Effect of Probiotics on the Preterm Delivery Rate in Pregnant Women at High Risk for Preterm Birth

Study Overview
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Brief Summary
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Preterm birth (PB) continues to be the main cause of perinatal morbidity and mortality, with emotional and economic consequences. Despite improvements in health, PB prevalence remains stable, possibly due to complex causes such as maternal age, stress, multiparity, etc. Shortening of the uterine cervix in early stages of gestation is a risk factor for PB. The presence of abnormal vaginal microbiota in the early stages of pregnancy is als a risk factor for PB. However, no studies have analysed the impact of probiotics (live microorganisms which, in adequate amounts, confer a health benefit on the host) on the PB in high-risk PB patients (pregnant women with threatened preterm delivery, i.e., uterine contractions and cervical shortening, with a 30% PB risk before 34 weeks, and 50% PB prior to 37 weeks (> 6-10% PB). Similarly, the effect of probiotics on vaginal flora dominated by lactic acid-producing bacteria could be analysed.

Detailed Description
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Hypothesis Pregnant women with threatened preterm labour (TPL) will present vaginal microbiome different from those without TPL. Treatment with probiotics will modify the vaginal microbioma of pregnant women with TPL. The PB rate before 37 weeks in pregnant women with TPL who have received probiotics since their diagnosis will be reduced by at least 30%. Goals To correlate the use of probiotics of pregnant women with TPL with the PB rate before 37 weeks. To ascertain the PB rate before 28, 30, 32 and 34 weeks in both groups. To assess neonatal morbidity between both groups. Methods Prospective, randomised, longitudinal, prospective, double-blind study. Relevance This study will determine whether the use of probiotics in pregnant women with TPL is associated with a lower risk of PB before 37 weeks. If so, it would allow us to act on the tertiary prevention of PB and treatment of TPL, the main cause of perinatal morbidity and mortality in our setting. It will also facilitate understanding of the pathophysiology of PB, influence of vaginal microbiota and the mechanism of action of probiotics.

Official Title
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Effect of Probiotics on the Preterm Delivery Rate (< 37 Weeks) in Pregnant Women at High Risk for Preterm Birth (Pregnant Women With Threatened Preterm Labour): PROPEV TRIAL Protocol

Conditions
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Preterm Birth

Intervention / Treatment
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* Dietary Supplement: Probiotic
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion criteria Threatened preterm labour: regular clinical and cardiotography-registered uterine dynamics, and cervical modifications (cervical shortening ≤ 25 mm between 24 and 29 weeks, and ≤ 15 mm between 30 and 34 weeks) according to our care protocol. Single gestation. Echographically-normal foetal morphology. Minimum age 18 years. Ability to understand informed consent. Signed informed consent. Exclusion criteria Multiple gestations. Pregnant women with diagnosis of chorioamnionitis. Cervical dilation.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Definition and design. Prospective, double-blind randomised study. Population Pregnant women admitted for TPL between weeks 24.0 and 34.6 of gestation at the participating centre.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Probiotics group<br>Probiotic drug | Dietary Supplement: Probiotic<br>* Reduce preterm birth with this dietary supplement<br>|
| Placebo Comparator: Control group<br>This group will receive placebo | Other: Placebo<br>* Placebo<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preterm birth rate <37 weeks | To evaluate the percentage of preterm birth in each group (in days of gestation) | From 24 to 37 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preterm birth rate <34 weeks | To evaluate the percentage of preterm birth in each group (in days of gestation) | From 24 to 34 weeks | 
| Preterm birth rate <32 weeks | To evaluate the percentage of preterm birth in each group (in days of gestation) | From 24 to 32 weeks | 
| Preterm birth rate <30 weeks | To evaluate the percentage of preterm birth in each group (in days of gestation) | From 24 to 30 weeks | 
| Preterm birth rate <28 weeks | To evaluate the percentage of preterm birth in each group (in days of gestation) | From 24 to 38 weeks | 
| Intergroup neonatal morbidity | To assess neonatal morbidity | First year of life of newborns | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Probiotics, Preterm birth, Threatened preterm labour