Researchers from the Aga Khan University are investigating whether microbiota (microscopic organisms) inside a mother’s vagina can predict the onset of preterm labour and which babies are likely to have complications related to being born too early.
Around the world, fifteen million babies are estimated to be born too early every year and approximately one million of those children die each year due to complications of preterm birth. Although certain bacteria can cause preterm labour, it is
"If we can identify the causes of preterm labor, we have the opportunity to prevent it, so that more babies can go to full term and avoid these complications"
Professor Rodney Adam, Professor of Pathology and Medicine, Aga Khan University
still not known if the general pattern of bacteria (the microbiota) impacts premature onset of labour.
The study titled The maternal and neonatal microbiota correlates of preterm labor and adverse neonatal outcomes will see researchers use new technology to look not just at single bacteria, but at the make-up of all the bacteria of the vagina. They are trying to determine whether the make-up of these bacteria impact whether a woman goes into preterm labour (before 37 weeks of pregnancy). If there are certain bacterial patterns found in women that are associated with preterm labour, then these insights can help inform interventions to prevent preterm labour in the future.
“When babies come too early, their risk of complications is much higher than when they are full term at the time of delivery," said Dr Rodney Adam, a professor of pathology and medicine at Aga Khan University. “These complications are among the major causes of childhood mortality. In addition, many of the survivors are left with disability. If we can identify the causes of preterm labour, we have the opportunity to prevent it, so that more babies can go to full term and avoid these complications.”
At birth, a baby has very few bacteria but rapidly acquires these microbes. This process is started when the baby passes through the vagina during the birth process. Even in C-section babies, the bacteria from the vagina are important contributors to the baby's health. Many of these bacteria are essential for good health, but certain types of bacteria can cause problems.
Each part of the body is colonised with many types of bacteria which are mostly beneficial. These microscopic organisms in our body, or microbiota, are often described as a ‘second genome’ that hold a number of undiscovered secrets about our health. The genetic make-up of these micro-organisms, whether in the intestine or the reproductive organs or on the skin, determines their influence on the body.
“For example, the normal bacteria on the skin protect us from bacteria that can cause skin infection. Likewise, most of the bacteria in the vagina are beneficial and should be there normally. However, when the wrong bacteria are present there can be adverse consequences. There are certain bacteria that can be present in the vagina that cause infection in newborns.” Professor Adam added.
Infections involving bacteria in the intestinal tract are among the most common complications. One type is bloodstream infection (sepsis) and another is necrotising enterocolitis which occurs when bacteria invade the intestinal wall causing the intestine to become inflamed. The reasons for these complications are yet to be explored.
“Globally, maternal and newborn health have improved dramatically thanks to joint efforts during the Millennium Development Goals. However, a lot needs to be done as too many mothers and newborns are facing complications of childbirth. A major challenge is preterm birth that can lead to serious complications for the child. Preterm birth can be due to many factors, and a common one is infections leading to preterm labour and delivery,” said Professor Marleen Temmerman, Director of the Centre of Excellence in Women and Child Health, East Africa.
“The exact mechanisms are not fully known and this project will contribute to knowledge and hopefully early detection and treatment of infection-related preterm birth,” she added.
The research project is a collaborative effort among three departments at the Aga Khan University Hospital, Nairobi: the departments of pathology, paadiatrics and obstetrics & gynaecology. The research team is led by Professor Rodney Adam who is the principal investigator of the study. Co- investigators include Professor Marleen Temmerman and Dr Maria Carvalho from the department of obstetrics & gynaecology; Dr Roseline Ochieng from the department of paediatrics; Dr Patricia Okiro from the department of pathology and Dr Rob Beiko from Dalhousie University, Canada.
The AKU co-investigators have additional roles as supervisors of three residents: Dr David Atandi (pathology), Dr Quek Mei Chi (paediatrics) and Dr Edgar Gulavi (obstetrics & gynaecology). Ms Melanie Fontaine from University of Alberta, Canada, is also involved in the project as a research intern. The research is coordinated by Ms Fridah Kirimi at Aga Khan University.
"Working with the AKUHN team on this project has been an immensely rewarding experience,” said Melanie Fontaine, a research intern on the project from the University of Alberta, Canada. “Infants born pre-term in LMICs are at a distinct disadvantage and lacking substantial research. The knowledge gained from directly assessing the microbiome of patients in this study will open up many more opportunities for future research, interventions and possible treatment options not only in Kenya, but also globally. I am extremely honoured to be a part of this research team."
Currently, participant recruitment is ongoing and the study is expected be completed in 2019. The study is informed by targets under Sustainable Development Goal 3 which call for steps to end all preventable deaths of newborns and children under the age of five by 2030.
