Interventions for preventing recurrent urinary tract infection during pregnancy

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Evidence-Based Medicine

Background:

• Recurrent urinary tract infections (RUTI) pose risks during pregnancy, potentially leading to preterm birth and low birth weight.
• Interventions for preventing RUTI in pregnant individuals include pharmacological and non-pharmacological methods.
• Optimal strategies for preventing RUTI in pregnant women remain unclear.

Purpose of the Study:

• To evaluate the effectiveness of interventions for preventing recurrent urinary tract infections (RUTI) in pregnant women.
• Primary outcomes assessed were RUTI, preterm birth, small-for-gestational age infants, and infant mortality.
• The study aimed to identify the best approach for RUTI prevention in this population.

Main Methods:

• A systematic search was conducted for randomized controlled trials (RCTs), quasi-RCTs, and clustered RCTs.
• Interventions included pharmacological and non-pharmacological methods for RUTI prevention during pregnancy.
• One trial involving 200 women was included, comparing nitrofurantoin plus surveillance versus surveillance alone.

Main Results:

• Nitrofurantoin with surveillance did not significantly reduce RUTI or preterm birth compared to surveillance alone.
• A significant reduction in asymptomatic bacteriuria (ASB) was observed with nitrofurantoin and surveillance in women with high clinic attendance.
• Limited data were reported for primary and secondary outcomes, hindering definitive conclusions.

Conclusions:

• Daily nitrofurantoin and close surveillance did not demonstrate prevention of RUTI compared to surveillance alone.
• A significant reduction in ASB was noted in highly compliant patients receiving nitrofurantoin and surveillance.
• Further high-quality RCTs are needed to compare various interventions for RUTI prevention in pregnant women.