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Urinary Tract Infections (UTI) During Pregnancy

Written by WebMD Editorial Contributors

Medically Reviewed by Nivin Todd, MD on September 04, 2022

In this Article

• UTI Symptoms
• Why Are UTIs More Common During Pregnancy?
• UTI Diagnosis
• UTI Treatment During Pregnancy
• UTI Complications During Pregnancy
• UTI Prevention

A urinary tract infection (UTI) is an infection of some part of your body's urinary system, which includes your:

• Kidneys
• Ureters (tubes that carries urine from your kidneys to your bladder)
• Bladder
• Urethra (a short tube that carries urine from your bladder to outside your body)

Bacteria cause most UTIs. Anyone can get one, but they're most common in women, and they can be extra concerning if you're pregnant.

If you think you might have a UTI, tell your doctor. With proper care, you and your baby should be fine.

Usually, these infections are in the bladder and urethra. But sometimes they can lead to kidney infections. If they do, UTIs may lead to preterm labor (giving birth too early) and low birth weight.

UTI Symptoms

If you have a UTI, you may have:

• An urgent need to pee, or peeing more often
• Trouble with peeing
• A burning sensation or cramps in your lower back or lower belly
• A burning feeling when you pee
• Urine that looks cloudy or has an odor
• Blood in your pee, which can turn it red, bright pink, or cola-colored

If you have a kidney infection, you may have:

• Fever
• Nausea
• Vomiting
• Upper back pain, often on just one side

If you have symptoms of a kidney infection, see your doctor right away. Without treatment, the infection can spread into your bloodstream and cause life-threatening conditions.

Why Are UTIs More Common During Pregnancy?

Hormones are one reason. In pregnancy, they cause changes in the urinary tract, and that makes women more likely to get infections. Changes in hormones can also lead to vesicoureteral reflux, a condition in which your pee flows back up from your bladder to your kidneys. This can cause UTIs.

When you’re pregnant, your pee has more sugar, protein, and hormones in it. These changes also put you at higher risk for a UTI.

Because you’re pregnant, your growing uterus presses on your bladder. That makes it hard for you to let out all the urine in your bladder. Leftover urine can be a source of infection.

Other causes of UTIs include:

Escherichia coli and other bacteria from your poop. E. Coli is the most common cause of UTIs and can move from your rectum to your urethra if you don’t wipe from front to back.

Sexual activity. Fingers, your partner’s penis, or devices can move bacteria near your vagina into your urethra.

Group B streptococcus. Many women have this bacteria in their colon and vagina. It can cause UTIs and women can pass it to their newborns. Your doctor will test you for this bacteria around weeks 36 to 37 of pregnancy. If you’re positive for group B strep, your doctor will give you IV antibiotics during labor.

UTI Diagnosis

You’ll take a urine test. Your doctor will test it for bacteria and red and white blood cells. A urine culture may also be checked. It shows what kind of bacteria are in the urine.

UTI Treatment During Pregnancy

You’ll take antibiotics for 3 to 7 days or as your doctor recommends. If your infection makes you feel uncomfortable, your doctor will probably start your treatment before you get your urine test results.

Your symptoms should go away in 3 days. Take all of your medication on schedule anyway. Don’t stop it early, even if your symptoms fade.

Many common antibiotics -- amoxicillin, erythromycin, and penicillin, for example -- are considered safe for pregnant women. Your doctor wouldn’t prescribe others, such as ciprofloxacin (Cipro), sulfamethoxazole, tetracycline, or trimethoprim (Primsol, Proloprim, Trimpex), that can affect your baby’s development.

UTI Complications During Pregnancy

Pyelonephritis is a UTI that affects the kidneys. If you’re pregnant it can cause:

• Preterm labor
• Severe infection
• Adult respiratory distress syndrome
• Anemia
• Long-term infection

UTI Prevention

To try to avoid getting a UTI:

• Drink at least eight glasses of water a day.
• Wipe yourself from front to back when you go to the bathroom.
• Empty your bladder shortly before and after sex.
• If you need a lubricant when you have sex, choose a water-based one.
• Don't douche.
• Avoid strong feminine deodorants or soaps that cause irritation.
• Wash your genital area with warm water before sex.
• Wear cotton underwear.
• Take showers instead of baths.
• Don’t wear pants that are too tight.
• Pee often.
• Avoid alcohol, citrus juices, spicy food, and caffeinated drinks, which can irritate your bladder.

Women's Health Guide

1. Screening & Tests
2. Diet & Exercise
3. Rest & Relaxation
4. Reproductive Health
5. Head to Toe

Urinary tract infections vs pregnancy: treatment and prevention

Summary. Urinary tract infections are one of the most common complications in pregnant women, which can lead to serious consequences not only for the expectant mother, but also for the child. When managing pregnant women with diseases of the urinary system, it is extremely important to choose the right and, most importantly, safe therapeutic tactics. What drugs are safe during pregnancy? What obstetric and therapeutic tactics are most effective for kidney diseases in pregnant women? What diagnostic methods are best used for asymptomatic bacteriuria, acute cystitis and pyelonephritis? Professor 9 spoke about this in her speech0003 Olga Grishchenko , Head of the Department of Perinatology, Obstetrics and Gynecology of the Kharkov Medical Academy of Postgraduate Education during the training workshop for gynecologists "Actual Guidelines of Gynecology, Reproductology, Obstetrics", held on March 29, 2019 in Kharkov. The event was organized by the MedExpert Group of Companies together with the National Medical University named after A.A. Bogomolets and National Medical Academy of Postgraduate Education named after P.L. Shupyk.

Urgency of the problem

Urinary tract infections (UTIs) are the most common bacterial infections in outpatient practice, they take the 2nd place, second only to respiratory tract infections. According to statistics, 50% of women in the world have an episode of UTI at least once in their lives, of which 25–40% experience a relapse of the disease within 6–12 months. Every year, about 10% of women develop acute cystitis, and pyelonephritis remains the leading cause of hospitalization during pregnancy for non-obstetric indications.

In the presence of UTIs in pregnant women, the risk of preterm labor and rupture of amniotic fluid, chorioamnionitis increases, premature or functionally immature children are born, and the level of perinatal mortality increases.

In the structure of UTI, asymptomatic bacteriuria is observed in 4-9.5% of pregnant women, acute pyelonephritis - in 12-25%, chronic pyelonephritis - in 33%, glomerulonephritis, urolithiasis - in 0.1-0.2%.

Risk factors and pregnancy

As a rule, infections, self-medication or improper treatment, asymptomatic bacteriuria, frequent UTIs in combination with inflammatory diseases (colpitis), lifestyle and nutrition can affect the occurrence of pathology of the urinary system.

Pregnant women have an increased risk of diseases of the urogenital tract. A high level of progesterone leads to the development of hypotension, hypokinesia, dyskinesia of the ureters and pyelocaliceal system. In turn, the uterus compresses the ureter, high intra-abdominal pressure occurs, especially in primiparas. During pregnancy, the renal pelvis enlarges, the growing uterus squeezes the ureter more and more, the outflow of urine from the kidneys becomes difficult, the urine stagnates, bacteria multiply in it, and inflammation easily occurs.

Infectious agents can enter the bladder by ascending (with inflammatory diseases of the urethra), descending (most often with tuberculous kidney damage), hematogenous (if there is a purulent focus in other parts of the body) and lymphogenic (with diseases of the genital organs) by.

Classification of UTIs in pregnant women

UTIs in pregnant women include asymptomatic bacteriuria, lower urinary tract infections (acute and recurrent cystitis) and upper urinary tract infections (acute pyelonephritis, chronic pyelonephritis in remission, exacerbation, latent course).

Cystitis in pregnancy: course, diagnosis

Cystitis is an inflammation of the bladder wall, one of the most common urological diseases, as a rule, its cause is an infection. Symptoms of cystitis in women are manifested in the form of frequent urination, cramps and pain when urinating, pulling sensations in the lower abdomen, weakness, fatigue, irritability, blood in the urine, cloudy urine, pus or yellow spots on the underwear.

Normally, urination is not accompanied by pain. In women, painful urination can be caused by diseases of the bladder, urethra, or vagina. So, pain in the bladder, as a rule, is felt in the area of ​​the womb, it can increase during urination or, conversely, decrease when the bladder is empty. Urethral pain associated with urination is felt by the patient directly in the urethra and is usually aggravated by urination. Urine entering the vaginal opening can cause pain if it is inflamed. Inflammation of the urethra is most often characterized by a bacterial nature and requires additional examination and treatment.

Primary diagnosis of cystitis involves an examination by specialized specialists (urologist, nephrologist, gynecologist), as well as taking an anamnesis and establishing possible causes of the disease (hypothermia, unprotected intercourse, taking medications, the presence of concomitant diseases).

Laboratory tests include a urinalysis for Nechiporenko cultures (helps identify the pathogen), a general urinalysis (allows you to identify erythrocytes, leukocytes, protein in the urine; the urine itself may be cloudy with an admixture of blood or pus), a general blood test (allows you to identify a picture inflammatory process, it is possible to increase the erythrocyte sedimentation rate (ESR), leukocytosis). Among instrumental methods, ultrasound examination (ultrasound) of the bladder, ureteroscopy and cystoscopy (in case of violation of the passage of urine) are used.

Asymptomatic bacteriuria during pregnancy

Asymptomatic bacteriuria during pregnancy is dangerous for both mother and fetus, against its background, 25% of women develop acute pyelonephritis. According to the World Health Organization, about 8% of women report asymptomatic bacteriuria, 15-57% of women with untreated asymptomatic bacteriuria develop symptoms of a UTI (acute cystitis or pyelonephritis). Therapy of this disease during pregnancy reduces the risk of developing acute UTIs, preterm birth, and low birth weight.

Diagnosis of asymptomatic bacteriuria can be established by detecting 10 ⁵ CFU/ml of one bacterial strain or 10 ² CFU/ml of uropathogen Escherichia coli field of view in the absence of clinical manifestations of UTI.