Factores asociados con complicaciones en el embarazo de mujeres con antecedente de reflujo vesicoureteral: una revisión sistemática del Grupo de Trabajo de Urología Pediátrica de la Sección de Jóvenes Urólogos Académicos (YAU) - Asociación Europea de Urología (EAU) [Factors associated with pregnancy related complications in women with a history of vesicoureteral reflux: A systematic review by the EAU-YAU Paediatric Urology Working Group]

Introduction: Vesicoureteral reflux (VUR) may have long lasting effects on affected individuals, especially in females. Its intertwined relationship with urinary tract infection (UTI) has been well documented and there is a further risk during pregnancy where UTIs are more problematic. Objective: To analyze existing data within the literature to identify factors associated with pregnancy-related complications in women with a history of VUR in childhood. Methods: PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched to identify all published reports of pregnancy outcomes in women with a history of VUR in childhood up to January 2024 (PROSPERO Registration ID: CRD42024550470). Selection criteria included all English-language original articles reporting pregnancy outcomes (maternal and fetal morbidities) in pregnant patients with a history of VUR in childhood. After screening and eligibility assessment, 17 articles met the PICO inclusion criteria. Results: The search yielded 1060 papers, of which 17 remained after exclusions, and assessed 2349 women with a history of VUR in childhood, 1167 pregnant women and a total of 2206 pregnancies. Compared with the general obstetric population, the results showed an increased rate of pregnancy-related complications (particularly febrile urinary tract infection, gestational hypertension, pre-eclampsia) in the presence of renal scarring, even if the women had undergone anti-reflux surgery in childhood, but not persistent low-grade VUR. Conclusion: Despite the lack of larger prospective randomized controlled trials with long-term follow-up, based on the findings of this systematic review, we conclude that close monitoring during pregnancy should be recommended in the presence of persistent high-grade VUR or in women with renal scarring, even if VUR has resolved.