Peggy Nygren, MA; Rongwei Fu, PhD; Michele Freeman, MPH; Christina Bougatsos, BS; Mark Klebanoff, MD, MPH; Jeanne-Marie Guise, MD, MPH
Nygren P, Fu R, Freeman M, Bougatsos C, Klebanoff M, Guise J. Evidence on the Benefits and Harms of Screening and Treating Pregnant Women Who Are Asymptomatic for Bacterial Vaginosis: An Update Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;148:220-233. doi: 10.7326/0003-4819-148-3-200802050-00008
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Published: Ann Intern Med. 2008;148(3):220-233.
Bacterial vaginosis is the most common lower genital tract syndrome among women of reproductive age. There has been continued debate about the value of screening and treating asymptomatic pregnant women for bacterial vaginosis.
To examine new evidence on the benefits and harms of screening and treating bacterial vaginosis in asymptomatic pregnant women.
English-language studies on Ovid MEDLINE (2000 to September 2007) and Cochrane Library databases (through September 2007), reference lists, and expert suggestions.
Screening, treatment, or adverse effect studies with pregnancy outcome data in women who are asymptomatic for bacterial vaginosis.
Study and patient characteristics, treatment variables, adverse pregnancy outcomes, and internal validity quality criteria from the U.S. Preventive Services Task Force (USPSTF) and Jadad scale were abstracted.
7 new randomized, controlled treatment trials and 2001 report data were combined in a series of meta-analyses to estimate the pooled effect of treatment on preterm delivery (<37, <34, and <32 weeks); low birthweight; and preterm, premature rupture of membranes.
No screening studies that compared a screened population with a nonscreened population were found. Significant heterogeneity was found among the high-risk treatment trials (PÂ < 0.001). It is not clear from the detailed description of the studies which factors explain the differences in preterm delivery rates and potentially the association of treatment effect; however, both raise concern for the unintended potential for harm.
No benefit was found in treating women with low- or average-risk pregnancies for asymptomatic bacterial vaginosis. More research is needed to better understand these groups and the conditions under which treatment can be harmful or helpful, and to explore the relevance of bacterial vaginosis to other adverse pregnancy outcomes, such as delivery before 34 weeks.
KQ = key question.
Appendix Table 1.
Appendix Table 2.
Appendix Table 3.
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Appendix Table 5.
BV = bacterial vaginosis; RCT = randomized, controlled trial. *Cochrane databases include the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects. †Other sources include reference lists and expert suggestions. ‡We included 7 additional studies for key question 2 and 2 for key question 3 from the 2001 report in the summary of this evidence.
Span = treatment timing spans less than 20 weeks and greater than 20 weeks. *Baseline risk is the percentage of deliveries before 37 weeks in the placebo group. Absolute risk reduction is the difference in probability of delivery before 37 weeks (control minus treatment). †McDonald et al. (58) and Carey et al. (57) performed a high-risk group subanalysis; high-risk group is included in total study population of the average-risk target group. Odendaal et al. (50) included 2 target populations; high-risk and low-risk groups are 2 separate groups.
PTD = preterm delivery. *McDonald et al. (58) and Carey et al. (57) performed a high-risk group subanalysis; high-risk group is included in total study population of the average-risk target group. Odendaal et al. (50) included 2 target populations; high-risk and low-risk groups are 2 separate groups.
*McDonald et al. (58) and Carey et al. (57) performed a high-risk group subanalysis; high-risk group is included in total study population of the average-risk target group.
BV = bacterial vaginosis; PTD = preterm delivery. *To calculate the confidence limits for the increase or decrease in adverse outcome, plug in the confidence limits of effect size here. †A negative sign (−) indicates a net increase in adverse outcomes (harm), and a positive sign (+) indicates a net decrease in adverse outcomes (benefit).
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