UTI in Pregnancy

Pregnancy is a happy journey, but sometimes there will be some ”small annoyances.”  Today, we will talk about UTI in pregnancy.

What is a UTI?
Urinary tract infections (UTIs) are common in pregnant women, and are defined either as a lower tract (acute cystitis) or upper tract (acute pyelonephritis) infection. Asymptomatic bacteriuria (ABU) is also very common in pregnancy.

Why are UTIs very common in pregnancy?
It is related to physiological changes that occur during pregnancy：

1. Smooth muscle relaxation→Ureteral dilatation→ascending infection
2. Pressure on the bladder from the enlarging uterus
3. Immunosuppression during pregnancy

What are the common urinary tract pathogens?

• E. Coli
• Klebsiella pneumoniae
• Proteus mirabilis
• Staphylococcus saprophyticus
• Non-Urinary Tract Pathogens
• Lactobacilli
• Enterococci
• GBSB
• Coagulase-negative staphylococci

How is a UTI diagnosed?

1.How to diagnose Acute Cystitis?
Presenting Symptoms:

•Dysuria (painful urination), urinary urgency, frequency

Lab Tests:

•Detect pyuria

•Positive urine culture

2. How to diagonose Acute Pyelonephritis?

Clinical Manifestations:

•Fever > 38 ℃

•Flank pain

•Nausea, vomiting

•Lower back pain

3. How to diagnose asymptomatic bacteriuria?

•High-level bacterial growth in urine culture in the absence of symptoms consistent with UTI

•Routine Screening
•Urine culture performed at 12-16 weeks

•Rescreen in high-risk women, including those with:

•  History of UTI
• Urinary tract anomalies
• DM
• History of pre-term birth

How to treat a UTI?

•Antibiotics will be safely used during pregnancy

•Generally safe during pregnancy:

•Penicillin (with or without beta-lactamase inhibitors)

•Cephalosporins

•Aztreonam (imipenem, meropenem, ertapenem, doripenem)

•Fosfomycin

Some medications should not be used in specific trimesters, such as:
•Nitrofurantoin:

• Avoid during the 1st trimester due to possible birth defects
• Avoid near term due to the potential risk of hemolytic anemia in the newborn

•Trimethoprim-sulfamethoxazole:

•  Avoid during the 1st trimester due to interference with the absorption of folic acid
•  Avoid in late stages of pregnancy due to potential neonatal jaundice

Avoid during pregnancy (if possible)

•Fluoroquinolones

•Aminoglycosides

Should asymptomatic bacteriuria be treated during pregnancy?

Yes.Bacteriuria

Pyelonephritis (Kidney Infection)
•Bacteriuria commonly occurs during pregnancy, typically during early pregnancy. Without treatment, as many as 30 to 40 percent of pregnant women with asymptomatic bacteriuria will develop a symptomatic UTI including pyelonephritis, which has been associated with adverse pregnancy effects.
•Untreated bacteriuria has been associated with an increased risk of preterm birth, low birth weight, perinatal mortality, and preeclampsia.

Healthy men or women with a UTI normally do not need follow-up testing if symptoms resolve. However, pregnant women usually are asked to have a repeat urine culture one to two weeks after completing the course of treatment to confirm bacteria is no longer present in the urine.

Expectant mothers should discuss any concerns about UTI with their healthcare provider.