VAGINAL MICROBIOME IN PREGNANT WOMEN WITH UTERINE HYPERPROLIFERATIVE DISEASES

The vaginal microbiota plays a critical role in the reproductive health of women with hyperproliferative uterine diseases (HPD), particularly in those with adenomyosis, uterine leiomyoma, polyps, and/or endometrial hyperplasia. The purpose of the study: to investigate the characteristics of the vaginal microbiome in pregnant women diagnosed with HPD. Materials and methods. This prospective, randomized cohort study analyzed the vaginal microbiome in 680 pregnant women of reproductive age who were monitored and delivered at the State Institution "Ukrainian Center for Maternity and Childhood of the National Academy of Medical Sciences of Ukraine" between 2018 and 2024. The first, main group included 517 pregnant women diagnosed with HPD, comprising uterine endometriosis (adenomyosis), uterine leiomyoma, endometrial polyps, and glandular endometrial hyperplasia. Endometrial polyps and glandular hyperplasia had been surgically removed via hysteroscopy prior to pregnancy. The second, comparison group consisted of 82 pregnant women without HPD, while the third, control group included 81 healthy pregnant women. The study was conducted in accordance with the basic principles of the Helsinki Declaration on Biometric Research and the powers of the GCNICN (1996) in accordance with biometric standards and in compliance with the principles of confidentiality and ethics (excerpt from Protocol № 5 of 24 June 2020 of the meeting of the Commission on Bioethics and Deontology of the State Institution ‘IPAG named after Academician O.M. Lukyanova of the National Academy of Medical Sciences of Ukraine’). Statistical processing of the research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 software. Parametric methods were used for quantitative characteristics with normal distribution. Descriptive statistics included the calculation of arithmetic means (M), standard deviation (SD) and 95% confidence interval (CI 95%). Differences in mean values were considered significant with a probability level of at least 95% (p<0.05). Results. Normocenosis was identified in 40.8% of pregnant women with HPD. Among this group, Ureaplasma urealyticum (18.3%), Mycoplasma genitalium (11.1%), cytomegalovirus (CMV, 61.8%), and herpes simplex virus type I (HSV-I, 87.3%) were detected with higher frequency. Chlamydia trachomatis was found in 4.9% of pregnant women with HPD. Between 2018 and 2020, Ureaplasma urealyticum and Mycoplasma genitalium were detected in approximately in 31% of pregnant women with HPD, whereas this figure decreased to 9% between 2021 and 2024. Chlamydia trachomatis detection in pregnant women with HPD dropped from 17% in 2018–2020 to 3% in 2021–2024. An increase in vaginal colonization by obligate anaerobic microorganisms (20.3%), primarily Gardnerella vaginalis and Atopobium vaginae, was observed against a background of lactobacilli deficiency (p<0.05). The aerobic opportunistic microbiota in the vaginal flora of pregnant women with HPD was dominated by Escherichia coli (27.8%), Streptococcus viridans (20.0%), and Streptococcus faecalis (19.3%). Conclusions. In pregnant women with hyperproliferative uterine diseases (adenomyosis, uterine leiomyoma, and/or a history of endometrial polyps or hyperplasia), alterations in vaginal microbiocenosis were identified. These were characterized by increased colonization by obligate anaerobic and aerobic opportunistic microorganisms, accompanied by a marked deficiency of lactobacilli.