# Integrated metagenomic and metabolomic profiling of spontaneous preterm birth in Chinese women

## TL;DR

This study explores how vaginal microbes and metabolic changes in Chinese women are linked to early childbirth, identifying potential markers for predicting and preventing preterm birth.

## Contribution

The study introduces integrated microbiome-metabolome signatures for spontaneous preterm birth in a Chinese cohort.

## Key findings

- sPTB is marked by reduced Lactobacillus dominance and higher microbial diversity compared to term pregnancies.
- Metabolomic analysis revealed decreased pantothenic acid and increased 4-pyridoxic acid in sPTB cases.
- A multi-metabolite model achieved high classification accuracy (AUROC = 0.9544) for sPTB.

## Abstract

Spontaneous preterm birth (sPTB) remains a major cause of neonatal morbidity and mortality. We used integrated metagenomics and untargeted metabolomics to identify vaginal microbial and host metabolic signatures associated with sPTB in Chinese women.

Vaginal swabs (sPTB, n = 37; term, n = 62) and available maternal plasma were profiled by shotgun metagenomic sequencing and UHPLC–HRMS metabolomics. Group differences in microbial diversity/taxa and metabolite features were evaluated, followed by pathway enrichment and microbiome–metabolome correlation analyses.

Compared with term controls, sPTB was characterized by reduced Lactobacillus dominance, higher vaginal microbial alpha diversity (p < 0.05), and distinct community structure (PERMANOVA p < 0.001). Metabolomic profiles of plasma and vaginal fluid differentiated sPTB from term pregnancy and highlighted decreased pantothenic acid and increased 4-pyridoxic acid, together with lipid and amino-acid perturbations. Pantothenic acid showed good discrimination (AUC = 0.82), and a multi-metabolite model improved classification (AUROC = 0.9544). KEGG analysis implicated vitamin B6 metabolism, pantothenate/CoA biosynthesis, and glycerophospholipid metabolism. Microbiome–metabolome integration dentified exploratory an sPTB-associated pattern in which Lactobacillus (e.g., L. crispatus) was positively correlated with pantothenic acid, while dysbiosis−/pathogen-associated taxa (including C. trachomatis) correlated with 4-pyridoxic acid.

sPTB in this Chinese cohort is associated with concurrent vaginal dysbiosis and systemic/local metabolic disturbances, supporting integrated microbiome–metabolite markers for risk stratification and potential preventive targets.