Combined Assessment of Vaginal Dysbiosis, Pro-inflammatory Cytokines, and Oxidative Stress Biomarkers in Pregnancy

Author(s): Ahmed kadhim hommood
Date: 09/10/2026
doi: https://doi.org/10.5281/zenodo.8425890

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Abstract

Background: While the relationship among microbial imbalance, inflammation, and oxidative stress with 
vaginal dysbiosis and adverse maternal and neonatal outcomes are established, they are not fully 
characterized.  Aims of the study: Investigate and assess the presence of bacterial vaginal dysbiosis in 
pregnant women, oxidative stress biomarkers, inflammatory cytokines and their antimicrobial 
susceptibility patterns and determine independent predictors of bacterial vaginal dysbiosis. Methodology: 
This study was a case–control design that recruited 100 pregnant women with vaginal dysbiosis and 50 
healthy pregnant controls in Thi-Qar, Iraq between July 10, 2025, and June 5, 2026. Amsel criteria and 
Nugent scoring were used to diagnose vaginal dysbiosis. High vaginal swabs were cultured on standard 
microbiological media and the bacterial isolates were identified by conventional biochemical methods and 
antimicrobial susceptibility was determined by the Kirby–Bauer method according to CLSI 2025. 
Commercial ELISA kits were used to measure serum inflammatory cytokines and Oxidative Stress 
Biomarkers.  Result: 100 women with vaginal dysbiosis were recruited along with 50 healthy controls. 
Baseline characteristics were similar except that cases were more likely to be rural residents, low SES, 
have previous vaginal infection, and to douche. Abnormal clinical and microbiological findings were 
significantly more common in women with vaginal dysbiosis and Gardnerella vaginalis was the 
predominant vaginal isolate. All inflammatory cytokines and oxidative stress markers were significantly 
increased, while antioxidant biomarkers were decreased (all P<0.001). Multivariable analyses revealed 
Gardnerella vaginalis, decreased levels of the Lactobacillus flora, and increased levels of malondialdehyde 
and of the inflammatory cytokine IL-6, as well as vaginal douching, to be independent risk factors for 
vaginal dysbiosis.  Conclusions: Vaginal dysbiosis in pregnancy is defined as an imbalance of microbes, 
with Gardnerella vaginalis predominating, less protective bacterial species of the Lactobacillus genus, 
greater systemic inflammation and higher oxidative stress. Combined microbiological and biomarker 
evaluation can enhance the early diagnosis, risk stratification and personalized treatment of pregnancy for 
reduced adverse pregnancy outcomes.

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