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 (RUTIs) pose risks during pregnancy, potentially leading to adverse outcomes like preterm birth and low birth weight.
• Interventions to prevent RUTIs in pregnant women include pharmacological (e.g., antibiotics) and non-pharmacological methods.
• Optimal strategies for preventing RUTIs in pregnant individuals are not well-established.

Purpose of the Study:

• To evaluate the effectiveness of interventions aimed at preventing RUTIs in pregnant women.
• Primary outcomes assessed were RUTI and preterm birth; infant outcomes included small-for-gestational age and mortality.

Main Methods:

• A systematic search of the Cochrane Pregnancy and Childbirth Group's Trials Register and reference lists was conducted.
• Included were randomized controlled trials (RCTs), quasi-RCTs, and cluster-RCTs comparing any intervention against another, placebo, or usual care.
• Data extraction and risk of bias assessment were performed independently by two reviewers.

Main Results:

• One trial with 200 participants, at moderate to high risk of bias, compared nitrofurantoin plus surveillance versus surveillance alone.
• No significant differences were observed for RUTI, recurrent pyelonephritis, or preterm birth (very low quality evidence).
• Nitrofurantoin significantly reduced asymptomatic bacteriuria (ASB) in women with high clinic attendance; evidence quality for secondary outcomes was very low.

Conclusions:

• Daily nitrofurantoin with close surveillance did not demonstrate a preventative effect on RUTIs compared to surveillance alone.
• A significant reduction in ASB was noted with nitrofurantoin in highly compliant patients.
• Limited data and low-quality evidence preclude definitive conclusions; further RCTs are needed to identify optimal RUTI prevention strategies in pregnancy.