Does antibiotic treatment of asymptomatic bacteriuria in pregnancy reduce the development of pyelonephritis and associated risk of low birthweight and preterm birth?

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Why is this study important?

Asymptomatic bacteriuria, the finding of urinary bacteria in the absence of urinary tract infection (UTI) symptoms, is common during pregnancy and more so in women from low-income countries and those with previous antepartum UTI.[1] While the prevalence of asymptomatic bacteriuria is similar between pregnant and non-pregnant women, the risk of progression to symptomatic cystitis or pyelonephritis is increased in pregnancy due to common physiologic changes. These changes include increased bladder volume with decreased detrusor tone, ureteric dilatation from direct uterine pressure and progestogenic relaxation of ureteric smooth muscle, and glycosuria in up to 70% of pregnant individuals.[2][3] Association of asymptomatic bacteria with subsequent preterm birth and low birth weight is controversial, and the benefits versus harms of treatment (e.g., antibiotics [Abx]) to eradicate bacteria is unknown.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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