We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Screening for Bacterial Vaginosis in Pregnant Adolescents and Women to Prevent Preterm Delivery: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
- Authors
Kahwati, Leila C.; Clark, Rachel; Berkman, Nancy; Urrutia, Rachel; Patel, Sheila V.; Zeng, Jennifer; Viswanathan, Meera
- Abstract
<bold>Importance: </bold>Preterm delivery results in adverse outcomes; identifying and treating bacterial vaginosis may reduce its occurrence.<bold>Objective: </bold>To update the evidence on screening and treatment of asymptomatic bacterial vaginosis in pregnancy for the US Preventive Services Task Force.<bold>Data Sources: </bold>MEDLINE, Cochrane Library, and trial registries through May 29, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through December 31, 2019.<bold>Study Selection: </bold>Fair- or good-quality English-language studies evaluating diagnostic accuracy of tests feasible within primary care; randomized clinical trials (RCTs); nonrandomized controlled intervention studies (for harms only); or meta-analyses of metronidazole or clindamycin.<bold>Data Extraction and Synthesis: </bold>Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; when at least 3 similar studies were available, meta-analyses were conducted.<bold>Main Outcomes and Measures: </bold>Sensitivity, specificity, preterm delivery, maternal adverse effects, congenital birth defects, childhood cancer.<bold>Results: </bold>Forty-four studies (48 publications) were included. No studies evaluated the benefits or harms of screening. Twenty-five studies (n = 15 785) evaluated the accuracy of screening tests; across individual studies and tests, sensitivity ranged from 0.36 to 1.0 and specificity ranged from 0.49 to 1.0. Among trials reporting findings from general obstetric populations (n = 7953), no significant association was observed between treatment and spontaneous delivery before 37 weeks (pooled absolute risk difference [ARD], -1.44% [95% CI, -3.31% to 0.43%]; 8 RCTs, n = 7571) or any delivery before 37 weeks (pooled ARD, 0.20% [95% CI, -1.13% to 1.53%]; 6 RCTs, n = 6307). Among 5 trials reporting findings among women with a prior preterm delivery, findings were inconsistent; 3 showed a significant beneficial effect, while 2 did not. Maternal adverse events from treatment were infrequent and minor (eg, candidiasis) but were slightly more common with active treatment compared with placebo across 8 RCTs. Two meta-analyses of observational studies reported no significant association between metronidazole exposure and congenital malformations (odds ratio, 0.96 [95% CI, 0.75 to 1.22]; odds ratio, 1.08 [95% CI, 0.90 to 1.29]). One cohort study reported no significantly increased incidence of childhood cancer among metronidazole-exposed children (adjusted relative risk, 0.81 [95% CI, 0.41 to 1.59]). However, studies of in utero exposure had important limitations.<bold>Conclusions and Relevance: </bold>Accuracy of screening tests for bacterial vaginosis varies. The evidence suggests no difference in the incidence of preterm delivery and related outcomes from treatment for asymptomatic bacterial vaginosis in a general obstetric population but was inconclusive for women with a prior preterm delivery. Maternal adverse events from treatment appear to be infrequent and minor, but the evidence about harms from in utero exposure was inconclusive.
- Subjects
ANTIBIOTICS; COMMUNICABLE disease diagnosis; BACTERIAL vaginitis diagnosis; RESEARCH; FERRANS &; Powers Quality of Life Index; PREMATURE infants; BACTERIAL vaginitis; COMMUNICABLE diseases; CLINDAMYCIN; RESEARCH methodology; SYSTEMATIC reviews; MEDICAL screening; EVALUATION research; MEDICAL cooperation; METRONIDAZOLE; MEDICAL protocols; COMPARATIVE studies; PREGNANCY complications; QUESTIONNAIRES
- Publication
JAMA: Journal of the American Medical Association, 2020, Vol 323, Issue 13, p1293
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.2020.0233