A project to validate the GLU test for preterm birth prediction in First Nations women
Kiarna Brown A B * , Holger W. Unger A B C , Margaret Peel D , Dorota A. Doherty E , Martin Lee F , Agatha Kujawa G , Sarah Holder B , Gilda Tachedjian H I J , Lindi Masson H I K L , Jane C. Thorn B , John P. Newnham E and Matthew S. Payne EA Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
B Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia.
C Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
D Geraldton Regional Aboriginal Medical Service, Rifle Range Road, Rangeway, WA, Australia.
E Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia.
F Rural Clinical School, The University of Western Australia, Perth, WA, Australia.
G Gove District Hospital, Nhulunbuy, NT, Australia.
H Life Sciences Discipline, Burnet Institute, Melbourne, Vic., Australia.
I Department of Microbiology, Monash University, Clayton, Vic., Australia.
J Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Vic., Australia.
K Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town 7925, South Africa.
L Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.
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Dr Kiarna Brown is a First Nations Specialist Obstetrician and Gynaecologist and Clinical Research Fellow. Her research interests are in reducing preterm birth for First Nations women. |
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Dr Holger Unger is an Obstetrician and Gynaecologist at the Royal Darwin Hospital and a Senior Research Fellow at the Menzies School of Health Research. He conducts clinical research that focusses on the prevention of adverse birth outcomes in low-resource and remote populations. |
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Maggie Peel is an experienced midwife and the Practice Manager at the Geraldton Regional Aboriginal Medical Service. She prides herself on empowering Aboriginal women to be able to receive and access the best antenatal care possible to assist them in gaining better health outcomes during their antenatal, intrapartum, and post-partum periods. |
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Professor Dorota Doherty is Head of the Biostatistics and Research Design Unit at the Women and Infants Research Foundation at King Edward Memorial Hospital (KEMH), and an Adjunct Professor at the Division of Obstetrics and Gynaecology, the University of Western Australia (UWA). Her expertise in biostatistical techniques has been pivotal in translational research in clinical medicine with complex epidemiological models that explore associations between subject phenotypes and health outcomes. |
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Dr Martin Lee is the Lead Medical Coordinator of the Rural Clinical School of Western Australia in Geraldton, maintains clinical work at Headspace Youth Focus, provides anaesthesia at St John of God Hospital, conducts sessional work at WA Cardiology, and is the current Chair of the Western Australian Primary Health Alliance – Midwest Gascoyne region. He has a keen rural community focus, and is passionate about quality workforce development and retention. |
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Dr Agatha Kujawa is a Rural Generalist and GP-Obstetrician working in Nhulunbuy, East Arnhem Land. She is passionate about the provision of equitable healthcare for those living in rural and remote areas in Australia. |
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Sarah Holder is a senior midwife and former Maternity Unit Manager at the Gove District Hospital located in Nhulunbuy, Arnhem Land. She has many years of experience in working with and caring for First Nations pregnant women in the NT. Sarah currently coordinates care for women with complex medical and psychosocial needs with Darwin’s Midwifery Group Practice. |
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Professor Gilda Tachedjian is Head of Life Sciences at The Burnet Institute. She is a microbiologist with >25 years of experience in identifying and developing HIV antiviral strategies, and is recognised as an expert on HIV prevention in women and the role of the vaginal microbiome and their metabolites in HIV acquisition. She has a growing interest in its role in adverse reproductive health outcomes. |
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Dr Lindi Masson is a Senior Research Fellow at the Burnet Institute, Honorary Research Associate at the University of Cape Town (UCT), Associate Member of the Institute of Infectious Disease and Molecular Medicine at UCT, Honorary Research Associate of the Centre for the AIDS Programme of Research in South Africa, and Adjunct Senior Lecturer at Monash University. She has been involved in genital microbiome and immunology research for >14 years. |
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Dr Jane Thorn is a Senior Obstetrician and Gynaecologist, and current Head of the Department of Obstetrics and Gynaecology at the Royal Darwin Hospital. She has provided antenatal and obstetric care for First Nations women in remote and urban communities at the Top End for over a decade. |
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Professor John Newnham is a Professor of Obstetrics at The University of Western Australia, and a sub-specialist in Maternal Fetal Medicine at KEMH. His enduring research interest has been to discover strategies to safely reduce the rate of preterm birth. He has published widely on this subject and is recognised as one of the world’s leading authorities. |
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Dr Matt Payne is a Senior Research Fellow at UWA with expertise in perinatal molecular microbiology. His major research interest is the role of the perinatal microbiome in preterm birth. Dr Payne is the lead investigator on the current study and designed the GLU test. |
Microbiology Australia 43(3) 130-134 https://doi.org/10.1071/MA22032
Submitted: 24 June 2022 Accepted: 15 August 2022 Published: 13 September 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the ASM. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
The protocol described in the present article aims to validate the GLU test, a test of mid-pregnancy vaginal microbiome, for PTB risk prediction in pregnant First Nations women. Preterm birth (PTB; birth before 37 completed weeks gestation) is associated with a higher risk of adverse neonatal outcomes. First Nations communities are affected by increasing PTB rates, highest in remote communities, reaching 23%. Being able to predict women at high risk of PTB is one of the greatest challenges of our time. No reliable clinical predictors of PTB risk currently exist, beyond a previous history. Spontaneous PTB (sPTB) is highly associated with microbial infection. Recently, a Western Australian research team developed an innovative mid-pregnancy vaginal microbial DNA test, the ‘Gardnerella, Lactobacillus, Ureaplasma’ (GLU) test, capable of predicting up to 45% of sPTB cases. However, this test has only been validated in predominantly Caucasian pregnant women. The protocol described aims to validate the GLU test in pregnant First Nations women and where applicable, make modifications to this test to improve sensitivity and specificity within this population.
Keywords: Australian First Nations, diagnostic test, genotype, microbiome, pregnancy, preterm labour, preterm premature rupture of membranes, real-time polymerase chain reaction, vagina.
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