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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

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Urinary tract infections in pregnant women

• Basic terms used to describe urinary tract infections
• Mechanism of urinary tract infections during pregnancy
• What bacteria causes urinary tract infections in pregnant women
• Why are urinary tract infections dangerous in pregnant women
• Symptoms of urinary tract infections in pregnancy
• Diagnostics
• Treatment of urinary tract infections in pregnant women

Urinary tract infections The most common group of infectious lesions during pregnancy. Hormonal and structural changes in the female body that occur during pregnancy cause a slowdown in the passage of urine through the urinary tract and sometimes lead to the occurrence of vesicoureteral reflux - the reflux of urine from the bladder into the ureters. Predisposing factors also include anatomical features - the length of the urethra in women is only 4-5 cm. In addition, during pregnancy, there may be problems with personal hygiene due to the large size of the abdomen.

Initially, all pregnant women are considered immunocompromised, with low resistance to any infectious agents. This decrease in immunity is a consequence of the normal physiological restructuring of the body of a pregnant woman. As a result, even healthy pregnant women can often suffer from complications of urinary tract infections.

Basic terms used to describe urinary tract infections

• Urinary tract infection : the presence of more than 1x105 bacteria in 1 ml of urine in patients who do not present symptoms or the presence of more than 100 bacteria in 1 ml in patients with symptoms and have more than 7 leukocytes in 1 ml (similar to Nechiporenko urinalysis). The diagnosis must be confirmed by bacteriological culture. Urinary tract infections are associated with a high risk of pyelonephritis, preterm birth, low birth weight, and increased mortality in childbirth.
• Asymptomatic bacteriuria (bacteriuria is the excretion of bacteria in the urine). This condition is characterized by the detection of more than 1.105 bacteria in one milliliter of urine in two consecutive tests. With asymptomatic bacteriuria, the patient has no complaints. This condition is associated with a high risk of complications such as acute cystitis (up to 40%) and acute pyelonephritis (up to 30%). In general, about 70% of all inflammatory diseases of the urinary tract in pregnant women are caused by asymptomatic bacteriuria.
• Acute cystitis - occurs in approximately 1% of pregnant women. Symptoms of cystitis: pain in the lower abdomen, blood in the urine, frequent urge to urinate, pain when urinating. These symptoms are often similar to those of pregnancy itself. In 15-50% of cases, acute cystitis during pregnancy is complicated by acute pyelonephritis.
• Acute pyelonephritis (inflammation of the kidneys) - develops in approximately 2% of pregnant women. The disease is characterized by pain in the affected side, high fever, bacteriuria. Also, with pyelonephritis, the same symptoms can occur as with cystitis. Acute pyelonephritis during pregnancy is the most dangerous of the inflammatory diseases of the urinary tract.

The mechanism of occurrence of urinary tract infections during pregnancy

Infection in the urinary tract in women during pregnancy occurs from the surface of the perineum, where there is a high concentration of bacteria that live in the rectum and vagina. Predisposing factors are weakened muscle tone of the ureters due to the influence of progesterone, urinary stagnation caused by compression of the ureters by the uterus, increased urine output during pregnancy.

An increase in the volume of urine and a decrease in the tone of the ureters and pelvis leads to their expansion and even greater stagnation of urine. In 86%, the renal pelvis and calyx dilate on the right side. These processes begin at the 10th week of pregnancy and only progress over time. Accordingly, in the first trimester, acute pyelonephritis occurs only in 2% of pregnant women, in the second trimester - in 52%, and in the third trimester - in 46%.

In addition to stagnation of urine and expansion of the components of the urinary system during pregnancy, the chemical properties of urine change: glucose and some amino acids may appear. The mechanism of increased excretion of certain amino acids in the urine during pregnancy is not completely clear, but their appearance in the urine predisposes to an increase in the pathogenic properties of Escherichia coli, one of the most common causative agents of urinary tract infection.

What bacteria causes urinary tract infections in pregnant women

The main pathogen that causes infections is Escherichia coli. It is the cause of 80-90% of diseases. This pathogen enters the urinary tract directly from the skin of the perineum. On the skin, it appears due to the anatomical proximity of the anus. E. coli is a representative of the normal microflora of the human large intestine, but getting into unusual living conditions, it can cause inflammation. The remaining 10-20% of bacteria that can cause inflammation of the urinary tract during pregnancy include Klebsiella, Streptococcus, Proteus, Staphylococcus, and various enterobacteria.

Why are urinary tract infections dangerous in pregnant women

In most cases, the prognosis for all forms of infections is favorable. In a complicated course, infectious-toxic shock, respiratory failure and hypoxia of the extremities associated with low blood pressure may develop. The effect on the fetus is not very pronounced, since the bacteria do not enter directly into the fetal bloodstream. However, phenomena such as maternal dehydration, low blood pressure, anemia, and the direct effect of bacterial toxins can cause disruption of the blood supply to the fetal brain. If infections of the urinary system are not treated, then there is a high risk of developing arterial hypertension, preeclampsia, anemia, premature birth, inflammation of the membranes - amnionitis. Naturally, all these factors seriously increase the risks of unsuccessful pregnancy and childbirth.

Symptoms of urinary tract infections in pregnant women

Asymptomatic bacteriuria does not bother the pregnant woman. With the development of an infection of the lower urinary tract, pain in the lower abdomen, frequent urge to urinate, and hematuria appear. These symptoms are not strictly characteristic, as they can also be caused in healthy pregnant women due to compression of the bladder and pelvic organs by the growing uterus, an increased rate of urine formation and an increase in the volume of circulating fluid in pregnant women.

With pyelonephritis, body temperature often rises (above 38 degrees), there is pain in the side, loss of appetite, nausea and vomiting. Sometimes body temperature can, on the contrary, fall.

Diagnostics

If symptoms occur that may be associated with the presence of a urinary tract infection, a general blood test, a general urinalysis and a Nechiporenko urinalysis, as well as a bacteriological examination of urine (bacteriological culture) are done. These tests are also routinely carried out for pregnant women who are registered. Thus, monitoring is carried out for the presence of asymptomatic bacteriuria. If there are suspicions of the presence of anomalies in the structure of the urinary system or a violation of its function, ultrasound of the kidneys is immediately performed. Also, ultrasound of the kidneys is performed if antibiotic therapy does not improve within 49-72 hours. Despite the fact that there are no specific ultrasound signs of cystitis and pyelonephritis, this study reveals structural changes in the urinary tract, such as dilation of the ureter, pelvis, calyces, and the presence of vesicoureteral reflux. Also, with ultrasound of the kidneys, obstruction of the ureter by a stone is excluded.

Treatment of urinary tract infections in pregnant women

Depending on the severity of the disease, treatment can be carried out on an outpatient basis or in a hospital setting.

It is essential to treat asymptomatic bacteriuria, as it is the main cause of the development of more severe diseases. Treatment can be broken down into behavioral therapies and antibiotic therapy.

Behavioral methods include simple hygiene rules:

• No bath during pregnancy, only shower
• Wipe the perineum after urination or defecation only from front to back
• Wash hands thoroughly before going to the toilet
• Do not use perineal washcloths
• Use only liquid soap to avoid breeding bacteria in the soap bar
• When showering, the area around the urethra should be washed first

Penicillins, cephalosporins, sulfonamides and nitrofurans are used for antibiotic treatment.

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