Gynecology · Published 2026-07-11 · DOI 10.26442/20795696.2026.2.203648
Tatiana P. Zefirova, Zarina M. Mingulova, Larisa G. Sozaeva, Natalia M. Podzolkova
Background. Asymptomatic bacteriuria (ASB) is often diagnosed during pregnancy and may be associated with gestational complications. The standard therapy for ASB in pregnant women is the appointment of antibiotics. However, given the global increase in antibiotic resistance and the possible negative effect of antibiotics on the fetus, the question of the expediency of such treatment is questioned. In this regard, an urgent task is to study the effectiveness of alternative remedies, in particular, herbal preparations. Aim. To evaluate the efficacy and safety of phytotherapy in pregnant women with ASB based on clinical and microbiological studies. To determine the pathogenic potential of Escherichia coli strains, the main causative agent of urinary infection. Materials and methods. 97 pregnant women were included in the prospective study, the main group consisted of 65 pregnant women with a confirmed diagnosis of ASB, of which 40 patients received antibacterial therapy and 25 patients were treated with the complex herbal preparation Canephron® N. The control group included 32 pregnant women without ASB. The clinical efficacy of therapy, gestational outcomes, the relationship between ASB and the vaginal microbiota were evaluated, and the pathogenic potential of E. coli strains, the most common causative factor of this pathology, was determined. Results. There were no differences in the frequency of pregnancy complications and the nature of perinatal outcomes between women who received antibiotics and those who took Canephron® N and patients of the control group. The absolute majority of women in three groups completed full-term pregnancy at 39–41 weeks (p = 0.934). Assessing the condition of newborns, we found that there were no statistically significant differences between the groups and subgroups in terms of weight and height (p = 0.934), the number of underweight children (p = 0.897), newborns with developmental delay (p = 0.962) and morphofunctional immaturity (p = 0.772). During the detection of E. coli virulence genes, only 33.8% of pregnant women with ASB revealed potentially dangerous combinations of them and, as a result, an increased risk of infection in the absence of treatment. Vaginal infections and dysbiotic conditions are associated with ASB; they were more common in group I (p = 0.015): nonspecific vaginitis was noted in 63.1%, vulvovaginal candidiasis in 4.6%, bacterial vaginosis in 1.5%. In group II – nonspecific vaginitis – in 28.1%, vulvovaginal candidiasis – in 9.4%, bacterial vaginosis – in 3.1%. The presence of vaginal infections increases the probability of colonization of the bladder by opportunistic flora by more than 15 times (95% confidence interval 5,433–45,867; p 0.001). Conclusion. In most cases of ASB in pregnant women, Escherichia coli is caused with a low potential for pathogenicity. In this regard, it is justified to use Canephron® N preprate instead of antibiotics, which demonstrates high efficacy and good tolerability. Careful monitoring of the state of the vaginal microbiota is necessary and, if necessary, rehabilitation of the infection.
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Zefirova, T., Mingulova, Z., Sozaeva, L., et al. (2026). Therapeutic possibilities for asymptomatic bacteriuria in pregnant women: A prospective study. Gynecology. https://doi.org/10.26442/20795696.2026.2.203648