Exploring Non-antibiotic Interventions for Preventing Urinary Tract Infections During Pregnancy: A Systematic Review

Urinary tract infections (UTIs) are a common health concern in pregnancy and often require antibiotic therapy. Antimicrobial resistance (AMR) resulting from antibiotic misuse is a major public health challenge, and non-antibiotic interventions (NAIs) may provide a safer means of prevention. This systematic review evaluated non-antibiotic strategies for preventing UTIs during pregnancy as a way to reduce antibiotic prescribing and combat AMR. The review aims to evaluate the role of NAIs in preventing UTIs during pregnancy, with a focus on their potential to reduce antibiotic prescribing and AMR within the NHS care system. A systematic search of Ovid Medline, Web of Science, and Scopus identified studies that compared NAIs to a placebo, usual treatment, or no intervention. Eligible studies included randomised controlled trials, cohort studies, and other relevant designs. Study quality was assessed using established appraisal tools, and a narrative synthesis was conducted due to intervention heterogeneity. Eight studies met the inclusion criteria, examining cranberry products, Mediterranean diet, OM-89 (an oral immunostimulant also known as Uro-Vaxom), ascorbic acid, and knowledge-based interventions. Evidence from seven studies suggests that NAIs may reduce UTI incidence, but the findings are limited, and further research is needed to confirm their effectiveness during pregnancy. The review concludes that NAIs, particularly cranberry products and the Mediterranean diet, may reduce UTI incidence during pregnancy and offer a promising strategy to limit antibiotic use and AMR. However, given the methodological limitations and low quality of available evidence, further high-quality research is required to establish the safety, efficacy, and cost-effectiveness of these therapies in pregnant women.