Interventions for preventing recurrent urinary tract infection during pregnancy

Abstract

Objectives: Recurrent urinary tract infections (RUTI) are common in women who are pregnant and may cause serious adverse pregnancy outcomes for both mother and child including preterm birth and small for gestational age babies. Interventions used to prevent RUTI in women who are pregnant can be pharmacological (antibiotics) or nonpharmacological (cranberry products, acupuncture, probiotics and behavioural modifications). So far little is known about the best way to prevent RUTI in pregnant women. Method(s): We used standard Cochrane methodology (last search February 2011). The primary maternal outcomes were (recurrent) urinary tract infection before birth (variously defined) and preterm birth (<37 weeks). The primary infant outcomes were small-for-gestational age and total mortality. Result(s): The review included one trial involving 200 women. This trial compared a daily dose of nitrofurantoin and close surveillance with close surveillance only. No significant differences were found for the described primary outcomes: recurrent pyelonephritis (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.31-2.53), urinary tract infection before birth (RR 0.30 95% CI 0.06-1.38) and preterm birth (<37 weeks) (RR 1.18 95% CI 0.42-3.35). The incidence of asymptomatic bacteriuria (ASB) (>=103 colonies per milliliter) (secondary outcome), only reported in women with a clinic attendance rate of >90% (RR 0.55, 95% CI 0.34-0.89), was significantly reduced in women who received nitrofurantoin and close surveillance. Conclusion(s): Daily dose of nitrofurantoin and close surveillance has not been shown to prevent RUTI compared with close surveillance alone, although a significant reduction of ASB was found in women with a clinic attendance rate of > 90% and who received nitrofurantoin and close surveillance. Furthermore, there is limited reporting of both primary and secondary outcomes for both women and infants. Due to lack of RCT, no conclusions can be drawn regarding the optimal intervention to prevent RUTI in women who are pregnant. RCT comparing different pharmacological and non-pharmacological interventions are necessary to investigate potentially effective interventions to prevent RUTI in women who are pregnant.