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Urinary tract infection during pregnancy

Urinary tract infection(UTI) is the most common infection affecting expecting women worldwide. Around 10-20% of pregnant women are present with complaints of UTI during their antenatal period. It is also the second most common illness observed during gestation after anemia. UTIs in pregnancy can be divided into three entities. These are asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis.

Asymptomatic bacteriuria(ASB), as the name suggests, presents with positive urine culture without any symptoms. ASB is very common in women, irrespective of being pregnant or not. But in pregnant women, ASB requires adequate treatment to prevent maternal and fetal complications. Acute cystitis, on the other hand, is much more common in pregnant women. It is observed that at least one in three pregnant women with ASB might develop acute cystitis.

The term cystitis indicates inflammation of the bladder. The main symptoms of cystitis include discomfort or burning sensation while passing urine, painful urination, increased frequency of urination, urgency, pain in the lower abdomen, and blood in the urine.

Acute pyelonephritis occurs when the inflammation affects the kidneys. It is less common than ASB and acute cystitis but is a more severe condition leading to various complications during pregnancy. This is mainly observed during the second and third trimesters of pregnancy which is attributed to the increased urinary retention observed during this period. Symptoms of acute pyelonephritis include high body temperature, chills, nausea, vomiting, and pain in the lumbar area.

What are risk factors involved?

Some risk factors contributing to UTIs in pregnancy include a previous history of recurrent UTIs before pregnancy, increased sexual activity, multi-parity, advanced maternal age, diabetes mellitus, and deformities of the urinary tract.

Pathophysiology

Pregnancy can cause many physiological and adaptive changes in the urinary tract. Both hormonal and mechanical factors play a significant role in such changes. The upper part of the urinary tract usually dilates, and there is decreased movement in the ureter. Smooth muscles in the ureter and bladder relax excessively, and bladder capacity also increases. The gravid uterus also exerts excessive pressure on the urinary tract causing a mechanical obstruction. It is also observed that the ph of urine during pregnancy is sometimes higher than normal, and there is excessive secretion of glucose in urine. Progesterone plays a significant role in many of these changes observed during gestation.

What are the complications of UTI in pregnancy?

It includes premature Labour and delivery of low birth weight babies and increased maternal morbidity (hypertension, anemia, and amnionitis).

How can UTI be diagnosed?

UTI is diagnosed by urinalysis and urine culture. A clean catch urine sample should be given for testing. Although the urine dips stick test to detect nitrite and leukocyte esterase activity is widely used, it is not sensitive enough to detect ASB in most cases. Hence, urine culture is considered the gold standard for detecting UTIs in pregnancy.

An insight from mamahood

To conclude, to all mothers-to-be, UTIs in pregnancy need immediate medical attention. Since prevention is always better than cure, good hygiene during pregnancy is advised, especially in the genital area. Washing the genital area and voiding after intercourse has proven to decrease the incidence of UTIs. We recommended drinking at least 3-4 liters of water and not delaying the voiding of urine. Certain studies also observed that cranberry juice and daily intake of ascorbic acid decrease UTIs in pregnancy.

UTIs in pregnancy should be treated with antibiotics, and the choice of antibiotics depends upon their safety profile, effectiveness, price, and availability. Always consult your physician if you are experiencing UTI symptoms so that it is diagnosed and treated immediately and avoid any complications. Do not take any antibiotics without the approval of your physician because some of the antibiotics can cause adverse effects on the fetus.

Our References

Mamahood content is written by practicing physicians and healthcare professionals who rely on evidence-based resources, the latest research, and their experience to ensure our users get credible and updated information they can trust.

  • Ghouri, F., Hollywood, A., & Ryan, K. (2022). A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy.
  • Gilbert, N., O’brien, V., Hultgren, S., Macones, G., Lewis, W., & Lewis, A. (2022). Urinary Tract Infection as a Preventable Cause of Pregnancy Complications: Opportunities, Challenges, and a Global Call to Action.
  • H, S., & M, J. (2022). Urinary tract infections during pregnancy – an updated overview. Retrieved 31 August 2022, from https://pubmed.ncbi.nlm.nih.gov/28216479/
  • Schieve, L., Handler, A., Hershow, R., Persky, V., & Davis, F. (2022). Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome.
  • Schnarr, J., & Smaill, F. (2022). Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy.

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