Preterm birth is an urgent public health problem with an incidence rate of 10% worldwide. The vaginal tract of cisgender women of reproductive age harbors a complex community of microbes that make up the vaginal microbiome, which plays a key role in women’s sexual and reproductive health. A healthy vaginal microbiome is commonly characterized by a microbe environment that is dominated by Lactobacillus. Dysbiosis of the microbiome to a more diverse microbial community has been associated with adverse sexual and reproductive health outcomes in the host, leading to increased study of how the vaginal microbiota may be involved in preterm birth. Research was conducted on the healthy and dysbiotic states of the vaginal microbiome and their connection to preterm birth by examining risk factors and proposed mechanisms. It was found that microbe-mediated inflammation, membrane damage, and infection as well as exposure to chemical compounds in hygiene products made women more susceptible to preterm birth. Potential microbiome-focused healthcare and policy interventions including microbiome profiling, probiotic and antibiotic use, as well as public health messaging, were proposed as preventative and therapeutic strategies for preterm birth.