The blurred line between balance and crisis: From vaginal microbiome dynamics and pregnancy health to novel paradigms in managing vaginal dysbiosis
Microbe (Netherlands), cilt.12, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 12
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.microb.2026.100782
- Dergi Adı: Microbe (Netherlands)
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus
- Anahtar Kelimeler: Lactobacillus, Microbiota, Pregnancy complications, Probiotics, Therapeutics, Vulvovaginal candidiasis
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
A significant part of women's health depends on the vaginal microbiome (VMB), whose balance can be disrupted by internal and external factors, including pregnancy, making women more susceptible to infections and their subsequent complications. This study, as a narrative review, combines advanced evidence regarding the dynamics of the VMB during pregnancy, maternal and fetal pathologies associated with dysbiosis, immune-inflammatory mechanisms, and new therapeutic patterns, highlighting recent advancements. A comprehensive search in the databases Google Scholar, PubMed/Medline and Web of Science (2014–2026) was conducted using keywords related to human studies on pregnant women with/without vaginal dysbiosis, pregnancy complications, and maternal-fetal outcomes. Evidence shows that vaginal dysbiosis and increased microbial diversity, characterized by a decrease in Lactobacillus dominance and an enrichment of community state type (CST) IV (e.g., G. vaginalis), increase the risks and pregnancy complications. While the increased dominance and prevalence of Lactobacillus crispatus (L. crispatus) can have a protective role. Immunological regulatory disruption, namely disruption of TLR-4/NF-κB signaling and IL-8-mediated decrease of neutrophil recruitment, sustains inflammation and microbial imbalance. While targeted modulation of the VMB through vaginal microbiota transplantation (VMT) (by inducing nearly 90% dominance of lactobacilli), strain-specific probiotics like Lactobacillus casei rhamnosus, or Lactoferrin (LF) as a novel strategy reverses dysbiosis and reduces complications like preterm birth and preterm premature rupture of membranes (PPROM) by 50%, conventional treatments like antibiotics face issues like drug resistance and recurrence rates of 50–80%. Achieving promising results in restoring microbial balance requires conducting studies aimed at standardizing VMT and optimizing personalized probiotics.