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Predictors of spontaneous preterm birth in primigravid women remain undetermined. We evaluated whether biomarkers in vaginal secretions and/or differences in the dominant bacterium in the vaginal microbiome predicted the risk for spontaneous preterm birth in primigravid women with a cervical length &gt;25mm. In a prospective study, 146 second trimester pregnant women with their first conception and a cervix &gt;25mm were enrolled. The vaginal microbiome composition was characterized by analysis of 16S ribosomal RNA gene sequences. The concentrations of  d - and  l -lactic acid, matrix metalloproteinase (MMP) 2, 8 and 9 and tissue inhibitor of metalloproteinase (TIMP) 1 and 2 in vaginal secretions were measured by ELISA. Cervical length was determined by vaginal ultrasonography. Pregnancy outcome data were subsequently collected. There was a spontaneous preterm birth (SPTB) in 13 women (8.9%) while in an additional 8 women (5.5%) preterm delivery was medically indicated.  Lactobacillus iners  was the dominant vaginal bacterium in 61.5% of women with a SPTB but only in 31.2% of those who delivered at term ( p  = .0354). The vaginal concentration of TIMP-1 ( p  = .0419) and L-lactic acid ( p  = .0495) was higher in women with a SPTB as compared to those who delivered at term.  Lactobacillus iners  dominance was associated with elevated levels of TIMP-1 ( p  = .0434) and TIMP-2 ( p  = .0161) and lower levels of D-lactic acid ( p  &lt; .0001) compared to when  L. crispatus  was dominant. In this exploratory study of primigravid women, elevations in vaginal TIMP-1 and L- lactic acid and  L. iners  dominance in the vaginal microbiome are associated with an increased occurrence of SPTB.

An exploratory study of associations with spontaneous preterm birth in primigravid pregnant women with a normal cervical length