Maternal and Child Health Journal

, Volume 15, Issue 7, pp 1020–1028

Evaluation of Syracuse Healthy Start’s Program for Abnormal Flora Management to Reduce Preterm Birth Among Pregnant Women

  • Emilia H. Koumans
  • Sandra D. Lane
  • Richard Aubry
  • Kathleen DeMott
  • Noah Webster
  • Brooke A. Levandowski
  • Stuart Berman
  • Lauri E. Markowitz
Article

DOI: 10.1007/s10995-010-0661-0

Cite this article as:
Koumans, E.H., Lane, S.D., Aubry, R. et al. Matern Child Health J (2011) 15: 1020. doi:10.1007/s10995-010-0661-0

Abstract

Randomized trials of bacterial vaginosis (BV) treatment among pregnant women to reduce preterm birth have had mixed results. Among non-pregnant women, BV recurs frequently after treatment. Randomized trials of early BV treatment for pregnant women in which recurrence was retreated have shown promise in reducing preterm birth. Syracuse’s Healthy Start (SHS) program began in 1997; in 1998 prenatal care providers for pregnant women living in high infant mortality zip codes were encouraged to screen for abnormal vaginal flora at the first prenatal visit. Vaginal swabs were sent to a referral hospital laboratory for Gram staining and interpretation. SHS encouraged providers to treat and rescreen women with bacterial vaginosis or abnormal flora (BV). We abstracted prenatal and hospital charts of live births between January 2000 and March 2002 for maternal conditions and treatments. We merged abstracted data with local electronic data. We evaluated the effect of BV screening before 22 weeks gestation, treatment, and rescreening using a retrospective cohort study design. Among 838 women first screened before 22 weeks, 346 (41%) had normal flora and 492 (59%) women had BV at a mean of 13 weeks gestation; 202 (24%) did not have treatment documented and 290 (35%) received treatment at a mean of 15 weeks gestation; 267 (92%) of those treated were re-screened. Among pregnant women with early BV, 42 (21%) untreated women and 28 (10%) treated women delivered preterm (Odds Ratio [OR] 0.4, 95% confidence interval [CI] 0.2–0.7)). After adjustment for age, race, prior preterm birth and other possible confounders, treatment remained associated with a reduced risk of preterm birth compared to no treatment (aOR = 0.5, 95% CI 0.3–0.9); the aOR for women with normal flora was not significantly different. Conclusion: Screening, treatment, and rescreening for BV/abnormal flora between the first prenatal visit and 22 weeks gestation showed promise in reducing preterm births and deserves further study.

Keywords

Premature birthVaginosis, bacterialPrenatal care

Copyright information

© US Government 2010

Authors and Affiliations

  • Emilia H. Koumans
    • 1
  • Sandra D. Lane
    • 2
  • Richard Aubry
    • 3
  • Kathleen DeMott
    • 4
  • Noah Webster
    • 5
  • Brooke A. Levandowski
    • 6
  • Stuart Berman
    • 1
  • Lauri E. Markowitz
    • 1
  1. 1.Division of STD PreventionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Departments of Health and WellnessSyracuse UniversitySyracuseUSA
  3. 3.Center for Maternal and Child Health and Department of Obstetrics and GynecologySUNY Upstate Medical UniversitySyracuseUSA
  4. 4.The Royal College of PhysiciansLondonUK
  5. 5.Syracuse Healthy Start/Case Western UniversityClevelandUSA
  6. 6.Syracuse Healthy Start/IpasChapel HillUSA