The First People's Hospital of Linping District, Urology Surgery, Hangzhou, Zhejiang Province, China.
Rev Inst Med Trop Sao Paulo. 2024 Sep 6;66:e54. doi: 10.1590/S1678-9946202466054. eCollection 2024.
This systematic review and meta-analysis assessed the association between urinary tract infections (UTIs) during pregnancy and the risk of preterm birth (PTB). We searched multiple databases for relevant observational studies, categorizing them as UTI-based (comparing PTB incidence in women with and without UTIs) or PTB-based (comparing UTI prevalence in women with and without PTB). Using a random-effects model in Stata software version 17.0, we estimated pooled and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), and performed subgroup, sensitivity, and cumulative analyses to explore heterogeneity. In total, 30 studies comprising 32 datasets were included, involving a total of 249,810 cases and 2,626,985 healthy controls. The meta-analysis revealed a significant positive association between UTIs during pregnancy and PTB occurrence (OR, 1.92; 95% CI, 1.62-2.27). A sub-group analysis based on studies, the participants showed significant association in both PTB-based (OR, 2.01; 95% CI, 1.58-2.56) and UTI-based studies (OR, 1.79; 95% CI, 1.42-2.26). However, Egger's test indicated the presence of publication bias (p=0.020), and substantial heterogeneity was observed across the included studies (I2=96.6; p< 0.001). These findings emphasize the critical importance of early detection and effective management of UTIs in pregnant women to reduce the risk of PTB and its associated adverse outcomes. While the results highlight a robust link between UTIs during pregnancy and PTB risk, the potential influence of publication bias and substantial heterogeneity should be considered to interpret these findings. Further research is needed to better understand the underlying mechanisms and to develop targeted interventions for high-risk pregnant women.
本系统评价和荟萃分析评估了妊娠期间尿路感染（UTI）与早产（PTB）风险之间的关联。我们在多个数据库中搜索了相关的观察性研究，并将其分为基于 UTI 的研究（比较患有和不患有 UTI 的女性的 PTB 发生率）和基于 PTB 的研究（比较患有和不患有 PTB 的女性的 UTI 患病率）。我们使用 Stata 软件版本 17.0 中的随机效应模型，估计了汇总和调整后的优势比（OR）及其 95%置信区间（CI），并进行了亚组、敏感性和累积分析，以探索异质性。共有 30 项研究包含 32 个数据集，共纳入 249810 例病例和 2626985 名健康对照者。荟萃分析显示，妊娠期间 UTI 与 PTB 发生之间存在显著的正相关关系（OR，1.92；95%CI，1.62-2.27）。基于研究的亚组分析表明，在基于 PTB 的研究（OR，2.01；95%CI，1.58-2.56）和基于 UTI 的研究（OR，1.79；95%CI，1.42-2.26）中，均存在显著关联。然而，Egger 检验表明存在发表偏倚（p=0.020），且纳入的研究之间存在显著的异质性（I2=96.6；p<0.001）。这些发现强调了早期发现和有效管理妊娠期间 UTI 对于降低 PTB 及其相关不良结局风险的重要性。尽管这些结果突出了妊娠期间 UTI 与 PTB 风险之间存在强有力的联系，但应考虑发表偏倚和显著异质性的潜在影响来解释这些发现。需要进一步的研究来更好地理解潜在机制，并为高危孕妇开发针对性的干预措施。
