0.009). Escherichia coli was the predominant pathogen (53%). TNF-α and hs-CRP levels were significantly elevated in PTL cases (p < 0.001), suggesting an inflammatory pathway in PTL pathophysiology. Conclusions: ASB is a significant risk factor for PTL, likely mediated by systemic inflammation. Routine ASB screening and targeted antimicrobial therapy may reduce PTL risk. Further study is required to explore the mechanistic connections amongst microbial infection and inflammatory responses in PTL.

Downloads

Download data is not yet available.

References

Abde, M., Weis, N., Kjærbye-Thygesen, A., & Moseholm, E. (2024). Association between asymptomatic bacteriuria in pregnancy and adverse pregnancy and birth outcomes: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology.

Ananth, C. V., & Vintzileos, A. M. (2006). Epidemiology of preterm birth and its clinical subtypes. The Journal of Maternal-Fetal & Neonatal Medicine, 19(12), 773–782.

Blencowe, H., Cousens, S., Chou, D., Oestergaard, M., Say, L., Moller, A.-B., Kinney, M., Lawn, J., & Born Too Soon Preterm Birth Action Group. (2013). Born too soon: The global epidemiology of 15 million preterm births. Reproductive Health, 10, 1–14.

Chawanpaiboon, S., Vogel, J. P., Moller, A.-B., Lumbiganon, P., Petzold, M., Hogan, D., Landoulsi, S., Jampathong, N., Kongwattanakul, K., & Laopaiboon, M. (2019). Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis. The Lancet Global Health, 7(1), e37–e46.

Chu, D. M., Seferovic, M., Pace, R. M., & Aagaard, K. M. (2018). The microbiome in preterm birth. Best Practice & Research Clinical Obstetrics & Gynaecology, 52, 103–113.

Farhan, R. K. (n.d.). Recurrent urinary tract infections in pregnancy and its relation to preterm labour in Dour City.

Fox, C., & Eichelberger, K. (2015). Maternal microbiome and pregnancy outcomes. Fertility and Sterility, 104(6), 1358–1363.

Gilstrap, L. C., & Ramin, S. M. (2001). Urinary tract infections during pregnancy. Obstetrics and Gynecology Clinics of North America, 28(3), 581–591.

Hochler, H., Lipschuetz, M., Suissa-Cohen, Y., Weiss, A., Sela, H. Y., Yagel, S., Rosenbloom, J. I., Grisaru-Granovsky, S., & Rottenstreich, M. (2023). The impact of advanced maternal age on pregnancy outcomes: A retrospective multicenter study. Journal of Clinical Medicine, 12(17), 5696.

Howson, C. P., Kinney, M. V., McDougall, L., Lawn, J. E., & Born Too Soon Preterm Birth Action Group. (2013). Born too soon: Preterm birth matters. Reproductive Health, 10, 1–9.

Huang, L., Hou, Q., Huang, Y., Ye, J., Huang, S., Tian, J., Tang, R., Liu, C., Long, Y., & Qin, X. (2019). Serum multiple cytokines for the prediction of spontaneous preterm birth in asymptomatic women: A nested case-control study. Cytokine, 117, 91–97.

Kahveci, B., Melekoglu, R., Evruke, I. C., & Cetin, C. (2018). The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies. BMC Pregnancy and Childbirth, 18, 1–7.

Kazemier, B. M., Schneeberger, C., De Miranda, E., Van Wassenaer, A., Bossuyt, P. M., Vogelvang, T. E., Reijnders, F. J. L., Delemarre, F. M. C., Verhoeven, C. J. M., & Oudijk, M. A. (2012). Costs and effects of screening and treating low-risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study. BMC Pregnancy and Childbirth, 12, 1–5.

Liu, L., Oza, S., Hogan, D., Chu, Y., Perin, J., Zhu, J., Lawn, J. E., Cousens, S., Mathers, C., & Black, R. E. (2016). Global, regional, and national causes of under-5 mortality in 2000–2015: An updated systematic analysis with implications for the sustainable development goals. The Lancet, 388(10063), 3027–3035.

Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., Eckert, L. O., Geerlings, S. E., Köves, B., & Hooton, T. M. (2019). Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 68(10), e83–e110.

Rao, P., Rajwade, K., Arora, P., Tiknaik, A., Parthasarthy, S., Ozalkar, S., Nikam, P., Gupte, S., & Shah, S. (2022). The maternal microbiota impact on pregnancy outcomes: A systematic review. Acta Scientific Microbiology, 5(1).

Riboni, F., Vitulo, A., Plebani, M., Dell’Avanzo, M., Battagliarin, G., & Paternoster, D. (2012). Combination of biochemical markers in predicting preterm delivery. Archives of Gynecology and Obstetrics, 285, 61–66.

Robertson, S. A., Hutchinson, M. R., Rice, K. C., Chin, P.-Y., Moldenhauer, L. M., Stark, M. J., Olson, D. M., & Keelan, J. A. (2020). Targeting Toll-like receptor-4 to tackle preterm birth and fetal inflammatory injury. Clinical & Translational Immunology, 9(4), e1121.

Romero, R., Dey, S. K., & Fisher, S. J. (2014). Preterm labor: One syndrome, many causes. Science, 345(6198), 760–765.

Shahzad, M., Khan, E. M., Khan, O. Q., Tariq, U. B., & Sabahat, A. (2022). Urinary tract infections: Epidemiology, mechanisms of infection, and treatment. Pakistan Journal of Medical & Health Sciences, 16(10), 810.

Smaill, F. M., & Vazquez, J. C. (2019). Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database of Systematic Reviews, (11).

Wang, E., Tang, P., & Chen, C. (2024). Urinary tract infections and risk of preterm birth: A systematic review and meta-analysis. Revista do Instituto de Medicina Tropical de São Paulo, 66, e54.

Zhurabekova, G., Oralkhan, Z., Balmagambetova, A., Berdalinova, A., Sarsenova, M., Karimsakova, B., Altynbay, N., Malik, A., & Tastambek, K. (2024). Socioeconomic determinants of preterm birth: A prospective multicenter hospital-based cohort study among a sample of Kazakhstan. BMC Pregnancy and Childbirth, 24(1), 769.