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The potential for probiotics to prevent bacterial vaginosis and preterm labor

  • Gregor Reid
    Correspondence
    Reprint requests: Gregor Reid, PhD, Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, 268 Grosvenor St, London, Ontario N6A 4V2, Canada.
    Affiliations
    From the aCanadian Research and Development Centre for Probiotics, Lawson Health Research Institute, and the Departments of bMicrobiology and Immunology, cSurgery, and dObstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada
    Search for articles by this author
  • Alan Bocking
    Affiliations
    From the aCanadian Research and Development Centre for Probiotics, Lawson Health Research Institute, and the Departments of bMicrobiology and Immunology, cSurgery, and dObstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada
    Search for articles by this author

      Abstract

      Infections of the urogenital tract in women represent a major burden on the quality of life of women and on the health care system of Canada and other countries. Complications arising from bacterial vaginosis (BV) include increased risk of sexually transmitted diseases including human immunodeficiency virus and elevated risk of preterm birth (PTB). Pharmaceutical interventions, such as antibiotics, have been suboptimally effective and have failed to reduce the incidence of PTB. The absence of lactobacilli in the vagina, a specific feature of BV, raises the question as to whether restoration of lactobacilli, by probiotic therapy, can restore the normal flora and improve the chances of having a healthy term pregnancy. The rationale for probiotic use in pregnant women is quite strong. Certain lactobacilli strains can safely colonize the vagina after oral and vaginal administration, displace and kill pathogens including Gardnerella vaginalis and Escherichia coli, and modulate the immune response to interfere with the inflammatory cascade that leads to PTB. Additional attributes of probiotics include their potential to degrade lipids and enhance cytokine levels, which promote embryo development. In a society that focuses on disease rather than health and drug therapy rather than natural preventive measures, it will take some effort to get remedies such as probiotics into mainstream care. Perhaps the escalating health care budgets and emergence of “superbugs” will provide the incentives to put in place clinical trials designed to evaluate how best to use the commensal organisms that, after all, make up more of our body than human cells, and without which none of us would survive.

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