Impact of Glycemic Variability on Vaginal Flora Alterations and Concomitant Antimicrobial Resistance During Pregnancy: Implications for Fetomaternal Outcomes.

Purpose: Vaginal flora alterations (AVF) have been implicated in both health and disease states. Few studies have looked at the connection between AVF and adverse fetomaternal outcomes(AFMOs), and even fewer have assessed their concurrent link with gestational diabetes mellitus (GDM). Therefore, this study investigated the association between AVF and GDM and their impact on AFMOs. In addition, we assessed the antimicrobial resistance(AMR) of isolated pathogens and sought to identify the associated risk factors.

Methods: This prospective, cross-sectional study was conducted among 640 pregnant women; divided into two groups, GDM and non-GDM. We administered standardized questionnaires to collect data regarding sociodemographic and clinical characteristics; collected vaginal samples at 26-38 weeks for Nugent scoring and determination of bacterial and fungal species; assessed AMR of the isolated pathogens and followed up patients for assessment of AFMOs.

Results: We found AVF in 47.5% of participants, with 36.6% having single AVF and 10.9% mixed AVF. There was a significantly higher occurrence of all studied AVF subtypes in GDM group. We noted high prevalence of AMR and MDR among isolated pathogens. We also found association of AFMO with different AVF subtypes, with higher prevalence of AFMOs among participants with mixed AVF.

Conclusion: The impact of AVF on AFMOs, along with their association with hyperglycemia; provides a potential avenue for working on minimizing AFMOs, which will eventually contribute toward improving the health of both the women and their offspring. The high prevalence of AVF and AMR in this study, calls for effective infection control and stewardship programmes.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-024-02095-0.