Urinary Tract Infections in Pregnancy

Urinary Tract Infections (UTIs) affect millions of people and are one of the most common bacterial infections in pregnancy. Since pregnancy causes so many changes in a woman’s body, the risk of infection increases during this time. About 90% of all UTIs are caused by the bacteria Escherichia coli  (E.coli), and 50-60% of all women will get a UTI in their lifetime compared to just about 13-14% of men. Pregnant women have a 1 in 10 chance of getting a UTI at some point during pregnancy.

 Typically, UTIs occur when bacteria from our skin or rectum are transferred into our urinary tract, causing infections. In pregnant women, hormonal and mechanical changes, as well as difficulty with proper hygiene due to a distended belly, make UTIs common. Although most of these infections can be minor inconveniences, some can lead to serious illnesses, including death. 

 What is an Urinary Tract Infection?

A UTI is an infection of any part of the urinary system including the urethra, bladder, ureters, and kidneys. The kidneys filter water and waste, converting it into urine which is carried to the bladder by thin tubes called the ureters. The bladder, a balloon-shaped organ, stores the urine until it leaves the body via a tube called the urethra. Any part of the urinary system can be affected by bacteria.

• Early infections occur most often in the urethra (urethritis)
• If left untreated, the infection can spread into the bladder (cystitis)
• Complicated UTIs spread to the kidneys to cause pyelonephritis, a serious illness that needs immediate medical attention 

 

 

Due to all the physiological changes associated with pregnancy, pregnant women are at an increased risk for serious health complications from both symptomatic and asymptomatic UTIs. Untreated bacteria can lead to preterm labor, low birth weight, and other health risks to both mother and fetus.

 Why are UTIs More Common in Pregnancy?

Pregnancy changes the anatomy of the urinary tract. The kidneys enlarge, and the fetus compresses the ureter and bladder. This compression makes it harder to fully empty the bladder. Also, hormone levels (progesterone and estrogen) increase, which can weaken the ureter and bladder. In fact, 1 in 3 pregnant women will have some sort of bladder infection at some point in their pregnancy. Although UTI is caused by microorganisms such as E.coli (bacteria) entering the urethra and infecting other parts of the urinary system, a few other things can increase the risk factors of UTI, especially in pregnant women.

 Pregnant women have reduced urine acidity as well as a higher concentration of sugar, protein, and hormones in their urine. Excess sugar can encourage bacterial growth, leading to UTIs.

 Due to changes in hormones, some pregnant women can suffer from a condition known as vesicoureteral reflux, which causes this highly concentrated urine to flow back up from the bladder into the kidneys, leading to UTIs. During pregnancy, the uterus enlarges and presses on the bladder, thus making it harder to fully empty the bladder. This leftover urine can lead to UTIs.

 Group B streptococcus, which is found naturally in the colon and the vagina, also increases the risk of UTIs in pregnancy. Most pregnant women are screened around 36 weeks of pregnancy. If they test positive for Group B streptococcus, they are treated with IV antibiotics during labor to prevent infecting the newborn and causing birth complications.

Other reasons why UTIs are more common in pregnancy are as follows: 

•  Poor toilet hygiene or difficulty maintaining proper hygiene due to pregnancy.
• Poor sexual hygiene.
• A history of UTI, including pre-pregnancy UTI.
• Structural abnormalities of the urinary tract or urinary tract blockages can worsen with a growing pregnant belly.

 How to Reduce the Risk of UTIs during Pregnancy 

The natural bacterial flora in the vagina and urinary tract are often disrupted by the hormonal changes that occur during pregnancy and menopause. These changes can provide a favorable environment for harmful bacteria like E. coli to thrive. Although pregnancy itself is a risk factor for UTIs, several ways to reduce the risk of UTIs during pregnancy include:

• Practicing better personal hygiene.
• Keeping your genital area clean using mild soap and water.
• Wiping from front to back to minimize the risk of spreading E.coli
• Staying away from strongly fragranced products like bubble baths or feminine washes to prevent skin irritation that might provide bacteria entry into your urinary system.
• Urinating before and after sex.
• Staying hydrated.
• Scheduling a urinalysis or urine culture around 12-16 weeks of pregnancy or during your first prenatal visit

 Some risks may be harder to reduce. For instance, some people are genetically predisposed to getting UTIs due to a cluster of genes that are associated with recurrent UTIs. If your mom gets frequent UTIs, you may, too. Also, if you have an autoimmune disorder or a suppressed immune system, your body might be unable to fight off bacteria as efficiently as you want, making you more likely to suffer a UTI. These risk factors can get worse with the shifting hormones associated with pregnancy. If you’re at a higher risk of getting UTIs, your doctor might recommend some preventative measures to reduce the risk of UTIs to keep you and your growing fetus healthy.

 

 

 UTIs by Pregnancy Trimester

The risk of UTI increases around week 6 of pregnancy and varies throughout the pregnancy.

First Trimester – According to the Center of Disease Control and Prevention (CDC), about 41% of all pregnancy-related UTIs are diagnosed in the first trimester. Due to this high percentage, a urinalysis and urine culture is recommended on your first prenatal visit to your doctor regardless of whether you have symptoms of UTI or not.

 Second Trimester – during this trimester, about half as many pregnant women are diagnosed with UTI compared to those in the first trimester. 

Third Trimester – during this trimester, only about half as many women are diagnosed with UTI compared to the second trimester. 

A repeat urine culture is recommended during the third trimester as up to 90% of pregnancy-related acute kidney infections, mostly caused by untreated UTI, are diagnosed during the second and third trimesters.

 Signs and Symptoms of UTI in Pregnancy

 Some of the most common symptoms of a UTI in pregnancy can mimic the signs and symptoms of pregnancy. For instance, the constant feeling of needing to urinate even after you just peed is a natural part of pregnancy but could also be a worrisome symptom of UTI. Some common symptoms of UTI in pregnancy can include:

• A burning pain while urinating. Although this can be a sign of a yeast infection, it is best to get an accurate diagnosis from your healthcare provider.
• Passing small amounts of urine frequently.
• Smelly urine that might look cloudy, red, pink, cola-colored.
• Strong and frequent urge to urinate.
• Pelvic pain

 Other symptoms of complicated UTI in pregnancy include: 

• Flank pain (usually on one side, in the middle of the back)
• High-grade fever
• Chills and shivers
• Reduced urine output
• Nausea or vomiting
• Headaches
• Lower back pain 

The symptoms of UTI can vary in different people. For instance, an older person over 65 may develop low blood pressure, urinary incontinence, poor appetite, confusion, and delirium when ill with a UTI. Pregnant women, on the other hand, are more susceptible to asymptomatic UTIs. Unfortunately, untreated asymptomatic UTI can lead to symptomatic UTI; this can be complicated by acute kidney infection (acute pyelonephritis), which can potentially recur within the same pregnancy.

 Effects of UTI on Pregnancy

UTIs can rapidly lead to severe kidney infections. These infections can cause sepsis (bacteria in the blood) and respiratory problems for the mother and fetus, leading to preterm labor or a need to deliver the baby urgently. UTIs in pregnancy can also lead to low birth weight. UTIs can also increase the risk of developing preeclampsia, a serious life-threatening condition (for mother and baby) that is characterized by high protein in the urine and high blood pressure.

 

 

 Treatment of UTI in Pregnancy

If you have any symptoms of a UTI, contact your healthcare provider as soon as possible. You will need a urine test (urinalysis) to check for bacteria in your urine. You may also need a urine culture (it takes a few days to get the results) to determine the best antibiotics to eradicate the bacteria.

To prevent any further complications from the UTI, your doctor may initially start you on a broad-spectrum antibiotic and then possibly switch to a different one when the cultures return.

 A UTI cannot hurt your baby; however, failure to treat the UTI can lead to complications such as preterm birth and low-birth-weight infants. Also, an untreated UTI can lead to kidney complications, which can cause early contractions and delivery.

Supportive Treatments of UTI in Pregnancy

Although antibiotics are the first line of defense against UTIs, there are steps you can take at home to support your urinary health and heal from an infection.

•  Stay hydrated with plenty of fluids (especially water) to dilute urine and flush out bad bacteria.
•  Avoid drinks that can irritate the bladder, such as coffee.
• Drink unsweetened 100% cranberry juice or take cranberry pills. Cranberry has some infection-fighting properties that can help prevent UTIs. You should avoid cranberry juice if you are taking blood thinners, as this can lead to bleeding.
• Wash carefully around your genitals and anus.
• Wipe from front to back after using the bathroom to prevent bacteria from the anal region from spreading to the vagina and urethra.
•  Shower instead of taking a bath.
• Avoid douching or using irritating feminine products that irritate the urethra and can lead to a UTI.
•  Urinate when the urge arises and at least every 2-3 hours.
• Empty your bladder soon after sexual intercourse.