Cranberry extract for urinary tract infection treatment in pregnancy: A systematic review
Downloads
HIGHLIGHTS
- Cranberry represents a promising and effective alternative for both the treatment and prevention of urinary tract infections during pregnancy.
- Cranberry acts by inhibiting bacterial adhesion to the urinary tract epithelium and exerting direct antibacterial activity.
ABSTRACT
Objective: Urinary tract infections (UTIs) represent the second most common infectious disease worldwide, affecting nearly 150 million people annually. Owing to anatomical and physiological alterations, UTIs are especially frequent during pregnancy, manifesting with symptoms including dysuria, cloudy urine, increased urinary frequency, and occasionally hematuria. Recurrent UTIs are defined as two or more episodes within six months or three episodes within a year. Cranberries are widely recognized for their potential in preventing UTIs during pregnancy. Their protective action involves blocking the adhesion of uropathogenic bacteria to the urinary tract epithelium, a process mediated by phenolic compounds and A-type proanthocyanidins (PACs).
Materials and Methods: In this systematic review, the authors searched PubMed, ScienceDirect, ResearchGate, and Google Scholar for eligible articles published from 2013 to 2024. The search strategy employed Medical Subject Headings (MeSH) and keywords pertaining to Cranberry Extract/Juice and UTI Assessment Methods in Pregnancy. Search expressions were adapted to the specific requirements of each database to optimize retrieval precision. All identified studies were assessed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results: Of the 30 studies included, a daily administration of 500 mg cranberry extract over six months exhibited notable effectiveness as an alternative therapeutic approach for UTIs in pregnancy.
Conclusion: Cranberry (Vaccinium macrocarpon) extract prevents UTIs by impeding bacterial adherence and exerting antibacterial properties. This review supports cranberry as a promising and safe alternative for UTI prevention and management in pregnancy, appropriate for routine daily use.
Hoffman BL, Schorge JO, Bradshaw KD, et al. William Gynecology. 3rd Edition. McGraw Hill Education, 2016.
Getaneh T, Negesse A, Dessie G, et al. Prevalence of urinary tract infection and its associated factors among pregnant women in Ethiopia: A systematic review and meta-analysis. Biomed Res Int. 2021 ;2021:6551526. doi: 10.1155/2021/6551526. PMID: 34901276; PMCID: PMC8654570.
Balachandran L, Jacob L, Al Awadhi R, et al. Urinary tract infection in pregnancy and its effects on maternal and perinatal outcome: A retrospective study. Cureus. 2022;14(1):e21500. doi: 10.7759/ cureus.21500. PMID: 35223276; PMCID: PMC88 60729.
Schneeberger C, Geerlings SE, Middleton P, et al. Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst Rev. 2012;11:CD009279. doi: 10.1002/146518 58.CD009279.pub2. Update in: Cochrane Database Syst Rev. 2015;(7):CD009279. doi: 10.1002/1465 1858.CD009279.pub3. PMID: 23152271.
González de Llano D, Moreno-Arribas MV, Bartolomé B. Cranberry polyphenols and preven-tion against urinary tract infections: Relevant considerations. Molecules. 2020;25(15):3523. doi: 10.3390/molecules25153523. PMID: 32752183; PMCID: PMC7436188.
Babar A, Moore L, Leblanc V, et al. High dose versus low dose standardized cranberry proantho-cyanidin extract for the prevention of recurrent urinary tract infection in healthy women: a double-blind randomized controlled trial. BMC Urol. 2021;21(1):44. doi: 10.1186/s12894-021-00811-w. PMID: 33757474; PMCID: PMC7986024.
Fu Z, Liska D, Talan D, et al. Cranberry reduces the risk of urinary tract infection recurrence in otherwise healthy women: A systematic review and meta-analysis. J Nutr. 2017;147(12):2282-88. doi: 10.3945/jn.117.254961. Epub 2017 Oct 18. PMID: 29046404.
Gbinigie O, Allen J, Boylan et al. Does cranberry extract reduce antibiotic use for symptoms of acute uncomplicated urinary tract infections (CUTI)? Protocol for a feasibility study. Trials. 2019;20(1): 767. doi: 10.1186/s13063-019-3860-z. PMID: 3187 0413; PMCID: PMC6929469.
Hudson RE, Job KM, Sayre CL, et al. Examination of complementary medicine for treating urinary tract infections among pregnant women and children. Front Pharmacol. 2022;13:883216. doi: 10.3389/fphar.2022.883216. PMID: 35571128; PMCID: PMC9094615.
Bolgarina Z, Gonzalez-Gonzalez LF, Rodroiguez GV, et al. Cranberry supplements for urinary tract infection prophylaxis in pregnant women: A systematic review of clinical trials and observa-tional studies on efficacy, acceptability, outcomes measurement methods, and studies' feasibility. Cureus. 2023;15(10):e46738. doi: 10.7759/cureus. 46738. Erratum in: Cureus. 2023;15(10):c140. doi: 10.7759/cureus.c140. PMID: 38022216; PMCID: PMC10631496.
Gbinigie OA, Spencer EA, Heneghan CJ, et al. Cranberry extract for symptoms of acute, uncomplicated urinary tract infection: a systematic review. Antibiotics (Basel). 2020;10(1):12. doi: 10.3390/antibiotics10010012. PMID: 33375566; PMCID: PMC7824375.
Wing DA, Rumney PJ, Hindra S, et al. Pilot study to evaluate compliance and tolerability of cranberry capsules in pregnancy for the prevention of asymptomatic bacteriuria. J Altern Complement Med. 2015;21(11):700-6. doi: 10.1089/acm.2014. 0272. Epub 2015 Aug 21. PMID: 26535612; PMCID: PMC4642828.
Wang CH, Fang CC, Chen NC, et al. Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(13):988-96. doi: 10.1001/archinternmed.2012.3004. PMID: 22777 630.
Heitmann K, Nordeng H, Holst L. Pregnancy outcome after use of cranberry in pregnancy - the Norwegian Mother and Child Cohort Study. BMC Complement Altern Med. 2013;13:345. doi: 10.1186/1472-6882-13-345. PMID: 24314317; PMCID: PMC3924191.
Stapleton AE, Dziura J, Hooton TM, et al. Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: A randomized controlled trial. Mayo Clin Proc. 2012;87(2):143-50. doi: 10.1016/j. mayocp.2011.10.006. PMID: 22305026; PMCID: PMC349 7550.
Liska DJ, Kern HJ, Maki KC. Cranberries and urinary tract infections: How can the same evidence lead to conflicting advice? Adv Nutr. 2016;7(3): 498-506. doi: 10.3945/an.115.011197. PMID: 271 84277; PMCID: PMC4863270.
Konesan J, Liu L, Mansfield KJ. The clinical trial outcomes of cranberry, D-mannose and NSAIDs in the prevention or management of uncomplicated urinary tract infections in women: A systematic review. Pathogens. 2022;11(12):1471. doi: 10.3390/ pathogens11121471. PMID: 36558804; PMCID: PMC9788503.
Jeitler M, Michalsen A, Schwiertz A, et al. Effects of a supplement containing a cranberry extract on recurrent urinary tract infections and intestinal microbiota: A prospective, uncontrolled exploratory study. J Integr Complement Med. 2022;28(5):399-406. doi: 10.1089/jicm.2021.0300. Epub 2022 Mar 14. PMID: 35285701; PMCID: PMC9127832.
Guay DR. Cranberry and urinary tract infections. Drugs. 2009;69(7):775-807. doi: 10.2165/0000 3495-200969070-00002. PMID: 19441868.
Ledda A, Belcaro G, Dugall M, et al. Highly standardized cranberry extract supplementation (Anthocran®) as prophylaxis in young healthy subjects with recurrent urinary tract infections. Eur Rev Med Pharmacol Sci. 2017;21(2):389-93. PMID: 28165546.
Vostalova J, Vidlar A, Simanek V, et al. Are high proanthocyanidins key to cranberry efficacy in the prevention of recurrent urinary tract infection? Phytother Res. 2015;29(10):1559-67. doi: 10.1002/ ptr.5427. Epub 2015 Aug 13. PMID: 26268913.
Wing DA, Shell A, Lee YL, et al. Antimicrobial activity of urine after ingestion of differing daily doses of cranberry juice cocktail in pregnancy: A pilot study. Open Complement. Med. J. 2001;2: 15–9. doi: 10.2174/1876391X01002010015.
Salari N, Khoshbakht Y, Hemmati M, et al. Global prevalence of urinary tract infection in pregnant mothers: a systematic review and meta-analysis. Public Health. 2023;224:58-65. doi: 10.1016/j. puhe.2023.08.016. Epub 2023 Sep 19. PMID: 37734277.
Koradia P, Kapadia S, Trivedi Y, et al. Probiotic and cranberry supplementation for preventing recurrent uncomplicated urinary tract infections in premenopausal women: a controlled pilot study. Expert Rev Anti Infect Ther. 2019;17(9):733-40. doi: 10.1080/14787210.2019.1664287. Epub 2019 Sep 13. Erratum in: Expert Rev Anti Infect Ther. 2019;17(11):939. doi: 10.1080/14787210.2019.167 3041. PMID: 31516055.
van Wietmarschen H, van Steenbergen N, van der Werf E, et al. Effectiveness of herbal medicines to prevent and control symptoms of urinary tract infections and to reduce antibiotic use: A literature review. Integr Med Res. 2022;11(4):100892. doi: 10.1016/j.imr.2022.100892. Epub 2022 Oct 9. PMID: 36345487; PMCID: PMC9636546.
Gupta K, Chou MY, Howell A, et al. Cranberry products inhibit adherence of p-fimbriated Escherichia coli to primary cultured bladder and vaginal epithelial cells. J Urol. 2007;177(6):2357-60. doi: 10.1016/j.juro.2007.01.114. PMID: 17509 358; PMCID: PMC3684265.
Xia JY, Yang C, Xu DF, et al. Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis. PLoS One. 2021;16(9):e0256992. doi: 10.1371/journal.pone.0256992. PMID: 34473789; PMCID: PMC8412316.
Kontiokari T, Sundqvist K, Nuutinen M, et al. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322 (7302):1571. doi: 10.1136/bmj.322.7302. 1571. PMID: 11431298; PMCID: PMC33514.
Maki KC, Kaspar KL, Khoo C, et al. Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. Am J Clin Nutr. 2016;103(6):1434-42. doi: 10.3945/ajcn.116.130542. Erratum in: Am J Clin Nutr. 2017;106(2):708. doi: 10.3945/ajcn.117. 161851. PMID: 27251185.
Gurley BJ. Cranberries as antibiotics?: Comment on "Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind non-inferiority trial in premenopausal women". Arch Intern Med. 2011;171(14):1279-80. doi: 10.1001/ archinternmed.2011.332. PMID: 21788543.
Pérez-López FR, Haya J, Chedraui P. Vaccinium macrocarpon: an interesting option for women with recurrent urinary tract infections and other health benefits. J Obstet Gynaecol Res. 2009;35(4):630-9. doi: 10.1111/j.1447-0756.2009.01026.x. PMID: 19751320.
Monroy-Torres R, Medina-Jiménez AK. Cranberry juice and other functional foods in urinary tract infections in women: a review of actual evidence and main challenges. Bentham Science. 2019;29: 183–211. doi: 10.2174/9781681086378119050007.
Younus Al Gaoale ZI, Sheekhoo Al Azzawi KG, Dhannooon Al-Sabaawi MB. Urinary tract infections in pregnant women. New opportunities anti-relapse therapy. Medico-Legal Updat. 2022; 22(3). doi: 10.37506/mlu.v22i3.3307.
Wawrysiuk S, Naber K, Rechberger T, et al. Prevention and treatment of uncomplicated lower urinary tract infections in the era of increasing antimicrobial resistance-non-antibiotic approaches: a systemic review. Arch Gynecol Obstet. 2019;300 (4):821-8. doi: 10.1007/s00404-019-05256-z. Epub 2019 Jul 26. PMID: 31350663; PMCID: PMC675 9629.
Griffiths P. The role of cranberry juice in the treatment of urinary tract infections. Br J Community Nurs. 2003;8(12):557-61. doi: 10. 12968/bjcn.2003.8.12.11853. PMID: 14688663.
Efros M, Bromberg W, Cossu L, et al. Novel concentrated cranberry liquid blend, UTI-STAT with Proantinox, might help prevent recurrent urinary tract infections in women. Urology. 2010; 76(4):841-5. doi: 10.1016/j.urology.2010.01.068. PMID: 20399486.
Copyright (c) 2025 Rahmawati Abdul Hakim, Dhian Eka Putri, Rahajeng

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
1. Copyright of the article is transferred to the journal, by the knowledge of the author, whilst the moral right of the publication belongs to the author.
2. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-Non Commercial-Share alike (CC BY-NC-SA), (https://creativecommons.org/licenses/by-nc-sa/4.0/)
3. The articles published in the journal are open access and can be used for non-commercial purposes. Other than the aims mentioned above, the editorial board is not responsible for copyright violation
The manuscript authentic and copyright statement submission can be downloaded ON THIS FORM.


















