To Lube or not to Lube: The Effect of Intrapartum Lubricant use on Vaginal Microbiota

PurposeThis study aimed to characterize the composition of vaginal microbiota during labor and to investigate the effect of lubricant use on its bacterial composition.Research QuestionsWhat is the composition of vaginal microbiota in late pregnancy, throughout labor, and in the postpartum period? Does intrapartum lubricant use affect the composition of vaginal microbiota during labor?SignificanceThe composition of vaginal microbiota is critically important during pregnancy because maternal microbes transferred at birth form the basis of the neonate's microbiome. Vaginal dysbiosis, a disruption in composition, is linked with many biological and behavioral factors, including use of personal lubricants. Studies show that lubricants can alter microbial composition and damage the integrity of vaginal epithelium. These findings are concerning because similar lubricants are frequently used during labor. However, the effect of lubricant use on vaginal microbiota during labor has not been studied.MethodsThe prospective cohort study was nested within a federally‐funded study (R01NR014826). Fifteen participants collected mid‐vaginal specimens during pregnancy, labor, and in the postpartum period, and clinical labor data were extracted from medical records. 16S rRNA gene profiling was used for bacterial composition, and multiple linear regression was used to investigate the effect of intrapartum lubricant use.ResultsThe composition of vaginal microbiota varied among participants, with a notable high abundance of Lactobacillus iners and Gardnerella vaginalis. A significant bivariate negative correlation between lubricant use and relative abundance of L. crispatus disappeared when controlling for time since ruptured membranes. A trend between lubricant use and changes in the composition of vaginal microbiota as measured by the Jensen‐Shannon distance was noted but not significant.DiscussionThe study offers novel information about the composition of vaginal microbiota during labor and the effect of lubricant use on its composition. The potential relationship between increased lubricant use and decreased L. crispatus has important clinical significance for perinatal providers and can be used to begin to build evidence that supports a less invasive approach to perinatal practice. The study was limited by a small sample, a lack of control group, and the analysis of relative abundance, as opposed to absolute abundance. A larger study is needed to further elucidate the association between lubricant use and vaginal dysbiosis.