Preterm birth complicates 8-10% of all pregnancies in the United States and is the leading cause of infant morbidity and mortality. The majority of this morbidity and mortality is concentrated in infants delivered prior to 30 weeks' gestational age. One of the best predictors of poor outcome in the current pregnancy is a history of poor outcome in a previous pregnancy. Recent data from the University of Alabama at Birmingham (UAB) indicate that over one half of women who have a spontaneous pregnancy loss between 19 and 24 weeks' gestation in an index pregnancy have another preterm birth in the subsequent pregnancy. Data from several institutions including UAB support the hypothesis that upper genital tract colonization with Ureaplasma urealyticum (U. urealyticum) and other microorganisms may have an important etiologic role in spontaneous preterm birth. Although numerous microorganisms have been isolated, U. urealyticum has consistently been found to be the predominant microorganism isolated from both the chorioamnion and the amniotic fluid in women with spontaneous preterm labor. Data indicate that the association between upper tract microbial colonization and spontaneous preterm birth is inversely proportional to gestational age, i.e., the earlier the gestational age of a preterm birth due to spontaneous preterm labor, the stronger the association with microbial invasion of the upper genital tract. Also, colonization of the endometrium with U. urealyticum and histologic evidence of inflammation have been demonstrated in non-pregnant women. To date, the role of microbial invasion of the upper genital tract in spontaneous second trimester pregnancy losses is much less well studied. This investigation is designed to provide a systematic microbiologic evaluation of the upper genital tract in women with a spontaneous second trimester pregnancy loss or early preterm birth, not only at the time of the spontaneous loss, but also during the interval between pregnancies. Particular emphasis will be placed on the role of U. urealyticum; however, other potential pathogens including aerobic and anaerobic bacteria will also be investigated. Hypotheses to be tested include: l) Upper genital tract colonization with U. urealyticum and other microorganisms is associated with early spontaneous pregnancy losses and 2) Chronic colonization of the endometrium with U. urealyticum and other microorganisms during the interval between pregnancies may partially explain the high incidence of spontaneous preterm birth in women with a previous spontaneous second trimester loss. Accomplishment of the proposed specific aim will also significantly complement the other projects in achieving the overall goal of the multidisciplinary proposal to prevent and confine sexually transmitted disease related morbidity.

Project Start
Project End
Budget Start
Budget End
Support Year
1
Fiscal Year
1995
Total Cost
Indirect Cost
Name
University of Alabama Birmingham
Department
Type
DUNS #
004514360
City
Birmingham
State
AL
Country
United States
Zip Code
35294
Andres, Robert L; Zhao, Yuan; Klebanoff, Mark A et al. (2013) The impact of tobacco use on preterm premature rupture of the membranes. Am J Perinatol 30:185-90
Mastrobattista, Joan M; Klebanoff, Mark A; Carey, J Christopher et al. (2008) The effect of body mass index on therapeutic response to bacterial vaginosis in pregnancy. Am J Perinatol 25:233-7
Hendler, Israel; Andrews, William W; Carey, Christopher J et al. (2007) The relationship between resolution of asymptomatic bacterial vaginosis and spontaneous preterm birth in fetal fibronectin-positive women. Am J Obstet Gynecol 197:488.e1-5
Annang, Lucy; Grimley, Diane M; Hook 3rd, Edward W (2006) Vaginal douche practices among black women at risk: exploring douching prevalence, reasons for douching, and sexually transmitted disease infection. Sex Transm Dis 33:215-9
Andrews, William W; Klebanoff, Mark A; Thom, Elizabeth A et al. (2006) Midpregnancy genitourinary tract infection with Chlamydia trachomatis: association with subsequent preterm delivery in women with bacterial vaginosis and Trichomonas vaginalis. Am J Obstet Gynecol 194:493-500
Geisler, William M; Chyu, Laura; Kusunoki, Yasamin et al. (2006) Health insurance coverage, health care-seeking behaviors, and genital chlamydial infection prevalence in sexually active young adults. Sex Transm Dis 33:389-96
Sizemore Jr, James M; Lakeman, Fred; Whitley, Richard et al. (2006) The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic. J Infect Dis 193:905-11
Ross, Shannon A; Novak, Zdenek; Ashrith, Guha et al. (2005) Association between genital tract cytomegalovirus infection and bacterial vaginosis. J Infect Dis 192:1727-30
Geisler, William M; Yu, Shuying; Hook 3rd, Edward W (2005) Chlamydial and gonococcal infection in men without polymorphonuclear leukocytes on gram stain: implications for diagnostic approach and management. Sex Transm Dis 32:630-4
Lichtenstein, Bronwen; Hook 3rd, Edward W; Sharma, Amit K (2005) Public tolerance, private pain: stigma and sexually transmitted infections in the American Deep South. Cult Health Sex 7:43-57

Showing the most recent 10 out of 35 publications