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a well-established marker of preterm birth32) are strong risk factors for PTB in the absence of HIV, we also adjusted for these factors in our analyses. Additional models were fitted to test whether HIV and ART status modified the associations of vaginal microbiota with sPTB. We also explored the relationship between vaginal microbiome and vaginal inflammatory markers with term birth. To explore the potential for causality, we compared the associations between the vaginal microbiome and vaginal inflammation with PTB and term birth using robust adjusted multivariable analysis to take into account confounding, and estimated the potential effect size of a causal relationship using the directed acyclic graph approach. Finally, we examined the effect of pregnancy and maternal factors on sPTB and term birth using robust adjusted multivariable analysis.
The authors thank the study participants and their families. The authors also thank the study team, the laboratory teams, and the data safety and monitoring board. We also thank Shannon Kingsley and John Kirkland for their assistance with the project. Finally, we acknowledge the Department of Microbiology and Pathology at the University of Michigan for their research support of the ZAPPS study.
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