Abstract
Objectives
Although current guidelines advice to screen for asymptomatic bacteriuria during pregnancy, little is known about the best moment of testing. The goal of this study is to analyze the optimal timing (first vs. second trimester) to screen for asymptomatic bacteriuria during pregnancy.
Methods
A retrospective cohort analysis, comparing patients that were screened for asymptomatic bacteriuria in the first vs. second trimester was performed. The main question was to compare the rate of positive urinary culture in both trimesters. Study included patients all followed a prenatal consultation at the University Hospital of Brussels between 2012 and 2017. Other outcomes considered were the nature of identified germs, treatments, possible risk and confounding factors (age, BMI, gravidity-parity-abortus [GPA], type of conception, ethnicity, education, prior urinary tract infection (UTI), diabetes, hypertension, prior preterm delivery and sickle cell disease) and complications (UTI, preterm delivery, preterm rupture of the membranes and chorio-amnionitis).
Results
A total of 2,005 consecutive files were reviewed, 655 concerned patients screened during the first trimester group and 1,350 in the second trimester group. Asymptomatic bacteriuria was present in only 71 cases (3.54%), 23 in the first trimester group (3.50%) and 48 in the second trimester group (3.55%). Escherichia coli was the most frequently identified germ (37 cases (1.8%), 14 in the first trimester group and 23 in the second trimester group). Our logistic regression analysis shows no statistical difference according to the moment the urinary culture was done for the presence of asymptomatic bacteriuria (E. coli or others), for its association with hospitalization for pyelonephritis, preterm contractions, preterm pre-labor rupture of the membranes (PPROM) and/or preterm delivery.
Conclusions
If recommendations remain to screen for asymptomatic bacteriuria at least once during pregnancy, this study indicates that the moment of testing (first vs. second trimester) has no clinical impact on obstetrical outcomes.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Ethical Board of the University Hospital of Brussels.
References
1. Kalinderi, K, Delkos, D, Kalinderis, M, Athanasiadis, A, Kalogiannidis, I. Urinary tract infection during pregnancy: current concepts on a common multifaceted problem. J Obstet Gynaecol (Lahore). 2018;38:448–53. https://doi.org/10.1080/01443615.2017.1370579.Search in Google Scholar
2. Szweda, H, Jóźwik, M. Urinary tract infections during pregnancy – an updated overview. Dev Period Med 2016;20:263–72.Search in Google Scholar
3. Angelescu, K, Nussbaumer-Streit, B, Sieben, W, Scheibler, F, Gartlehner, G. Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review. BMC Pregnancy Childbirth 2016;16. https://doi.org/10.1186/s12884-016-1128-0.Search in Google Scholar
4. Margent, P. A qui profite le dépistage des bactériuries asymptomatiques? J Int Med 2019.Search in Google Scholar
5. Services, USP, Force, T. Screening for asymptomatic bacteriuria in adults: an updated systematic review for the U.S. Preventive Services Task Force. JAMA 2019;322:1195–205. https://doi.org/10.1001/jama.2019.10060.Search in Google Scholar
6. Glaser, AP, Schaeffer, AJ. Urinary tract infection and bacteriuria in pregnancy. Urol Clin 2015;42:547–60. https://doi.org/10.1016/j.ucl.2015.05.004.Search in Google Scholar
7. Smaill, FM, Vazquez, JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2019;2019:CD000490. https://doi.org/10.1002/14651858.CD000490.pub4.Search in Google Scholar
8. Lumbiganon, P, Laopaiboon, M, Thinkhamrop, J. Screening and treating asymptomatic bacteriuria in pregnancy. Curr Opin Obstet Gynecol 2010;22:95–9. https://doi.org/10.1097/gco.0b013e3283374adf.Search in Google Scholar
9. Azami, M, Jaafari, Z, Masoumi, M, Shohani, M, Badfar, G, Mahmudi, L, et al.. The etiology and prevalence of urinary tract infection and asymptomatic bacteriuria in pregnant women in Iran: a systematic review and meta-analysis. BMC Urol 2019;19:1–15. https://doi.org/10.1186/s12894-019-0454-8.Search in Google Scholar
10. Rogozińska, E, Formina, S, Zamora, J, Mignini, L, Khan, KS. Accuracy of onsite tests to detect asymptomatic bacteriuria in pregnancy: a systematic review and meta-analysis. Obstet Gynecol 2016;128:495–503. https://doi.org/10.1097/AOG.0000000000001597.Search in Google Scholar
11. Guinto, VT, Guia, BD, Festin, MR, Dowswell, T, Europe PMC Funders Group. Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2010;CD007855. https://doi.org/10.1002/14651858.CD007855.Search in Google Scholar
12. Kazemier, BM, Koningstein, FN, Schneeberger, C, Ott, A, Bossuyt, PM, de Miranda, E, et al.. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis 2015;15:1324–33. https://doi.org/10.1016/S1473-3099(15)00070-5.Search in Google Scholar
13. Schneeberger, C, Kazemier, BM, Geerlings, SE. Asymptomatic bacteriuria and urinary tract infections in special patient groups: women with diabetes mellitus and pregnant women. Curr Opin Infect Dis 2014;27:108–14. https://doi.org/10.1097/qco.0000000000000028.Search in Google Scholar
14. McLoughlin, G. Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Res Nurs Health 2020;43:206–7. https://doi.org/10.1002/nur.22005.Search in Google Scholar PubMed
15. Schneeberger, C, Se, G, Middleton, P, Ca, C. Interventions for preventing recurrent urinary tract infection during pregnancy (review) summary of findings for the main comparison. Cochrane Database Syst Rev 2015;CD009279. https://doi.org/10.1002/14651858.CD009279.Search in Google Scholar
16. Griebling, TL. Re: benefits and harms of treatment of asymptomatic bacteriuria: a systematic review and meta-analysis by the European Association of Urology Urological Infection Guidelines Panel. J Urol 2018;200:677. https://doi.org/10.1016/j.juro.2018.07.014.Search in Google Scholar PubMed
17. Widmer, M, Lopez, I, Gülmezoglu, AM, Mignini, L, Roganti, A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev 2015;2015. https://doi.org/10.1002/14651858.CD000491.pub3.Search in Google Scholar PubMed PubMed Central
18. Nicolle, LE. Asymptomatic bacteriuria. Curr Opin Infect Dis 2014;27:90–6. https://doi.org/10.1097/qco.0000000000000019.Search in Google Scholar PubMed
19. Metzger, BE. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82. https://doi.org/10.2337/dc10-0719.Search in Google Scholar
20. Figueras, F, Gratacós, E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014;36:86–98. https://doi.org/10.1159/000357592.Search in Google Scholar PubMed
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review
- Neonatal lupus erythematosus – practical guidelines
- Original Articles – Obstetrics
- Optimal timing to screen for asymptomatic bacteriuria during pregnancy: first vs. second trimester
- Amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk
- COL1A1, COL4A3, TIMP2 and TGFB1 polymorphisms in cervical insufficiency
- Pregnancy and neonatal outcomes of twin pregnancies – the role of maternal age
- Comparison of maternal third trimester hemodynamics between singleton pregnancy and twin pregnancy
- Daily monitoring of vaginal interleukin 6 as a predictor of intraamniotic inflammation after preterm premature rupture of membranes – a new method of sampling studied in a prospective multicenter trial
- Association between the number of pulls and adverse neonatal/maternal outcomes in vacuum-assisted delivery
- Original Articles – Fetus
- The effect of nuchal umbilical cord on fetal cardiac and cerebral circulation-cross-sectional study
- Recognition of facial expression of fetuses by artificial intelligence (AI)
- Correlation of first-trimester thymus size with chromosomal anomalies
- Fetal intracranial structures: differences in size according to sex
- Original Articles – Neonates
- Antenatal care and perinatal outcomes of asylum seeking women and their infants
- Maturation of the cardiac autonomic regulation system, as function of gestational age in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation
- Short Communication
- The impact of transfers from neonatal intensive care to paediatric intensive care
- Letter to the Editor
- Differential microRNA expression in placentas of small-for-gestational age neonates with and without exposure to poor maternal gestational weight gain
Articles in the same Issue
- Frontmatter
- Review
- Neonatal lupus erythematosus – practical guidelines
- Original Articles – Obstetrics
- Optimal timing to screen for asymptomatic bacteriuria during pregnancy: first vs. second trimester
- Amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk
- COL1A1, COL4A3, TIMP2 and TGFB1 polymorphisms in cervical insufficiency
- Pregnancy and neonatal outcomes of twin pregnancies – the role of maternal age
- Comparison of maternal third trimester hemodynamics between singleton pregnancy and twin pregnancy
- Daily monitoring of vaginal interleukin 6 as a predictor of intraamniotic inflammation after preterm premature rupture of membranes – a new method of sampling studied in a prospective multicenter trial
- Association between the number of pulls and adverse neonatal/maternal outcomes in vacuum-assisted delivery
- Original Articles – Fetus
- The effect of nuchal umbilical cord on fetal cardiac and cerebral circulation-cross-sectional study
- Recognition of facial expression of fetuses by artificial intelligence (AI)
- Correlation of first-trimester thymus size with chromosomal anomalies
- Fetal intracranial structures: differences in size according to sex
- Original Articles – Neonates
- Antenatal care and perinatal outcomes of asylum seeking women and their infants
- Maturation of the cardiac autonomic regulation system, as function of gestational age in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation
- Short Communication
- The impact of transfers from neonatal intensive care to paediatric intensive care
- Letter to the Editor
- Differential microRNA expression in placentas of small-for-gestational age neonates with and without exposure to poor maternal gestational weight gain