Treatment of pregnant women with asymptomatic bacterial vaginosis with clindamycin
Bacterial vaginosis is present in up to 20 % of women during pregnancy, and is associated with complications such as preterm birth. Approximately half of the infected pregnant women are asymptomatic. Asymptomatic pregnant women with bacterial vaginosis and without a medical history of preterm births are usually not treated with antibiotics in Norway.
We searched systematically for articles in international databases, included articles that met our inclusion criteria, critically appraised and summarised the results descriptively or in meta-analysis. We included seven randomized controlled clinical trials showing that:
- Clindamycin is associated with little or no change in the risk of preterm birth before 37 weeks when administered to pregnant women with asymptomatic bacterial vaginosis. This applies when the treatment is given during the second trimester and if treatment is given before 20 weeks gestation. Our quality assessments suggest that the quality of the evidence is moderate.
- Treatment of asymptomatic bacterial vaginosis with clindamycin is probably associated with little or no difference in the incidence of low birth weight or postpartum uterus infections. Our quality assessment suggest that the quality of the evidence is low for these outcomes, implying that further research is likely to change the effect estimates.
- The quality of available research is too low to determine whether treatment with clindamycin can reduce the risk of preterm birth before 33 week gestation. This conclusion applies both if the treatment is given during the second trimester and if treatment is given before 20 week gestation (early treatment).