Systematic Review and Meta-Analysis: Global Prevalence and Antimicrobial Resistance Patterns of Asymptomatic Bacteriuria in Pregnant Women

Background Asymptomatic bacteriuria (ASB) during pregnancy is a significant global health concern associated with adverse maternal and neonatal outcomes, including pyelonephritis, preterm birth, and low birth weight. Understanding its global prevalence and antimicrobial resistance (AMR) patterns is critical for guiding screening and treatment strategies. This systematic review and meta-analysis aimed to estimate the global prevalence of ASB among pregnant women and assess the antimicrobial resistance profiles of common bacterial uropathogens. Methods A comprehensive literature systematically searched four major databases (PubMed, Scopus, Web of Science, Google Scholar) for studies published between 2000 and 2024. A total of 38 studies from 18 countries met the inclusion criteria and collectively encompassing a total pooled sample size of 15361 pregnant women for systematic review. Observational studies reporting ASB prevalence and/or antimicrobial susceptibility patterns in pregnant women were included. Data were pooled using a random-effects model with Restricted Maximum Likelihood (REML). Heterogeneity was quantified using I² and τ² statistics. Publication bias was assessed via funnel plot visualization and Egger’s regression test. Sensitivity analyses and subgroup analyses were conducted. Weighted mean resistance estimates were calculated for major antibiotics. We conducted a comprehensive systematic review and meta-analysis following PRISMA 2020 guidelines. Results The pooled global prevalence of ASB among pregnant women was 13.8% (95% CI: 12.8–14.8%) . Heterogeneity was high (I² = 71.97%, p < 0.0001). Escherichia coli (55.6%) was the predominant isolate, followed by Klebsiella spp. (13.7%) and Staphylococcus spp. (6.1%). Antibiotic resistance was highest to ampicillin (79.2%), ceftriaxone (49.2%), and ciprofloxacin (34.8%). Nitrofurantoin showed the lowest weighted resistance (14.9%), though variation existed across regions. Funnel plot symmetry and Egger’s test indicated no significant publication bias after exclusion of two outlier studies. Conclusion ASB remains a significant global concern, affecting approximately one in seven pregnant women, with notable regional disparities in prevalence and AMR. High resistance to commonly used antibiotics underscores the urgent need for region-specific treatment guidelines and strengthened antimicrobial stewardship. Nitrofurantoin remains an effective first-line agent in most regions. Enhanced surveillance and culture-guided therapy are essential to reduce complications and prevent the spread of resistant strains.