Urinary Tract Infections and Pregnancy

Urinary Tract Infections (UTIs) are common. Their prevalence during pregnancy is estimated to be between 2 and 10%, which is similar to the prevalence in non-pregnant women. However, being pregnant does complicate things. For example, it is generally recommended to avoid antibiotics during the first trimester and, if they have to be taken, it is important to discuss with your doctor which ones provide the fewest risks to you and your unborn baby.

Diagnosing UTIs during pregnancy

Most women will have acquired their UTI prior to falling pregnant and many remain asymptomatic. This is one reason why a urine sample is requested during pregnancy (doctors also use the urine sample to check for high sugars, which might be an early warning sign of gestational diabetes and proteins, which can be indicative of preeclampsia).

Left untreated, 30-40% of asymptomatic UTIs progress to pyelonephritis. Pyelonephritis can be very unpleasant. It has an overall incidence rate of approximately 2% in pregnant women, compared to <1% of the general population. The most obvious symptoms are lumbar pain, vomiting, fever (>38°C) and tenderness in the area between the lower ribs and the spine. One in five women with pyelonephritis will also have septicaemia and most will require hospitalisation and IV antibiotics for at least 48 hours.

Symptomatic UTIs

One of the most well-known forms of symptomatic UTI is cystitis. Common symptoms include cloudy urine, a frequent need to urinate and dysuria. Symptomatic UTIs and pyelonephritis correlate with an increased risk of premature delivery and low birth weight. However, studies to date have failed to ascertain the overall contribution of the conditions to preterm births. A rare, but serious complication of UTIs in pregnant women is the risk of transmission to the baby during delivery.

Treating UTIs during pregnancy

Usually the treatment of choice for UTIs are antibiotics, however, as most have been shown to cross the placenta, care must be taken when choosing which one to prescribe. Streptomycin and tetracycline should definitely be avoided due to their teratogenic properties. Derivatives of penicillin, such as amoxicillin, and cephalosporins are generally considered to be amongst the safest options. Their safety profiles and mechanisms of action are better understood than the newer drugs as they have been in the market for longer.

As with many aspects of health, prevention is certainly the best option. Whilst the incidence of UTIs does not increase significantly during pregnancy, changes to the structure and composition of the urinary tract and increased urine retention do provide optimal conditions for the growth of bacteria. Certain steps can help to minimise the risk of acquiring a UTI.

Does cranberry juice help to prevent UTIs?

Cranberry juice has long been recommended as an aide for avoiding and/or helping to manage UTIs. Studies show that cranberry consumption may prevent bacteria from attaching to the walls of the urinary tract and may reduce the inflammatory response that happens following exposure to bacteria. However, some experts question whether regular cranberry juice contains sufficient active ingredients to have a therapeutically beneficial effect. The general consensus is that those women who experience recurrent UTIs might benefit from cranberry supplementation and that prophylactic use is unlikely to do any harm.

What other steps can be taken to reduce the risk of UTI?

Aside from cranberry juice, other fruit juices are best avoided in favour of water. Remaining hydrated is important, so aim to drink between 1.5 and 2 litres of water a day. Maintain good hygiene by keeping the genital area clean, but avoiding douching, particularly during pregnancy. Douching has been associated with an increased risk of pelvic inflammatory disease. Use mild soaps that are free of harsh ingredients and synthetic detergents. Finally, maintain good toilet habits; go to the toilet as soon as you feel the urge, as holding urine in your bladder for longer than necessary can increase the exposure to bacteria. Bouts of diarrhoea and constipation can also increase your susceptibility to UTIs if bacteria from the rectum enters the vagina.

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Sources:

• “Can Cranberry Stop Your UTIs?” Health Essentials from Cleveland Clinic, Health Essentials from Cleveland Clinic, 18 Feb. 2020, health.clevelandclinic.org/can-cranberry-juice-stop-uti/.
• Mantzorou, Maria, and Constantinos Giaginis. “Cranberry Consumption Against Urinary Tract Infections: Clinical State and Future Perspectives.” Current Pharmaceutical Biotechnology, vol. 19, no. 13, 2018, pp. 1049–1063., doi:10.2174/1389201020666181206104129.
• Martino, J. L. “Vaginal Douching: Evidence for Risks or Benefits to Women’s Health.” Epidemiologic Reviews, vol. 24, no. 2, 1 Dec. 2002, pp. 109–124., doi:10.1093/epirev/mxf004.
• Matuszkiewicz-Rowińska, J, et al. “Urinary Tract Infections in Pregnancy: Old and New Unresolved Diagnostic and Therapeutic Problems.” Archives of Medical Science, vol. 11, no. 1, 16 Mar. 2015, pp. 67–77., doi:10.5114/aoms.2013.39202.
• Norwitz, E R, and J A Greenberg. “Antibiotics in Pregnancy: Are They Safe?” Reviews in Obstetrics and Gynecology, vol. 2, no. 3, 2009, pp. 135–136.
• Vasileiou, I, et al. “Current Clinical Status on the Preventive Effects of Cranberry Consumption against Urinary Tract Infections.” Nutrition Research, vol. 33, no. 8, Aug. 2013, pp. 595–607., doi:10.1016/j.nutres.2013.05.018.
• Windham, L. “How to Prevent UTI During Pregnancy.” WikiHow, www.wikihow.com/Prevent-UTI-During-Pregnancy.