UTIs During Pregnancy: Should I Be Concerned?

Pregnant people have a higher risk for many common health ailments due to physical body changes during pregnancy. Urinary tract infections (UTI) and the development into a more serious infection of the kidney, called pyelonephritis, is the most common medical condition seen in pregnant people. Why do pregnant people have a higher risk, what is the treatment, and how can UTIs be prevented?

What is a UTI?

A urinary tract infection or UTI is a bacterial infection of the bladder and related body structures. Cystitis is an infection of the lower urinary tract involving only the bladder. Pyelonephritis, or a kidney infection, occurs when bacteria travel up the ureters from the bladder to the kidneys.

Approximately 40% of people with vaginas will have at least one UTI in their lifetime, with 10% suffering yearly infections. Comorbidities, including diabetes, age, pregnancy, a compromised immune system, and structural abnormalities, can complicate UTIs.

The rate of UTIs among people with vaginas is high because of the closeness of the anus to the urethral opening and a short urethral length. This proximity makes transferring bacteria, most commonly Escherichia coli, from the rectum to the urethra a common occurrence.

Causes of UTI during pregnancy

UTIs are a frequent ailment for people with vaginas, but pregnant people are at an exceptionally high risk of a complicated infection for a few reasons:

Urinary tract changes

During pregnancy, the urethra, the tube from the bladder to the body’s exterior, relaxes or dilates as the heavy pregnant uterus compresses the ureters, the tubes from the kidneys to the bladder. The pregnancy hormone progesterone causes smooth muscle relaxation, dilating or opening up the urethra and ureters. This dilation causes urine to sit still, becoming a breeding ground for bacteria.

Immunocompromised state

Pregnancy is a natural state of immunosuppression. With the body preoccupied with developing life, bacteria may be able to take hold and cause an infection.

Asymptomatic bacteriuria

Asymptomatic bacteriuria (ASB) is the most common cause of UTIs in pregnant people. ASB is when bacteria in the urine do not initially cause any UTI symptoms but, if untreated, can cause a symptomatic UTI.

In 30% of cases, ASB will cause cystitis, a bladder infection, and can lead to pyelonephritis, a kidney infection, in up to 50% of pregnant people. Commonly, urine samples are taken at every prenatal visit to monitor for the presence if ASB. If detected, ASB is usually treated with antibiotics.

UTI symptoms during pregnancy

Pregnant people with ASB have no symptoms. Those with active infections will present with typical UTI symptoms, which include:

• Pain or burning with urination
• Increased frequency of urination
• Urgency to urinate
• Pain in and around the pubis

Pyelonephritis, a kidney infection, will cause more severe symptoms, which include:

• Pain on one or both sides of the mid to lower back
• Fever and chills
• Nausea and vomiting
• Malaise or general discomfort
• Possible contractions
• Fast heart rate
• Low blood pressure

Pyelonephritis, a severe condition in pregnancy, is generally treated with intravenous antibiotics and other medications while admitted to the hospital.

When to speak with your doctor?

Contact your healthcare or obstetric provider immediately if you have any signs of a UTI. Addressing the symptoms of a UTI is vital because of the risk of a more serious infection. Your healthcare provider will be able to evaluate your symptoms and collect a clean catch urine sample and possibly a blood sample.

Also, if you are 20 weeks pregnant or more, the obstetrical team will assess your baby to ensure fetal well-being and monitor for contractions. One study found that 3.5% of antepartum or pre-delivery hospital admissions were due to UTIs.

Pyelonephritis can cause septic shock, a life-threatening condition, in pregnant people. While the results are inconsistent, some studies have shown that UTIs are associated with preterm birth.

Preventing UTIs during pregnancy

UTIs may be challenging to prevent during pregnancy due to the increased risk of infection. However, some studies have shown that basic hygiene can help decrease the risk of developing an infection. Basic genital hygiene principles include:

• Washing the genital area and urinating after sexual intercourse
• Wiping front to back after using the bathroom
• Urinating frequently
• Drinking appropriate amounts of water

Some studies have also shown the benefits of:

• Cranberry juice
• Vaccination or immunization
• Ascorbic acid or vitamin C
• Canephron®N. An herbal supplement containing rosemary, lovage, and centaury

Are UTIs dangerous for a developing baby?

UTIs can cause smooth muscle irritability, which can provoke contractions. Sometimes these contractions can lead to preterm labor. Preterm labor could be problematic for your developing baby depending on the gestational age or number of weeks pregnant you are.

UTIs in pregnancy, though common, can quickly develop into a complicated, serious infections. It is essential to be aware of the symptoms of a UTI so that you can receive prompt treatment to safeguard your health and that of your developing baby.