Interactive effects of bacterial vaginal colonization and HIV on pregnancy outcomes: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
Abstract Background The independent impact of HIV and bacterial vaginal colonization on pregnancy outcomes has been documented and is compounded by the burden of rapidly escalating antimicrobial resistance. However, the interactive effect of HIV and lower genital tract bacterial colonization, on pregnancy outcomes has not been thoroughly studied and is examined in our study. Methods We performed a systematic review and meta-analysis to quantitatively assess the interaction between HIV and vaginal bacterial colonization and associations with birth weight and preterm birth. We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, African Journals Online, and PubMed databases to identify studies published up to December 31, 2023. We included observational reporting on vaginal colonization with bacterial pathogens stratified by HIV status that reported pregnancy outcomes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used a modified Newcastle-Ottawa Scale to assess study quality. Meta-analysis was conducted using random-effects modeling in STATA Version 18. Pooled log-odds ratios were calculated. The study protocol was registered in PROSPERO(CRD42023485123). Results We selected 13 studies, involving 6,073 pregnant women, from 5,807 studies identified. The overall pooled prevalence of bacterial colonization was 26%(95%CI:17.3-37.4). There was no significant effect of HIV status and vaginal colonization on birth weight(OR=1.2, 95%CI:-2.57-2.20, p =0.88) and borderline increased odds of preterm birth (OR=2.64, 95%CI:-0.01-1.94, p =0.05). There was no significant association between HIV status and bacterial colonization(OR=1.08, 95%CI =-0.91-1.07), nor in antimicrobial resistance between pregnant women with HIV and those without. Conclusion Bacterial colonization is prevalent among pregnant women, but there is no clear evidence to suggest that HIV and bacterial colonization interact to affect birth weight or preterm birth. Research with large sample sizes, strict selection criteria, reliable and valid measurement, adequate control for confounding variables, and birthweight and gestational age at delivery assessment as continuous outcomes are still needed to provide robust evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.042 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.050 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".