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The association between bacteriuria and adverse pregnancy outcomes: a systematic review and meta-analysis of
Hans R W Piazzolla1, Frederikke Modin1, Sofie I Halkjær2
1The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Insights
Significant bacteriuria in pregnancy is linked to preterm delivery, low birth weight, and preterm labor. However, current evidence quality is insufficient to confirm causality or guide treatment for bacteriuria in pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Perinatal Medicine
Background:
- Antibiotics are frequently prescribed during pregnancy to treat bacteriuria and urinary tract infections, aiming to prevent adverse pregnancy outcomes.
- Significant bacteriuria in pregnancy, defined as the presence of a substantial number of bacteria in urine, is a condition that warrants careful consideration due to potential risks.
- The management of bacteriuria in pregnancy is crucial for maternal and fetal well-being, necessitating a clear understanding of its associated risks.
Conclusions:
- An association exists between significant bacteriuria in pregnancy and preterm delivery, low birth weight, and preterm labor.
- The current evidence quality is insufficient to definitively establish causality or rule out confounding factors.
- There is a need for more high-quality research to guide the active identification and treatment of bacteriuria during pregnancy.
Background:
Antibiotics for bacteriuria and urinary tract infection are commonly prescribed during pregnancy to avoid adverse pregnancy outcomes. The aim of this study was to evaluate the association between significant bacteriuria in pregnancy and any of the four pregnancy outcomes: preterm delivery; low birth weight; small for gestational age; and preterm labour.
Methods:
Systematic review with meta-analysis of observational studies. We searched PubMed, EMBASE, the Cochrane CENTRAL library, and Web of Science for observational studies published before 1 March 2022. The risk of bias was assessed using the Newcastle-Ottawa scale. Study identification, data extraction and risk-of-bias assessment was performed by two independent authors. We combined the included studies in meta-analyses and expressed results as ORs with 95% CIs (Prospero CRD42016053485).
Results:
We identified 58 studies involving 421 657 women. The quality of the studies was mainly poor or fair. The pooled, unadjusted OR for the association between any significant bacteriuria and: (i) preterm delivery was 1.62 (95% CI: 1.30-2.01; 27 studies; I2 = 61%); (ii) low birth weight was 1.50 (95% CI: 1.30-1.72; 47 studies; I2 = 74%); (iii) preterm labour was 2.29 (95% CI: 1.53-3.43; 3 studies; I2 = 0%); and (iv) small for gestational age was 1.33 (95% CI: 0.88-2.02; 7 studies; I2 = 54%). Four studies provided an adjusted OR, but were too diverse to combine in meta-analysis.
Conclusions:
This systematic review identified an association between significant bacteriuria in pregnancy and the three complications: preterm delivery; low birth weight; and preterm labour. However, the quality of the available evidence is insufficient to conclude whether this association is merely due to confounding factors. There is a lack of high-quality evidence to support active identification and treatment of bacteriuria in pregnancy.
