{"doi":"10.1093/cid/ciaa1876","title":"Influence of Intramuscular Depot Medroxyprogesterone Acetate Initiation on Vaginal Microbiota in the Postpartum Period","abstract":"BACKGROUND: The vaginal microbiome plays a key role in women's reproductive health. Use of exogenous hormones, such as intramuscular depot medroxyprogesterone acetate (DMPA-IM), may alter the composition of vaginal bacterial community. METHODS: Vaginal swab samples were collected from postpartum Kenyan women initiating DMPA-IM or nonhormonal contraception (non-HC). Bacterial vaginosis was assessed by Nugent score (Nugent-BV) and bacterial community composition was evaluated using broad-range 16S ribosomal RNA gene polymerase chain reaction with high-throughput sequencing. Changes in Nugent score, alpha diversity (Shannon diversity index), and total bacterial load between contraceptive groups from enrollment to 3 months after initiation were estimated using multivariable linear mixed effects regression. RESULTS: Among 54 human immunodeficiency virus-negative women, 33 choosing DMPA-IM and 21 choosing non-HC, Nugent-BV was more common among DMPA-IM users at enrollment. At follow-up, Nugent score had decreased significantly among DMPA-IM users (change, -1.89; 95% confidence interval [CI], -3.53 to -.25; P = .02) while alpha diversity remained stable (0.03; -.24 to .30; P = .83). Conversely, Nugent score remained relatively stable among non-HC users (change, -0.73; 95% CI, -2.18 to .73; P = .33) while alpha diversity decreased (-0.34; -.67 to -.001; P = .05). The total bacterial load decreased slightly in DMPA-IM users and increased slightly among non-HC users, resulting in a significant difference in change between the contraceptive groups (difference, -0.64 log10 gene copies per swab sample; 95% CI, -1.19 to -.08; P = .02). While significant changes in Nugent score and alpha diversity were observed within contraceptive groups, changes between groups were not significantly different. CONCLUSIONS: Postpartum vaginal bacterial diversity did not change in DMPA-IM users despite a reduction in Nugent-BV, but it decreased significantly among women using non-HC. Choice of contraception may influence Lactobacillus recovery in postpartum women.","journal":"Clinical Infectious Diseases","year":2020,"id":106967,"datarank":0.31191623125197543,"base_score":2.0794415416798357,"endowment":2.0794415416798357,"self_citation_contribution":0.31191623125197543,"citation_network_contribution":0.0,"self_endowment_contribution":0.31191623125197543,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.959,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":282873,"name":"Sujatha Srinivasan","orcid":"0000-0002-7267-3859","position":1,"is_corresponding":false},{"id":316700,"name":"Kenneth Tapia","orcid":"0000-0002-9393-0770","position":2,"is_corresponding":false},{"id":440807,"name":"Eric Munene Muriuki","orcid":null,"position":3,"is_corresponding":false},{"id":331197,"name":"Bhavna Chohan","orcid":"0000-0002-2125-6799","position":4,"is_corresponding":false},{"id":439693,"name":"Jacqueline Mae Wallis","orcid":"0000-0001-7964-202X","position":5,"is_corresponding":false},{"id":440808,"name":"Congzhou Liu","orcid":null,"position":6,"is_corresponding":false},{"id":421616,"name":"Brandon L. Guthrie","orcid":"0000-0002-2059-3291","position":7,"is_corresponding":false},{"id":407493,"name":"R. Scott McClelland","orcid":"0000-0003-2574-4201","position":8,"is_corresponding":false},{"id":282874,"name":"Noah G. Hoffman","orcid":"0000-0001-6791-7727","position":9,"is_corresponding":false},{"id":282875,"name":"David N. Fredricks","orcid":"0000-0003-2735-6800","position":10,"is_corresponding":false},{"id":331199,"name":"Alison C. Roxby","orcid":"0000-0001-9449-8062","position":11,"is_corresponding":false},{"id":422581,"name":"Bridget M. Whitney","orcid":"0000-0002-3738-5704","position":0,"is_corresponding":true}],"reference_count":52,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:12:31.053776Z","pmid":"33354707","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}