Screening for maternal infection in pregnancy to prevent preterm birth: a systematic review

To analyze whether screening for maternal infections during pregnancy to prevent premature birth is associated with a reduction in premature birth.

A systematic review was conducted. PubMed, Scopus, Cochrane Library and ProQuest databases were screened for original studies carried out on pregnant women and used Medical Subject Headings (MeSH) terms and free-text keywords related to pregnancy, infection screening, and preterm birth.

Randomized and observational studies that evaluated antenatal screening for maternal genital or urinary infections, compared screened populations with usual care without additional targeted infection screening, and reported preterm birth (<37 weeks) or related obstetric outcomes were included.

Study selection and extraction were performed independently by two reviewers.

Out of 858 records obtained, 10 studies met the inclusion criteria. These studies screened for various genital and urinary infections. The effect estimates for the unselected antenatal populations were mostly not significant. Nevertheless, maternal infection screening in selected or high-risk populations and subgroup analyses among nulliparous women screened for bacterial vaginosis (BV) or Chlamydia trachomatis/Neisseria gonorrhoeae (CT/NG) was associated with reduction in preterm birth. Marked heterogeneity in populations, settings, target infections, and screening protocols limited direct comparison across studies.

Antenatal infection screening in unselected pregnant populations did not show a significant reduction in preterm birth. However, more favourable findings were observed in selected or high-risk populations, although overall effects are heterogeneous. Further well-designed studies in clearly defined target populations are needed to define optimal screening strategies for routine practice.PROSPERO registration number: CRD420251244205.