Changes in the vaginal microbiome during pregnancy and the postpartum period in South African women: a longitudinal study

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Needs review
Citation
PMID PubMed identifier for scientific articles.
DOI Digital object identifier for electronic documents.
URI
Authors
Li K, Li F, Jaspan H, Nyemba D, Myer L, Aldrovandi G, Joseph-Davey D
Journal
Research square
Year
2023
African women have more diverse vaginal microbiota than women of European descent, and there is interest in the impact of this diversity on maternal health, including HIV and STI acquisition. We characterized the vaginal microbiota in a cohort of women ≥ 18 years with and without HIV in a longitudinal cohort over two visits during pregnancy and one visit postpartum. At each visit we obtained HIV testing and self-collected vaginal swabs for point of care testing for STIs and microbiome sequencing. We categorized microbial communities and evaluated changes over pregnancy and associations with HIV status and STI diagnosis. Across 242 women (mean age 29, 44% living with HIV, 33% diagnosed with STIs), we identified four main community state types (CSTs): two lactobacillus-dominant CSTs (dominated by Lactobacillus crispatus and Lactobacillus iners respectively) and two diverse, non-lactobacillus-dominant CSTs (one dominated by Gardnerella vaginalis and one by other facultative anaerobes). From first antenatal visit to third trimester (24-36 weeks gestation), 60% of women in the Gardnerella -dominant CST shifted to L actobacillus -dominant CSTs. From third trimester to postpartum (mean 17 days post-delivery), 80% of women in Lactobacillus -dominant CSTs shifted to non-lactobacillus-dominant CSTs with a large proportion in the facultative anaerobe-dominant CST. Microbial composition differed by STI diagnosis (PERMANOVA R 2  = 0.002, p = 0.004), and women diagnosed with an STI were more likely to be categorized with L. iners -dominant or Gardnerella -dominant CSTs. Overall we found a shift toward lactobacillus dominance during pregnancy, and the emergence of a distinct, highly diverse anaerobe-dominant microbiome population in the postpartum period.

Experiment 1


Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Subjects

Location of subjects
South Africa
Host species Species from which microbiome was sampled. Contact us to have more species added.
Homo sapiens
Body site Anatomical site where microbial samples were extracted from according to the Uber Anatomy Ontology
Vagina Distal oviductal region,Distal portion of oviduct,Vaginae,Vagina,vagina
Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
HIV infection [X]Human immunodeficiency virus disease,[X]Human immunodeficiency virus disease (disorder),[X]Unspecified human immunodeficiency virus [HIV] disease,[X]Unspecified human immunodeficiency virus [HIV] disease (disorder),HIV - Human immunodeficiency virus infection,HIV INFECT,HIV Infection,HIV infection,HIV Infections,HIV infectious disease,HTLV III INFECT,HTLV III Infections,HTLV III LAV INFECT,HTLV III LAV Infections,HTLV WIII INFECTIONS,HTLV WIII LAV INFECTIONS,HTLV-III Infection,HTLV-III Infections,HTLV-III-LAV Infection,HTLV-III-LAV Infections,HUMAN IMMUNO VIRUS DIS,human immunodeficiency virus,Human immunodeficiency virus [HIV] disease,HUMAN IMMUNOdeficiency VIRUS [HIV] INFECTION,Human immunodeficiency virus caused disease or disorder,Human immunodeficiency virus disease,Human immunodeficiency virus disease (disorder),Human immunodeficiency virus disease or disorder,Human immunodeficiency virus infection,Human immunodeficiency virus infection (disorder),Human immunodeficiency virus infection, NOS,Human immunodeficiency virus infectious disease,human immunodeficiency virus infectious disease,Infection, HIV,Infection, HTLV-III,Infection, HTLV-III-LAV,Infections, HIV,Infections, HTLV-III,Infections, HTLV-III-LAV,LYMPHOTROPIC VIRUS TYPE III INFECTIONS HUMAN T,T LYMPHOTROPIC VIRUS TYPE III INFECT HUMAN,T Lymphotropic Virus Type III Infections, Human,T-Lymphotropic Virus Type III Infections, Human,Unspecified human immunodeficiency virus [HIV] disease (disorder),hIV infection
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Human immunodeficiency virus (HIV) at Visit B
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Human immunodeficiency virus (HIV) at Visit B
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Human immunodeficiency virus (HIV) whose gestational age range at Visit B (third trimester visit) was 24–36 weeks.
Group 0 sample size Number of subjects in the control (unexposed) group
135
Group 1 sample size Number of subjects in the case (exposed) group
107

Lab analysis

Sequencing type
16S
16S variable region One or more hypervariable region(s) of the bacterial 16S gene
V4
Sequencing platform Manufacturer and experimental platform used for quantifying microbial abundance
Illumina

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
raw counts
Statistical test
Zero-Inflated Negative Binomial Regression
Significance threshold p-value or FDR threshold used for differential abundance testing (if any)
0.05
MHT correction Have statistical tests be corrected for multiple hypothesis testing (MHT)?
Yes

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
unchanged

Signature 1

Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S6

Description: Differential abundance testing of microbial species in women with and without Human immunodeficiency virus, HIV (zero-inflated negative binomial model)

Abundance in Group 1: decreased abundance in Pregnant women ≥ 18 years of age with Human immunodeficiency virus (HIV) at Visit B

NCBI Quality ControlLinks
Lactobacillus jensenii

Revision editor(s): Tosin

Experiment 2


Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Human immunodeficiency virus (HIV) at Postpartum (PPt) visit
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Human immunodeficiency virus (HIV) at Postpartum (PPt) visit.
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Human immunodeficiency virus (HIV) whose mean gestational age at the postpartum visit was 17 days after delivery.

Lab analysis

Statistical Analysis

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
unchanged

Signature 1

Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S6

Description: Differential abundance testing of microbial species in women with and without Human Imunodeficiency virus, HIV (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with Human immunodeficiency virus (HIV) at Postpartum (PPt) visit.

NCBI Quality ControlLinks
Fannyhessea vaginae
Metamycoplasma hominis

Revision editor(s): Tosin

Signature 2

Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S6

Description: Differential abundance testing of microbial species in women with and without Human Imunodeficiency virus, HIV (zero-inflated negative binomial model)

Abundance in Group 1: decreased abundance in Pregnant women ≥ 18 years of age with Human immunodeficiency virus (HIV) at Postpartum (PPt) visit.

NCBI Quality ControlLinks
Prevotella corporis
Hallella bergensis

Revision editor(s): Tosin

Experiment 3


Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Sexually transmitted disease disease (VD), venereal,disease, sexually Transmitted,disease, venereal,diseases, sexually Transmitted,diseases, venereal,infection, sexually Transmitted,infections, sexually Transmitted,sexually transmitted disease,sexually Transmitted disorder,sexually Transmitted infection,sexually Transmitted infections,STD,STDs,STI,STIs,Transmitted infection, sexually,Transmitted infections, sexually,VD,VD, venereal disease,venereal disease,venereal disease (VD),venereal diseases,Sexually transmitted disease
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without any sexually transmitted infection (STI) at Visit A
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) at Visit A
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) diagnosis whose mean gestational age at Visit A (first ANC visit) was 18.6 weeks (SD 6.3), with a range of 6–30 weeks.
Group 0 sample size Number of subjects in the control (unexposed) group
162
Group 1 sample size Number of subjects in the case (exposed) group
80

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 a

Description: Differential abundance testing of vaginal microbial species in women with and without any sexually transmitted infection, STI diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) at Visit A

NCBI Quality ControlLinks
Hallella colorans
Hoylesella buccalis
Metamycoplasma hominis
Prevotella amnii
Prevotella bivia
Sneathia vaginalis
Veillonellaceae bacterium

Revision editor(s): Tosin

Experiment 4


Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without any sexually transmitted infection (STI) at Visit B
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) at Visit B
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) diagnosis whose gestational age range at Visit B (third trimester visit) was 24–36 weeks.

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 a

Description: Differential abundance testing of vaginal microbial species in women with and without any sexually transmitted infection, STI diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) at Visit B

NCBI Quality ControlLinks
Hoylesella buccalis

Revision editor(s): Tosin

Experiment 5


Needs review

Curated date: 2025/03/08

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without any sexually transmitted infection (STI) at Postpartum (PPt) visit
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) at Postpartum (PPt) visit.
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) diagnosis whose mean gestational age at the postpartum visit was 17 days after delivery.

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 a

Description: Differential abundance testing of vaginal microbial species in women with and without any sexually transmitted infection, STI diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with any sexually transmitted infection (STI) at Postpartum (PPt) visit.

NCBI Quality ControlLinks
Prevotella sp.

Revision editor(s): Tosin

Experiment 6


Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Chlamydia trachomatis infectious disease chlamydia,Chlamydia Infections,Chlamydia trachomatis caused disease or disorder,Chlamydia trachomatis disease or disorder,Chlamydia trachomatis infectious disease,chlamydia trachomatis infectious disease,chlamydial disease,Chlamydial Infection,Chlamydial infection
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Chlamydia trachomatis (CT) infection at Visit A
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection at Visit A
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection diagnosis whose mean gestational age at Visit A (first ANC visit) was 18.6 weeks (SD 6.3), with a range of 6–30 weeks.
Group 0 sample size Number of subjects in the control (unexposed) group
190
Group 1 sample size Number of subjects in the case (exposed) group
52

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 b

Description: Differential abundance testing of vaginal microbial species in women with and without Chlamydia trachomatis (CT) infection diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection at Visit A

NCBI Quality ControlLinks
Hallella colorans
Hoylesella buccalis
Prevotella amnii
Sneathia vaginalis
Veillonellaceae bacterium
uncultured Megasphaera sp.
uncultured Lachnospiraceae bacterium

Revision editor(s): Tosin

Experiment 7


Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Chlamydia trachomatis (CT) infection at Visit B
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection at Visit B
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection diagnosis whose gestational age range at Visit B (third trimester visit) was 24–36 weeks.

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 b

Description: Differential abundance testing of vaginal microbial species in women with and without Chlamydia trachomatis (CT) infection diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection at Visit B

NCBI Quality ControlLinks
uncultured Megasphaera sp.
Hoylesella buccalis

Revision editor(s): Tosin

Experiment 8


Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Chlamydia trachomatis (CT) infection at postpartum (PPt) visit.
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection at postpartum (PPt) visit
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection diagnosis whose mean gestational age at the postpartum visit was 17 days after delivery.

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 b

Description: Differential abundance testing of vaginal microbial species in women with and without Chlamydia trachomatis (CT) infection diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with Chlamydia trachomatis (CT) infection at postpartum (PPt) visit

NCBI Quality ControlLinks
Prevotella sp.

Revision editor(s): Tosin

Experiment 9


Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Gonorrhea Neisseria gonorrhoeae infection,chronic gonococcal infectious disease of lower genitourinary tract,chronic gonococcal infectious disease of upper genitourinary tract,Crosti-gianotti syndrome,Gianotti Crosti syndrome,acrodermatitis, infantile lichenoid,acrodermatitis, papular infantile,infections, Neisseria gonorrhoeae,papular acrodermatitis of childhood,Gonorrhea,gonorrhea
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Neisseria gonorrhoea (NG) infection at postpartum (PPt) visit.
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Neisseria gonorrhoea (NG) infection at postpartum (PPt) visit
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Neisseria gonorrhoea (NG) infection diagnosis whose mean gestational age at the postpartum visit was 17 days after delivery.
Group 0 sample size Number of subjects in the control (unexposed) group
228
Group 1 sample size Number of subjects in the case (exposed) group
14

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 c

Description: Differential abundance testing of vaginal microbial species in women with and without Neisseria gonorrhoea (NG) infection diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: decreased abundance in Pregnant women ≥ 18 years of age with Neisseria gonorrhoea (NG) infection at postpartum (PPt) visit

NCBI Quality ControlLinks
Hallella bergensis

Revision editor(s): Tosin

Experiment 10


Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Trichomonas vaginitis Leukorrhoea vaginalis - trichomonal,Trichomonal leukorrhoea,Trichomonal vaginitis &/or vulvovaginitis,Trichomonal vaginitis (disorder),Trichomonal vulvovaginitis,Trichomonal vulvovaginitis (disorder),Trichomonas vaginalis caused disease of genitourinary system,Trichomonas vaginalis disease of genitourinary system,Trichomonas vaginalis trichomoniasis,Trichomonas Vaginitis,Trichomonas vaginitis,Trichomonas vaginitis urogenital infection,urogenital infection by Trichomonas vaginalis,urogenital infection caused by Trichomonas vaginalis,urogenital Trichomonas,urogenital trichomoniasis,vaginal trichomoniasis (disorder),trichomonas vaginitis
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Trichomonas vaginalis (TV) infection at Visit A
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Trichomonas vaginalis (TV) infection at Visit A
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Trichomonas vaginalis (TV) infection diagnosis whose mean gestational age at Visit A (first ANC visit) was 18.6 weeks (SD 6.3), with a range of 6–30 weeks.
Group 0 sample size Number of subjects in the control (unexposed) group
204
Group 1 sample size Number of subjects in the case (exposed) group
38

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 d

Description: Differential abundance testing of vaginal microbial species in women with and without Trichomonas vaginalis (TV) infection diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: increased abundance in Pregnant women ≥ 18 years of age with Trichomonas vaginalis (TV) infection at Visit A

NCBI Quality ControlLinks
Metamycoplasma hominis

Revision editor(s): Tosin

Experiment 11


Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Pregnant women ≥ 18 years of age without Trichomonas vaginalis (TV) infection at postpartum (PPt) visit.
Group 1 name Corresponds to the case (exposed) group for case-control studies
Pregnant women ≥ 18 years of age with Trichomonas vaginalis (TV) infection at postpartum (PPt) visit
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Pregnant women ≥ 18 years of age with Trichomonas vaginalis (TV) infection diagnosis whose mean gestational age at the postpartum visit was 17 days after delivery.

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/03/09

Curator: Tosin

Revision editor(s): Tosin

Source: Supplement S10 d

Description: Differential abundance testing of vaginal microbial species in women with and without Trichomonas vaginalis (TV) infection diagnosis (zero-inflated negative binomial model)

Abundance in Group 1: decreased abundance in Pregnant women ≥ 18 years of age with Trichomonas vaginalis (TV) infection at postpartum (PPt) visit

NCBI Quality ControlLinks
Sneathia sanguinegens

Revision editor(s): Tosin