THE MICROBIOME IN THE DEVELOPMENT OF PRETERM BIRTH: MODERN DIAGNOSTIC AND THERAPEUTIC PERSPECTIVES

Abstract

Preterm birth (PTB) remains one of the most pressing problems in modern obstetrics and neonatology, being a leading cause of perinatal morbidity, neonatal mortality, and long-term neurological and metabolic complications in children. Despite significant advances in perinatal medicine, the incidence of PTB in most countries worldwide has not shown a substantial decline, highlighting the need to identify new pathogenetic mechanisms underlying its development. In recent years, increasing attention has been focused on the role of the microbiome in maintaining physiological pregnancy and in the development of obstetric complications.

This review summarizes current scientific data regarding the role of the vaginal, gut, oral, and intra-amniotic microbiome in the pathogenesis of preterm birth. The characteristics of the normal vaginal microbiome during pregnancy, the significance of Lactobacillus spp. dominance, as well as the role of vaginal dysbiosis, anaerobic flora, and microbe-induced inflammation in the premature activation of labor are discussed. Particular attention is paid to the molecular mechanisms involving Toll-like receptor activation, NF-κB signaling pathways, and the production of proinflammatory cytokines, prostaglandins, and matrix metalloproteinases involved in cervical remodeling, premature rupture of membranes, and stimulation of myometrial contractility.

Current approaches to microbiome diagnostics, including 16S rRNA sequencing, shotgun metagenomics, and metabolomic analysis, are analyzed as promising tools for developing personalized models for PTB risk prediction. Modern strategies for the correction of microbiome disturbances during pregnancy are also reviewed, including the use of probiotics, dietary modification, targeted antimicrobial therapy, and experimental vaginal microbiome transplantation. The перспективність integration of microbiome analysis into prenatal monitoring systems and the need for further large-scale studies to implement personalized preventive strategies into clinical practice are emphasized.

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