Research needed to close evidence gaps in widely-used test
OTTAWA, ON, July 9, 2018 – Today the Canadian Task Force on Preventive Health Care (Task Force) made a recommendation to continue using a routine screening test on pregnant women but noted the need for better evidence about its effectiveness.
Screening pregnant women for bacteria in their urine when they don’t have symptoms of a urinary tract infection (asymptomatic bacteriuria), followed by antibiotic treatment for women who test positive has been part of standard prenatal care in Canada for the last 40 years. The Task Force evaluated whether the procedure should be part of standard care. The Task Force made only a weak recommendation to continue the screening due to limited evidence of benefit and uncertain harm from antibiotic use.
“The Task Force could not strongly recommend the practice because of the lack of trials to inform whether women who were screened and their children were better off than those who were not” said Dr. Ainsley Moore, chair of the Task Force guideline working group. “Given this uncertainty, alongside broader concerns of inappropriate use of antibiotics, more research is clearly needed.
“This is one of many medical treatments that became part of standard care long ago without strong evidence and have continued to be delivered despite never having been rigorously evaluated,” said Dr. Roland Grad member of the Task Force guideline working group. “Some such standard practices surely improve the health of Canadians, but some of them may not, and some might even harm some patients.”
The Guideline was published today in the Canadian Medical Association Journal (CMAJ). The Guideline, developed by the Task Force, an independent body of primary care and prevention experts, examined the best and most current scientific evidence related to screening to formulate the recommendations.
The recommendation noted that some woman who are concerned about using antibiotics in pregnancy when there are no symptoms of an infection might prefer not to be tested. Such situations would warrant a discussion with their health care provider.
The Task Force is calling for studies on asymptomatic bacteriuria screening and treatment to close the evidence gaps. New methods have been developed for evaluating the effectiveness of such entrenched standards of care, and the CTFPHC emphasized the need for such a trial to inform care of asymptomatic bacteriuria among pregnant women.
This clinical practice guideline has been endorsed by the Society of Obstetricians and Gynecologists of Canada (SOGC), the Canadian Association of Midwives (CAM), the Nurse Practitioners’ Association of Canada (NPAC), and the Canadian Association of Perinatal and Women’s Health Nurses (CAPWHN).
For the complete report and details on the Task Force’s findings and recommendations and accompanying patient and clinician Knowledge Translation tools, please visit: www.canadiantaskforce.ca
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support Canadian primary care providers in delivering preventive health care. The mandate of the Task Force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.