Introduction. Pregnant women are at higher risk of urinary tract infection (UTI). The need for antimicrobial therapy of symptomatic UTIs in pregnant women is beyond doubt. The expediency of antibiotics for asymptomatic bacteriuria (ASB) is currently the subject of scientific debate. Most clinical recommendations report on the need for screening and antibacterial therapy of ASB during pregnancy, and the screening program women for many years. A number of studies have demonstrated that screening and treatment of ASB during pregnancy leads to a significant reduction in the risk of acute pyelonephritis, as well as complications of pregnancy and deliveries. However, clinical trials in the 1960s and 1980s have poor methodological quality.
Material and methods. The data were searched in the PubMed, Web of Science, Google Scholar, Elibrary.ru using the following keywords: «urinary tract infection in pregnancy», «asymptomatic bacteriuria in pregnancy», «pyelonephritis in pregnant», «pregnancy», «premature birth», «antibiotic use in pregnancy», «D-mannose», «proanthocyanidins», «cranberry».
Results. This review analyzes the results of recent clinical studies investigating the relationship between ASB and acute pyelonephritis, ASB and maternal and perinatal consequences. According to the modern concept, ASB is not a pathological condition, but only states the fact of detecting some representatives of the normal microbiome of female urine. New scientific data on the principles of the organization of the urine microbiome in pregnant women are presented, and the most common urotypes of the urinary microbiota during pregnancy are described. The problems of antibacterial therapy of symptomatic UTIs and ASB in pregnant women are described, due to both increased resistance of the microflora to antibiotics and possible teratogenic effects. Alternative strategies for the treatment of ASB in pregnant women are discussed.
Conclusion. The previous paradigm regarding the need for comprehensive screening and mandatory antibacterial therapy for ASB in pregnant women needs to be reconsidered. Most of the previous studies that supported this paradigm are of poor methodological quality. The discovery of the urinary microbiome and the presented evidence of non-sterility in female urine, as a manifestation of normalcy and health, necessitate caution when discussing the mandatory antibacterial therapy for ASB in pregnant women.
