Understanding the Role of Bacterial Flora in Vaginal Health During Pregnancy

Experts specializing in maternal health have issued warnings regarding the potential risks associated with excessive washing of the vagina using soap or detergents. According to gynecologists, this practice can disrupt the balance of lactobacillus, a beneficial type of bacteria responsible for maintaining the acidity of the vaginal environment. Insufficient levels of lactobacillus can lead to reduced vaginal acidity, creating an environment favorable to infection-causing bacteria, which can have negative effects on pregnancy outcomes such as preterm births and miscarriages.

Lactobacillus acidophilus, a type of probiotic, plays a crucial role in maintaining a healthy balance of bacteria in the stomach, intestines, and vagina, as explained by the Mayo Clinic, an online medical portal. Lactobacillus bulgaricus, another strain of bacteria, is rod-shaped and gram-positive. It thrives in acidic environments and produces lactic acid through the fermentation of carbohydrates. This lactic acid contributes to the preservation and flavor of fermented milk products like cheese and yogurt. Lactobacillus bulgaricus can be found in the gastrointestinal tract and vagina of humans and animals, serving as a protective barrier against harmful bacteria.

The experts have emphasized in various interviews that a deficiency of lactobacillus in the vaginal flora can increase the risk of ascending infections, miscarriages, and preterm births. Professor George Eleje, a specialist in Obstetrics and Gynecology from the Faculty of Medicine at Nnamdi Azikiwe University in Anambra State, highlighted the importance of lactobacillus as a beneficial vaginal flora and cautioned about the potential harm posed by other organisms, including anaerobic bacteria, during pregnancy.

According to Professor George Eleje, who is a Consultant Obstetrician and Gynecologist at the Nnamdi Azikiwe University Teaching Hospital, anaerobic bacteria play a significant role in the normal vaginal flora as well as the outer cervical canal. He suggests that substantial vaginal infections can be expected to result from anaerobic bacteria.

He explains that the normal vaginal microbiome consists of both aerobic and anaerobic bacteria, with lactobacillus being one of the predominant types of bacteria. Lactobacilli contribute to defending against infections by maintaining the vaginal pH (acidity).

However, any factors that alter the vaginal acidity, such as washing the vagina with soap, can decrease the levels of lactobacilli and create an environment where organisms that thrive in lower acidity, particularly candida albicans, can flourish.

Furthermore, certain conditions such as diabetes, HIV, or the use of immune suppressants can reduce the ability of lactobacilli to regulate the pH of the vagina. This, in turn, allows the presence of other organisms that would not normally survive in the vagina's acidic environment.

Eleje describes candida albicans as a fungus that is typically present in small amounts in the intestines and vagina. Normally, healthy bacteria in the body keep candida in balance. However, a decrease in lactobacilli levels can lead to an overgrowth of candida, resulting in candidiasis.

The professor further highlights the concept of ascending infections, which occur when infectious pathogens from the mother's external genitalia reach the amniotic sac, weakening the taffeta membrane. This can lead to preterm labor and premature rupture of the membrane.

According to Professor George Eleje, in pregnant women, infections can reach the placenta either through ascending infection from the vagina or via infected seminal fluid, which can then affect the baby.

To address this issue, he advises pregnant women to maintain vaginal health by avoiding the use of soap or detergents and instead using plain water for cleaning.

He points out that certain detergents can be harmful to lactobacilli and emphasizes the importance of pregnant women with diabetes in controlling their condition to prevent immune suppression, which can promote the growth of harmful organisms.

For pregnant women with Human Immunodeficiency Virus (HIV), he advises them to adhere to their medications to maintain good immunity during pregnancy.

Dr. Cynthia Okafor, a Consultant Gynecologist and Obstetrician at Epe General Hospital in Lagos State, adds that various infections have been linked to miscarriage and other adverse pregnancy outcomes, such as stillbirth and preterm delivery.

She highlights that infections have been found in a significant percentage of miscarriage tissue samples, whereas control samples from medically induced abortions were not infected, as revealed in a recent study.

A study titled "The role of infection in miscarriage" conducted by Sevi Giakumelou et al. and published in the National Library of Medicine affirms that lactobacillus species bacteria make up the majority of the normal genital tract flora in healthy women.

According to the study, there are several potentially harmful organisms that can displace lactobacilli and become the predominant bacteria in the vagina. These organisms include Gardnerella vaginalis, group B streptococci, Staphylococcus aureus, Ureaplasma urealyticum, or Mycoplasma hominis. This displacement of lactobacilli can lead to a condition called bacterial vaginosis.

The study notes that bacterial vaginosis affects approximately 24 to 25 percent of women of reproductive age. It causes an increase in vaginal pH from the normal range of 3.8 to 4.2 to a pH level of 7.0. While bacterial vaginosis is often asymptomatic, it can cause vaginal discharge that may appear gray in color and have a distinct "fishy" odor. The study also highlights the association of bacterial vaginosis with premature delivery and miscarriage.

However, the authors of the study concluded that further research is needed to determine whether specific infections indeed increase the risk of miscarriage and whether screening newly pregnant women for treatable infections would lead to improved reproductive outcomes.