Antibiotic cuts miscarriage, preterm risk

Mild bacterial infections of the vagina often produce no symptoms, but they are known to increase a woman's likelihood of having a miscarriage or preterm delivery . The current research aimed to establish whether antibiotic treatment, early in the second trimester, might reduce these risks. It was found that treating a mild vaginal infection with a common antibiotic, early in the second trimester, reduces a woman's risk of late miscarriage and premature birth.Researchers from the St George's Hospital, London, screened 6,120 women who were attending their first prenatal appointment for the presence of abnormal bacteria in the vagina, either bacterial vaginosis (disease of the vagina) or a milder stage of infection called abnormal vaginal flora. The 485 who tested positive were randomly assigned to either clindamycin capsules or inactive placebo capsules twice daily for five days, around week 17 of pregnancy.Women receiving clindamycin had significantly fewer miscarriages or spontaneous premature deliveries than did women who received placebo, the researchers reported. Spontaneous preterm delivery was defined as birth between 24 and 37 weeks; late miscarriage was loss of pregnancy between 13 and 24 weeks. Only 13 out of 244 women in the clindamycin group had a miscarriage or pre-term delivery, compared to 38 of 241 who were given the placebo.

The optimum time to screen and treat is as yet unknown and possibly could well be prepregnancy. Treatment of asymptomatic abnormal vaginal flora and bacterial vaginosis with oral clindamycin early in the second trimester significantly reduces the rate of late miscarriage and spontaneous preterm birth in a general obstetric population. However, the characteristics of the women in their study might differ from those in other parts of the world, so the study needs to be repeated in other settings.

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