Skip to main content


Log in

Effect of bacterial vaginosis on preterm birth: a meta-analysis

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript



Bacterial vaginosis is a common genital tract disorder. It can lead to preterm birth, but its contribution is equivocal. Bacterial vaginosis is curable and, if diagnosed and appropriately treated, may reduce preterm births. The study desired to confirm the association between bacterial vaginosis and preterm birth.


It was a meta-analysis. We included articles published from 2008 to 2022. The authors included studies that measured the association between bacterial vaginosis and preterm birth by relative risk/risk ratio (RR) or odds ratio (OR). We excluded studies with qualitative data. The study utilized five search engines, PubMed, Scopus, Google Scholar, Cochrane, and LILAC. We used the statistical package for social sciences (SPSS) to draw forest and funnel plots separately for RR and OR.


After an extensive search, the study included 20 articles yielding 26 relevant results with a total of 290,397 observations. This meta-analysis proves that bacterial vaginosis is undoubtedly associated with preterm birth. The overall relative risk of preterm delivery is about two-fold as overall OR1.79 (95% Confidence Interval 1.32–2.43). The overall RR of preterm birth is 1.44 (95% Confidence Interval 1.19–1.73).


Our study shows a significant association between bacterial vaginosis and preterm birth. The study concludes that investigation for bacterial vaginosis and management should be a part of the routine examination of a pregnant woman. The health system must initiate this strategy soon to reduce the prevalence of preterm births and consequent neonatal mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Beigi RH, Wiesenfeld HC, Hillier SL et al (2005) Factors associated with absence of H2O2-producing Lactobacillus among women with bacterial vaginosis. J Infect Dis 191:924–929.

    Article  PubMed  Google Scholar 

  2. Fredricks DN, Fiedler TL, Marrazzo JM (2005) Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 353:1899–1911.

    Article  CAS  PubMed  Google Scholar 

  3. Spandorfer SD, Neuer A, Giraldo PC et al (2001) Relationship of abnormal vaginal flora, proinflammatory cytokines and idiopathic infertility in women undergoing IVF. J Reprod Med Obstet Gynecol 46:806–810

    CAS  Google Scholar 

  4. Nugent RP, Krohn MA, Hillier SL (1991) Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29:297–301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bretelle F, Rozenberg P, Pascal A et al (2014) High atopobium vaginae and gardnerella vaginalis vaginal loads are associated with preterm birth. Clin Infect Dis.

    Article  PubMed  Google Scholar 

  6. Rauh VA, Culhane JF, Hogan VK (2000) Bacterial vaginosis: a public health problem for women. J Am Med Womens Assoc 55:220–224

    CAS  Google Scholar 

  7. Hiller S, Martius J, Krohn M et al (1988) A case-control study of chorioannionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 319:972–978

    Article  Google Scholar 

  8. Ravel J, Moreno I, Simó C (2021) Bacterial vaginosis and its association with infertility, endometritis and pelvic inflammatory disease. Am J Obstetr Gynecol.

    Article  Google Scholar 

  9. Goldenberg RL, Hauth JC, Andrews WW (2000) Intrauterince infection and preterm delivery. N Engl J Med 342:1500–1507

    Article  CAS  PubMed  Google Scholar 

  10. Guaschino S, De Seta F, Piccoli M et al (2006) Aetiology of preterm labour: bacterial vaginosis. BJOG An Int J Obstet Gynaecol 113:46–51.

    Article  CAS  Google Scholar 

  11. Krauss-Silva L, Almada-Horta A, Alves MB et al (2014) Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population. BMC Pregnancy Childbirth 14:1–10.

    Article  Google Scholar 

  12. Harper LM, Parry S, Stamilio DMCE et al (2012) The interaction effect of bacterial vaginosis and periodontal disease on the risk of preterm delivery. Am J Perinatol 29:347–352.

    Article  PubMed  Google Scholar 

  13. Bretelle F, Rozenberg P, Pascal A et al (2015) High atopobium vaginae and gardnerella vaginalis vaginal loads are associated with preterm birth. Clin Infect Dis 60:860–867.

    Article  CAS  PubMed  Google Scholar 

  14. Dingens AS, Fairfortune TS, Reed S, Mitchell C (2016) Bacterial vaginosis and adverse outcomes among full-term infants: a cohort study. BMC Pregnancy Childbirth.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bernardo FMM, Veiga ECA, Quintana SM et al (2021) Association of genitourinary infections and cervical length with preterm childbirth. Brazilian J Med Biol Res 54:1–7.

    Article  Google Scholar 

  16. Tellapragada C, Eshwara VK, Bhat P et al (2016) Risk factors for preterm birth and low birth weight among pregnant Indian women: a hospital-based prospective study. J Prev Med Public Heal 49:165–175.

    Article  Google Scholar 

  17. Nelson DB, Hanlon A, Nachamkin I et al (2014) Early pregnancy changes in bacterial vaginosis-associated bacteria and preterm delivery. Paediatr Perinat Epidemiol 28:88–96.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jones NM, Holzman C, Friderici KH et al (2010) Interplay of cytokine polymorphisms and bacterial vaginosis in the etiology of preterm delivery. J Reprod Immunol 87:82–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Johnson HL, Ghanem KG, Zenilman JM, Erbelding EJ (2011) Sexually transmitted infections and adverse pregnancy outcomes among women attending inner city public sexually transmitted diseases clinics. Sex Transm Dis 38:167–171.

    Article  PubMed  Google Scholar 

  20. Donders GG, Van Calsteren K, Bellen G et al (2009) Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG An Int J Obstet Gynaecol 116:1315–1324.

    Article  CAS  Google Scholar 

  21. Nejad VM, Shafaie S (2008) The association of bacterial vaginosis and preterm labor. J-Pak Med Assoc 58:104

    PubMed  Google Scholar 

  22. Yzeiraj-Kalemaj L, Shpata V, Vyshka G, Manaj A (2013) Bacterial vaginosis, educational level of pregnant women, and preterm birth: a case-control study. ISRN Infect Dis.

    Article  Google Scholar 

  23. Donders GG, Van Calsteren C, Bellen G et al (2010) Association between abnormal vaginal flora and cervical length as risk factors for preterm birth. Ultrasound Obstet Gynecol n/a-n/a.

    Article  Google Scholar 

  24. Aderoba A, Olokor O, Olagbuji B et al (2016) Bacterial vaginosis in spontaneous preterm and term birth: a case–control study. Trop J Obstet Gynaecol 33:297.

    Article  Google Scholar 

  25. Castillo R, Moyano E, Ortiz N, Villa C (2019) (38AD) Maternal risk factors associated with preterm birth. Arch Venez Farmacol y Ter 6:706–710

    Google Scholar 

  26. Ghosh C, Wojtowycz M (2021) Effect of gestational disorders on preterm birth, low birthweight, and NICU admission. Arch Gynecol Obstet 303:419–426.

    Article  PubMed  Google Scholar 

  27. Huaroto-Palomino Karina, Paucca-Huamancha Miguel Angel, Polo-Alvarez Meliza, Meza-Leon Jesus Nicolaza (2013) Factores de riesgo maternos, obstétricos y fetales asociados al parto pretérmino, en pacientes de un hospital público de Ica, Perú. Rev Médica Panacea 3:27–31.

    Article  Google Scholar 

  28. Nsereko E, Uwase A, Mukabutera A et al (2020) Maternal genitourinary infections and poor nutritional status increase risk of preterm birth in Gasabo District, Rwanda: a prospective, longitudinal, cohort study. BMC Pregnancy Childbirth 20:1–13.

    Article  CAS  Google Scholar 

  29. Shayo PA, Kihunrwa A, Massinde AN et al (2012) Prevalence of bacterial vaginosis and associated factors among pregnant women attending at Bugando Medical Centre, Mwanza, Tanzania. Tanzan J Health Res 14:1–10.

    Article  Google Scholar 

  30. Zeng M, Yang L, Mao Y et al (2022) Preconception reproductive tract infections status and adverse pregnancy outcomes: a population-based retrospective cohort study. BMC Pregnancy Childbirth 22:1–10.

    Article  Google Scholar 

  31. Blencowe H, Cousens S, Oestergaard MZ et al (2012) National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379:2162–2172.

    Article  PubMed  Google Scholar 

  32. World Health Organization (2022) Preterm birth. Accessed 24 May 2022

  33. National Center for HIV C, Hepatitis V, Prevention T, of STD Prevention D Bacterial Vaginosis-CDC Fact Sheet (2022) Accessed 24 May 2022

  34. Afolabi BB, Moses OE, Oduyebo OO (2016) Bacterial vaginosis and pregnancy outcome in Lagos, Nigeria. Open Forum Infect Dis 3:1–5.

    Article  Google Scholar 

  35. Mulinganya G, de Vulder A, Bisimwa G et al (2021) Prevalence, risk factors and adverse pregnancy outcomes of second trimester bacterial vaginosis among pregnant women in Bukavu, democratic republic of the Congo. PLoS ONE.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Juliana NCA, Suiters MJM, Al-Nasiry S et al (2020) The association between vaginal microbiota dysbiosis, bacterial vaginosis, and aerobic vaginitis, and adverse pregnancy outcomes of women living in Sub-Saharan Africa: a systematic review. Front Public Heal.

    Article  Google Scholar 

  37. Vandenwyngaerden E-A, Copromotor CP, Promotor VH (2021) Bacterial vaginosis and preterm birth: a systematic review and meta-analysis. Ghent University, Ghent

    Google Scholar 

  38. Pratiksha G, Neha A, Anju H, Gurvinder L (2016) Significance of bacterial vaginosis and periodontal infection as Predictors of preterm labor. Bangladesh J Med Sci 15:441–449

    Article  Google Scholar 

  39. Han C, Li H, Han L et al (2019) Aerobic vaginitis in late pregnancy and outcomes of pregnancy. Eur J Clin Microbiol Infect Dis 38:233–239.

    Article  PubMed  Google Scholar 

  40. Hassan MF, Rund NMA, El-Tohamy O et al (2020) Does aerobic vaginitis have adverse pregnancy outcomes? Prospective observational study. Infect Dis Obstet Gynecol.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nasir S, Mohammed B, Alabsi S (2018) Lactobacillus species detected by 16S rRNA gene sequence isolated from the vaginae of pregnant women and its relation to preterm labor. Int J Res Pharm Sci 9:160–164

    Article  CAS  Google Scholar 

  42. Cunha G, Bastos LB, Freitas SF et al (2021) Genital mycoplasma infection and spontaneous preterm birth outcome: a prospective cohort study. Int J Obstetr Gynaecol.

    Article  Google Scholar 

  43. Hemalatha R, Ramalaxmi A, Swetha E et al (2013) Evaluation of vaginal pH for detection of bacterial vaginosis. Indian J Med Res 138:354

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Bitzer E-M, Schneider A, Wenzlaff P et al (2011) M E D I C I N E self-testing of vaginal pH to prevent preterm delivery a controlled trial. Deutsches Ärzteblatt Int.

    Article  Google Scholar 

  45. Weckend MJ, Spineli LM, Grylka-Baeschlin S, Gross MM (2019) Association between increased antenatal vaginal pH and preterm birth rate: a systematic review. J Perinat Med 47:142–151.

    Article  PubMed  Google Scholar 

  46. Jazayeri A, Arnold H, Jazayeri MK, Spellacy WN (2002) A prospective study of vaginal pH as a predictor of preterm delivery. J Matern Fetal Neonatal Med 11:30–33.

    Article  CAS  PubMed  Google Scholar 

  47. Leitich H, Bodner-Adler B, Brunbauer M et al (2003) Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 189:139–147.

    Article  PubMed  Google Scholar 

  48. Lamont RF, Nhan-Chang C-L, Sobel JD et al (2011) Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis NIH public access. Am J Obs Gynecol 205:177–190.

    Article  Google Scholar 

  49. Flynn CA, Helwig AL, Meurer LN (1999) Bacterial vaginosis in pregnancy and the risk of prematurity: a meta-analysis. J Fam Pract 48:885–892

    CAS  PubMed  Google Scholar 

  50. Paige DM, Augustyn M, Adih WK et al (1998) Bacterial vaginosis and preterm birth: a comprehensive review of the literature. J Nurse Midwifery 43:83–89.

    Article  CAS  PubMed  Google Scholar 

Download references


We are thankful to Dr. Jayashree Gothankar, Professor and Head, Dr. Varsha Vaidya Professor, Dr. Prasad Pore, Professor, and Dr. Rupeshkumar Deshmukh, Statistician Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College.


There was no funding.

Author information

Authors and Affiliations



TM initiated the study, searched references, wrote the manuscript. PPD conceptualized the study, finalized the manuscript. SRK assisted reference search and manuscript writing. All authors have approved final manuscript.

Corresponding author

Correspondence to Prakash Prabhakarrao Doke.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

After obtaining the Institutional Ethics Committee’s (DCGI Regd. No. ECR/518/Inst/MH/2014/RR-17) permission, the study was conducted.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 26 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohanty, T., Doke, P.P. & Khuroo, S.R. Effect of bacterial vaginosis on preterm birth: a meta-analysis. Arch Gynecol Obstet 308, 1247–1255 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: