Lactobacillus iners-dominated vaginal microbiota in pregnancy

Authors: J. Mls;  J. Stráník;  M. Kacerovský
Authors‘ workplace: Porodnická a gynekologická klinika FN, Hradec Králové, přednosta prof. MUDr. J. Špaček, Ph. D., IFEPAG
Published in: Ceska Gynekol 2019; 84(6): 463-467


Objective: To summarize current knowledge regarding Lactobacillus iners-dominated vaginal microbiota in pregnancy, as well as an association between the presence of Lactobacillus iners and pregnancy complications

Type of study: Review.

Setting: Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove.

Methods and results: In this review, the results from literature available about the presence of L. iners-dominated microbiota in pregnancy and the association between the presence of L. iners-dominated microbiota and abortion, spontaneous preterm delivery with intact membranes, and preterm prelabor rupture of membranes are summarized.

Conclusion: L. iners-dominated vaginal microbiota appears to be associated with an increased risk of the development of specific pregnancies pathologies.


microbiota – premature birth – Lactobacillus iners


1. Anton, L., Sierra, LJ., Devine, A., et al. Common cervicovaginal microbial supernatants alter cervical epithelial function: mechanisms by which Lactobacillus crispatus contributes to cervical health. Front Microbiol, 2018, 9, p. 2181.

2. Boris, S., Barbés, C. Role played by lactobacilli in controlling the population of vaginal pathogens. Mirobes Infect, 2000, 2(5), p. 543–546.

3. Boskey, E., Cone, R., Whaley, K., Moench, T. Origins of vaginal acidity: high D/L lactate ratio is consistent with bacteria being the primary source. Hum Reprod, 2001, 16(9), p. 1809–1813.

4. Boskey, E., Telsch, K., Whaley, K., Moench, T., et al. Acid production by vaginal flora in vitro is consistent with the rate and extent of vaginal acidification. Infect Immun, 1999, 67(10), p. 5170–5175.

5. Brown, RG., Al-Memar, M., Marchesi, JR., Lee, YS., et al. Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes. Transl Res, 2019, 207, p. 30–43.

6. Collins, SL., McMillan, A., Seney, S., et al. Promising prebiotic candidate established by evaluation of lactitol, lactulose, raffinose, and oligofructose for maintenance of a lactobacillus-dominated vaginal microbiota. Am Soc Microbiol, 2018, 84(5), p. e02200–02217.

7. Doerflinger, SY., Throop AL., Herbst-Kralovetz, MM. Bacteria in the vaginal microbiome alter the innate immune response and barrier properties of the human vaginal epithelia in a species-specific manner. J Infect Dis, 2014, 209(12), p. 1989–1999.

8. El Aila, NA., Tency, I., Claeys, G., et al. Identification and genotyping of bacteria from paired vaginal and rectal samples from pregnant women indicates similarity between vaginal and rectal microflora. BMC Infect Dis, 2009, 9(1), p. 167.

9. El Aila, NA., Tency, I., Saerens, B., et al. Strong correspondence in bacterial loads between the vagina and rectum of pregnant women. Res Microbiol, 2011, 162(5), p. 506–513.

10. Falsen, E., Pascual, C., Sjődén, B., et al. Phenotypic and phylogenetic characterization of a novel Lactobacillus species from human sources: description of Lactobacillus iners sp. nov. Int J Syst Evol Micr, 1999, 49(1), p. 217–221.

11. France, MT., Mendes-Soares, H., Forney, LJ. Genomic comparisons of Lactobacillus crispatus and Lactobacillus iners reveal potential ecological drivers of community composition in the vagina. Appl Environ Microbio, 2016, 82(24), p. 7063–7073.

12. Freitas, AC., Bocking, A., Hill JE., Money, DM. Increased richness and diversity of the vaginal microbiota and spontaneous preterm birth. Microbiome, 2018, 6(1), p. 117.

13. Horvath, P., Barrangou, R. CRISPR/Cas, the immune system of bacteria and archaea. Science, 2010, 327(5962), p. 167–170.

14. Hyman, RW., Fukushima, M., Jiang, H., et al. Diversity of the vaginal microbiome correlates with preterm birth. Reprod Sci, 2014, 21(1), p. 32–40.

15. Jayaprakash, TP., Wagner, EC., Van Schalkwyk, J., et al. High diversity and variability in the vaginal microbiome in women following preterm premature rupture of membranes (PPROM): a prospective cohort study. PLoS One, 2016, 11(11), e0166794.

16. Kacerovský, M., Vrbacký, F., Kutová, R., et al. Cervical microbiota in women with preterm prelabor rupture of membranes. PLoS One, 2015, 10(5), e0126884.

17. Kindinger, LM., Bennett, PR., Lee, YS., et al. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome, 2017, 5(1), p. 6.

18. Lamont, RF., Sobel, JD., Akins, RA., et al. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG, 2011, 118(5), p. 533–549.

19. Leizer, J., Nasioudis, D., Forney, LJ., et al. Properties of epithelial cells and vaginal secretions in pregnant women when Lactobacillus crispatus or Lactobacillus iners dominate the vaginal microbiome. Reprod sci, 2018, 25(6), p, 854–860.

20. MacIntyre, DA., Chandiramani, M., Lee, YS., et al. The vaginal microbiome during pregnancy and the postpartum period in a European population. Sci Rep-UK, 2015, 5, p. 8988.

21. Macklaim, JM., Gloor, GB., Anukan, KC., et al. At the crossroads of vaginal health and disease, the genome sequence of Lactobacillus iners AB-1. P Natl Acad Sci USA, 2011, 108(Suppl.1), p, 4688–4695.

22. McMillan, A., Macklaim, JM., Burton, JP., Reid, G. Adhesion of Lactobacillus iners AB-1 to human fibronectin: a key mediator for persistence in the vagina? Reprod Sci, 2013, 20(7), p. 791–796.

23. Mirmonsef, P., Hotton, AL., Gilbert, D., et al. Free glycogen in vaginal fluids is associated with Lactobacillus colonization and low vaginal pH. PLoS One, 2014, 9(7), e102467.

24. Nasioudis, D., Forney, LJ., Schneider, GM., et al. Influence of pregnancy history on the vaginal microbiome of pregnant women in their first trimester. Sci Rep-UK, 2017, 7(1), p. 10201.

25. Petricevic, L., Domig, KJ., Nierscher, FJ., et al. Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery. Sci Rep-UK, 2014, 4, p. 5136.

26. Rampersaud, R., Lewis, EL., Larocca, TJ., Ratner, AJ. Environmental pH modulates inerolysin activity via post-binding blockade. Sci Rep-UK, 2018, 8(1), p. 1542.

27. Rampersaud, R., Planet, PJ., Randis,TM., et al. Inerolysin, a cholesterol-dependent cytolysin produced by Lactobacillus iners. J Bacteriol, 2011, 193(5), p. 1034–1041.

28. Ravel, J., Gajer, P., Abdo, Z., et al. Vaginal microbiome of reproductive-age women. P Natl Acad Sci USA, 2011, 108(Suppl. 1), p. 4680–4687.

29. Redondo-Lopez, V., Ceek, RL., Sobel, JD. Emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora. Rev Infect Dis, 1990, 12(5), p. 856–872.

30. Romero, R., Hassan, SS., Gajer, P., et al. The vaginal microbiota of pregnant women who subsequently have spontaneous preterm labor and delivery and those with a normal delivery at term. Microbiome, 2014, 2(1), p. 18.

31. Romero, R., Hassan, SS., Gajer, P., et al. The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women. Microbiome, 2014, 2(1), p. 4.

32. Van Houdt, R., Ma, B., Bruisten, SM., et al. Lactobacillus iners-dominated vaginal microbiota is associated with increased susceptibility to Chlamydia trachomatis infection in Dutch women: a case-control study. Sex Transm Infect, 2018, 94(2), p. 117–123.

33. Vásquez, A., Jakobsson, T., Ahrné, S., et al. Vaginal Lactobacillus flora of healthy Swedish women. J Clin Microbiol, 2002, 40(8), p. 2746–2749.

34. Witkin, S., Linhares, I. Why do lactobacilli dominate the human vaginal microbiota? BJOG, 2017, 124(4), p. 606–611.

35. Witkin, SS., Mendes-Soares, H., Linhares, IM., et al. Influence of vaginal bacteria and D-and L-lactic acid isomers on vaginal extracellular matrix metalloproteinase inducer: implications for protection against upper genital tract infections. Am Soc Microbiol, 2013, 4(4), p. e00460–00413.

36. Zhou, X., Bent, SJ., Schneider, MG., et al. Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology+, 2004, 150(8), p. 2565–2573.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 6

2019 Issue 6

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account