The Association Between Obesity and Weight Loss After Bariatric Surgery on the Vaginal Microbiota

Overview

Journal Microbiome

Publisher Biomed Central

Specialties Genetics
Microbiology

Date 2021 May 29

PMID 34049596

Citations 13

Authors

Olivia Raglan

David A MacIntyre

Anita Mitra

Yun S Lee

Ann Smith

Nada Assi

Jaya Nautiyal

Sanjay Purkayastha

Marc J Gunter

Hani Gabra

Julian R Marchesi

Phillip R Bennett

Maria Kyrgiou

Affiliations

Soon will be listed here.

Abstract

Background: Obesity and vaginal microbiome (VMB) dysbiosis are each risk factors for adverse reproductive and oncological health outcomes in women. Here, we investigated the relationship between obesity, vaginal bacterial composition, local inflammation and bariatric surgery.

Methods: Vaginal bacterial composition assessed by high-throughput sequencing of bacterial 16S rRNA genes and local cytokine levels measured using a multiplexed Magnetic Luminex Screening Assay were compared between 67 obese and 42 non-obese women. We further assessed temporal changes in the microbiota and cytokines in a subset of 27 women who underwent bariatric surgery.

Results: The bacterial component of the vaginal microbiota in obese women was characterised by a lower prevalence of a Lactobacillus-dominant VMB and higher prevalence of a high diversity (Lactobacillus spp., and Gardnerella- spp. depleted) VMB, compared with non-obese subjects (p<0.001). Obese women had higher relative abundance of Dialister species (p<0.001), Anaerococcus vaginalis (p=0.021), and Prevotella timonensis (p=0.020) and decreased relative abundance of Lactobacillus crispatus (p=0.014). Local vaginal IL-1β, IL-4, IL-6, IL-8, IFNγ, MIP-1α and TNFα levels were all higher among obese women, however, only IL-1β and IL-8 correlated with VMB species diversity. In a subset of obese women undergoing bariatric surgery, there were no significant overall differences in VMB following surgery; however, 75% of these women remained obese at 6 months. Prior to surgery, there was no relationship between body mass index (BMI) and VMB structure; however, post-surgery women with a Lactobacillus-dominant VMB had a significantly lower BMI than those with a high diversity VMB.

Conclusions: Obese women have a significantly different vaginal microbiota composition with increased levels of local inflammation compared to non-obese women. Bariatric surgery does not change the VMB; however, those with the greatest weight loss 6-month post-surgery are most likely to have a Lactobacillus-dominant VMB. Video abstract.

Citing Articles

Diverse vaginal microbiota in healthy Japanese women: a combined relative and quantitative analyses.

Ito M, Kataoka M, Sato Y, Nachi H, Nomoto K, Okada N Front Cell Infect Microbiol. 2025; 14:1487990.

PMID: 39967801 PMC: 11832463. DOI: 10.3389/fcimb.2024.1487990.

Population-level analyses identify host and environmental variables influencing the vaginal microbiome.

Qin L, Sun T, Li X, Zhao S, Liu Z, Zhang C Signal Transduct Target Ther. 2025; 10(1):64.

PMID: 39966341 PMC: 11836416. DOI: 10.1038/s41392-025-02152-8.

Correlation between uterine microbiota and pregnancy outcomes of embryo transfer in overweight and obese women.

Yan Y, Li Y, Wu L, Zhang Y, Guo H, Ji Y Front Cell Infect Microbiol. 2025; 15:1515563.

PMID: 39963402 PMC: 11830673. DOI: 10.3389/fcimb.2025.1515563.

An Analysis of the Digestive and Reproductive Tract Microbiota in Infertile Women with Obesity.

Bellver J, Gonzalez-Monfort M, Gonzalez S, Toson B, Labarta E, Castillon G Int J Mol Sci. 2024; 25(23.

PMID: 39684312 PMC: 11641297. DOI: 10.3390/ijms252312600.

The Vaginal Microbiome and Reproductive Health in Adolescents and Adults.

Malave-Ortiz S, Calvert M, Hood-Pishchany I, Shaw N J Pediatr Adolesc Gynecol. 2024; 38(2):117-123.

PMID: 39667660 PMC: 11875951. DOI: 10.1016/j.jpag.2024.12.008.

References

Key T, Allen N, Verkasalo P, Banks E . Energy balance and cancer: the role of sex hormones. Proc Nutr Soc. 2001; 60(1):81-9. DOI: 10.1079/pns200068. View

Legro R, Dodson W, Gnatuk C, Estes S, Kunselman A, Meadows J . Effects of gastric bypass surgery on female reproductive function. J Clin Endocrinol Metab. 2012; 97(12):4540-8. PMC: 3513539. DOI: 10.1210/jc.2012-2205. View

Elovitz M, Gajer P, Riis V, Brown A, Humphrys M, Holm J . Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm delivery. Nat Commun. 2019; 10(1):1305. PMC: 6428888. DOI: 10.1038/s41467-019-09285-9. View

Mitra A, MacIntyre D, Marchesi J, Lee Y, Bennett P, Kyrgiou M . The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: what do we know and where are we going next?. Microbiome. 2016; 4(1):58. PMC: 5088670. DOI: 10.1186/s40168-016-0203-0. View

Jamal M, Gunay Y, Capper A, Eid A, Heitshusen D, Samuel I . Roux-en-Y gastric bypass ameliorates polycystic ovary syndrome and dramatically improves conception rates: a 9-year analysis. Surg Obes Relat Dis. 2011; 8(4):440-4. DOI: 10.1016/j.soard.2011.09.022. View

Kozich J, Westcott S, Baxter N, Highlander S, Schloss P . Development of a dual-index sequencing strategy and curation pipeline for analyzing amplicon sequence data on the MiSeq Illumina sequencing platform. Appl Environ Microbiol. 2013; 79(17):5112-20. PMC: 3753973. DOI: 10.1128/AEM.01043-13. View

Brookheart R, Lewis W, Peipert J, Lewis A, Allsworth J . Association between obesity and bacterial vaginosis as assessed by Nugent score. Am J Obstet Gynecol. 2019; 220(5):476.e1-476.e11. PMC: 7232937. DOI: 10.1016/j.ajog.2019.01.229. View

Brotman R, Shardell M, Gajer P, Fadrosh D, Chang K, Silver M . Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2018; 25(11):1321-1330. DOI: 10.1097/GME.0000000000001236. View

Alekseyenko A, Perez-Perez G, De Souza A, Strober B, Gao Z, Bihan M . Community differentiation of the cutaneous microbiota in psoriasis. Microbiome. 2014; 1(1):31. PMC: 4177411. DOI: 10.1186/2049-2618-1-31. View

10.

Rich-Edwards J, Goldman M, Willett W, Hunter D, Stampfer M, Colditz G . Adolescent body mass index and infertility caused by ovulatory disorder. Am J Obstet Gynecol. 1994; 171(1):171-7. DOI: 10.1016/0002-9378(94)90465-0. View

11.

Moran L, Norman R . The effect of bariatric surgery on female reproductive function. J Clin Endocrinol Metab. 2012; 97(12):4352-4. DOI: 10.1210/jc.2012-3606. View

12.

Li J, Reshat R, Wu Q, Ashrafian H, Bueter M, le Roux C . Experimental bariatric surgery in rats generates a cytotoxic chemical environment in the gut contents. Front Microbiol. 2011; 2:183. PMC: 3171674. DOI: 10.3389/fmicb.2011.00183. View

13.

Parks D, Beiko R . Identifying biologically relevant differences between metagenomic communities. Bioinformatics. 2010; 26(6):715-21. DOI: 10.1093/bioinformatics/btq041. View

14.

Thurman A, Kimble T, Herold B, Mesquita P, Fichorova R, Dawood H . Bacterial Vaginosis and Subclinical Markers of Genital Tract Inflammation and Mucosal Immunity. AIDS Res Hum Retroviruses. 2015; 31(11):1139-52. PMC: 4651020. DOI: 10.1089/aid.2015.0006. View

15.

Kyrgiou M, Mitra A, Moscicki A . Does the vaginal microbiota play a role in the development of cervical cancer?. Transl Res. 2016; 179:168-182. PMC: 5164950. DOI: 10.1016/j.trsl.2016.07.004. View

16.

Schmidt F, Weschenfelder J, Sander C, Minkwitz J, Thormann J, Chittka T . Inflammatory cytokines in general and central obesity and modulating effects of physical activity. PLoS One. 2015; 10(3):e0121971. PMC: 4363366. DOI: 10.1371/journal.pone.0121971. View

17.

Gajer P, Brotman R, Bai G, Sakamoto J, Schutte U, Zhong X . Temporal dynamics of the human vaginal microbiota. Sci Transl Med. 2012; 4(132):132ra52. PMC: 3722878. DOI: 10.1126/scitranslmed.3003605. View

18.

Guelinckx I, Devlieger R, Vansant G . Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009; 15(2):189-201. DOI: 10.1093/humupd/dmn057. View

19.

Lim S, Norman R, Davies M, Moran L . The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev. 2012; 14(2):95-109. DOI: 10.1111/j.1467-789X.2012.01053.x. View

20.

Shannon B, Yi T, Perusini S, Gajer P, Ma B, Humphrys M . Association of HPV infection and clearance with cervicovaginal immunology and the vaginal microbiota. Mucosal Immunol. 2017; 10(5):1310-1319. PMC: 5526752. DOI: 10.1038/mi.2016.129. View