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Antibiotics for asymptomatic bacteriuria in pregnancy
Fiona M Smaill1, Juan C Vazquez
1Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Room 2N29, Hamilton, ON, Canada, L8N 3Z5.
The Cochrane Database of Systematic Reviews
|August 8, 2015
Summary
Antibiotic treatment for asymptomatic bacteriuria in pregnancy effectively reduces pyelonephritis risk. However, the evidence quality is very low, necessitating cautious interpretation of benefits for low birthweight and preterm birth.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Asymptomatic bacteriuria (ASB) affects 2-10% of pregnancies, with untreated cases leading to acute pyelonephritis in up to 30% of mothers.
- ASB is linked to adverse pregnancy outcomes, including low birthweight and preterm birth.
Purpose of the Study:
- To evaluate the impact of antibiotic treatment for ASB on pyelonephritis development.
- To assess the effect of ASB antibiotic treatment on the risks of low birthweight and preterm birth.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing antibiotic treatment versus placebo or no treatment for ASB in pregnant women.
- Searched Cochrane Pregnancy and Childbirth Group's Trials Register and study reference lists.
- Independent assessment of trials for inclusion, risk of bias, and data extraction by two reviewers.
Main Results:
- Fourteen RCTs involving nearly 2000 women were included.
- Antibiotic treatment significantly reduced pyelonephritis incidence (RR 0.23) but with very low-quality evidence.
- Associated with reduced low birthweight (RR 0.64) and preterm birth (RR 0.27), supported by low-quality evidence.
- Persistent bacteriuria at delivery was also reduced (RR 0.30).
Conclusions:
- Antibiotic treatment effectively reduces pyelonephritis in pregnancy, though evidence quality is very low, making effect estimates uncertain.
- Observed reductions in low birthweight and preterm birth align with infection-adverse outcome theories but require cautious interpretation due to poor study quality.
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