BACKGROUND
Data regarding the microbiome of the gestational membranes are emerging and conflicting.
Shifts in the microbial communities in the setting of labor, rupture of membranes,
and intraamniotic infection are yet to be understood.
OBJECTIVE
This study aimed to characterize the microbiome of the gestational membranes of women
in labor or with ruptured membranes, including those with and without intraamniotic
infection.
STUDY DESIGN
Women with a singleton pregnancy at ≥28 weeks’ gestation undergoing unscheduled cesarean
delivery in the setting of labor or rupture of membranes were included. Demographic
and clinical variables were collected. We defined suspected intraamniotic infection
by standard clinical criteria; placentae and gestational membranes were also reviewed
for histologic evidence of infection. Sterile swabs were collected from membranes
at the time of delivery. Bacteria were cultured from the swabs, and the isolates were
sequenced. DNA extraction and 16S sequencing of the swabs were also performed. Bacterial
taxonomy was assigned to each sequence. Alpha diversity indices and beta-diversity
metrics were calculated to test for differences in microbial community diversity and
composition between uninfected and infected groups. Differential abundance of bacteria
between infected and uninfected groups was tested at the class, family, and genus
level.
RESULTS
Samples were collected from 34 participants. Clinical intraamniotic infection was
diagnosed in 38% of participants, although 50% of placentae and membranes demonstrated
histologic signs of infection. Of all samples, 68% grew bacteria on culture; this
included 62% of the uninfected samples and 77% of the infected samples (P=.83). Multiple measures of alpha diversity were not significantly different between
uninfected and infected groups. Similarly, analysis of beta diversity revealed that
the microbial community was not significantly different between the uninfected and
infected group. Several bacteria traditionally characterized as pathogenic, including
Actinomyces and Streptococcus agalactiae, were identified in both infected and uninfected samples.
CONCLUSION
The pathogenesis and clinical implications of intraamniotic infection remain poorly
understood. Diverse bacteria are present in both infected and uninfected gestational
membranes. A unique microbiologic signature may exist among the gestational membranes
following labor or rupture of membranes, and further characterization of the pathogens
specifically implicated in intraamniotic infection may allow for targeted therapy.
Key words
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References
- The placenta harbors a unique microbiome.Sci Transl Med. 2014; 6: 237ra65
- Comment on “the placenta harbors a unique microbiome.Sci Transl Med. 2014; 6: 254le4
- Deep microbial analysis of multiple placentas shows no evidence for a placental microbiome.BJOG. 2020; 127: 159-169
- Lack of detection of a human placenta microbiome in samples from preterm and term deliveries.Microbiome. 2018; 6: 196
- Does the human placenta delivered at term have a microbiota? Results of cultivation, quantitative real-time PCR, 16S rRNA gene sequencing, and metagenomics.Am J Obstet Gynecol. 2019; 220 (:267.e1–39)
- Parallel detection of lactobacillus and bacterial vaginosis-associated bacterial DNA in the chorioamnion and vagina of pregnant women at term.J Matern Fetal Neonatal Med. 2019; 32: 2702-2710
- The placental membrane microbiome is altered among subjects with spontaneous preterm birth with and without chorioamnionitis.Am J Obstet Gynecol. 2016; 214 (:627.e1–16)
- Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance.Am J Obstet Gynecol. 2015; 213: S29-S52
- Bacterial aetiological agents of intra-amniotic infections and preterm birth in pregnant women.Front Cell Infect Microbiol. 2013; 3: 58
- The human microbiome and the great obstetrical syndromes: a new frontier in maternal-fetal medicine.Best Pract Res Clin Obstet Gynaecol. 2015; 29: 165-175
- A novel molecular microbiologic technique for the rapid diagnosis of microbial invasion of the amniotic cavity and intra-amniotic infection in preterm labor with intact membranes.Am J Reprod Immunol. 2014; 71: 330-358
- Amniotic infection syndrome; pathogenesis, morphology, and significance in circumnatal mortality.Clin Obstet Gynecol. 1959; 2: 705-734
- Safe prevention of the primary cesarean delivery.Am J Obstet Gynecol. 2014; 210: 179-193
- Power and sample-size estimation for microbiome studies using pairwise distances and PERMANOVA.Bioinformatics. 2015; 31: 2461-2468
- Classification of placental lesions.Am J Obstet Gynecol. 2015; 213: S21-S28
Thompson LR, Sanders JG, McDonald D, et al. The Earth Microbiome Project. 2017. Available at: wwwearthmicrobiomeorg. Accessed January 2020.
- Reproducible, interactive, scalable and extensible microbiome data science using QIIME 2.Nat Biotechnol. 2019; 37: 852-857
- DADA2: high-resolution sample inference from Illumina amplicon data.Nat Methods. 2016; 13 (Accessed January 2020): 581-583
Hannon GJ. FASTX Toolkit. 2010. http://hannonlabcshledu/fastx_toolkit/indexhtml.
- MAFFT: a novel method for rapid multiple sequence alignment based on fast Fourier transform.Nucleic Acids Res. 2002; 30: 3059-3066
- Optimizing taxonomic classification of marker-gene amplicon sequences with QIIME 2s q2-feature-classifier plugin.Microbiome. 2018; 6: 90
- The SILVA ribosomal RNA gene database project: improved data processing and web-based tools.Nucleic Acids Res. 2013; 41: D590-D596
- Moderated estimation of fold change and dispersion for RNA-seq data with DESeq2.Genome Biol. 2014; 15: 550
- The role of the phylogenetic diversity measure, PD, in bio-informatics: getting the definition right.Evol Bioinform Online. 2007; 2: 277-283
- Picante: R tools for integrating phylogenies and ecology.Bioinformatics. 2010; 26: 1463-1464
- Species-diversity and pattern-diversity in the study of ecological succession.J Theor Biol. 1966; 10: 370-383
Lahti L. Microbiome R Package. 2019. Available at: https://microbiomegithubio/. Accessed January 2020.
- The mathematical theory of communication. 1963.MD Comput. 1997; 14: 306-317
Jea O. Vegan: community ecology package. 2019. Available at: https://cranr-projectorg/web/packages/vegan/indexhtml. Accessed January 2020.
- phyloseq: an R package for reproducible interactive analysis and graphics of microbiome census data.PLoS One. 2013; 8: e61217
- A method of establishing groups of equal amplitude in plant sociology based on similarity of species content.Kongelige Danske Videnskabernes Selsk. 1948; (5.1–34:4-7)
- Nouvelles recherches sur la distribution florale.Bulletin de la Société vaudoise des Sciences Naturelles. 1908; 44: 223-270
- UniFrac: a new phylogenetic method for comparing microbial communities.Appl Environ Microbiol. 2005; 71: 8228-8235
- Quantitative and qualitative beta diversity measures lead to different insights into factors that structure microbial communities.Appl Environ Microbiol. 2007; 73: 1576-1585
- RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies.Bioinformatics. 2014; 30: 1312-1313
- Bacterial attachment to the chorioamniotic membranes.Am J Obstet Gynecol. 1984; 148: 915-928
- Microbial communities in placentas from term normal pregnancy exhibit spatially variable profiles.Sci Rep. 2017; 7: 11200
- Progress in pathogenesis and management of clinical intraamniotic infection.Am J Obstet Gynecol. 1991; 164: 1317-1326
- Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study.J Perinat Med. 2019; 47: 915-931
- The changing landscape of the vaginal microbiome.Clin Lab Med. 2014; 34: 747-761
- Diagnosis and management of clinical chorioamnionitis.Clin Perinatol. 2010; 37: 339-354
- Committee Opinion No. 712: intrapartum management of intraamniotic infection.Obstet Gynecol. 2017; 130: e95-101
Article info
Publication history
Published online: January 06, 2023
Accepted:
December 6,
2022
Received:
December 3,
2022
Footnotes
The authors report no conflict of interest.
This research was supported by the Duke University Charles B. Hammond Research Fund. The sponsor had no involvement in study design; collection, analysis, or interpretation of data; writing of the report; or the decision to submit the article for publication.
Cite this article as: Sayres LC, Younge NE, Rikard B, et al. The gestational membrane microbiome in the presence or absence of intraamniotic infection. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
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