UTIs in Pregnancy, Common but Preventable

Pregnancy is a beautiful journey, as your body undergoes numerus changes to nurture your growing baby, it can also bring unexpected health challenges. One common issue is urinary tract infections (UTIs), affecting roughly 1 in 10 expectant mothers.

These changes are both hormonal and mechanical. During pregnancy, rising progesterone levels increase the risk of UTIs. This hormonal shift relaxes the smooth muscles, causing the tubes that connect the kidneys to the bladder to widen and the bladder to expand. Additionally, the bladder’s muscle tone decreases, which can lead to urine retention and backflow from the bladder toward the kidneys (vesicoureteral reflux).

Another risk factor is the shorter urethra in women (only 3-4 centimeters), combined with the difficulty of maintaining hygiene due to the growing belly. This combination lowers the body’s ability to fend off bacterial invasion. The pressure from the baby’s head can also impact blood and lymph drainage from the bladder’s base, causing swelling and making the area more prone to trauma. Hormonal changes also increase the glomerular filtration rate in the kidneys, which often results in glucose in the urine (glucosuria)—a condition that fosters bacterial growth.

UTIs in pregnancy can appear at any time and may present with or without symptoms. Common symptoms include:

• Frequent urination
• Pain or discomfort when urinating
• A burning sensation during urination
• Lower back or lower abdominal cramps
• Cloudy or foul-smelling urine
• Fever, chills
• Side pain (if the infection has spread to the kidneys)
• Nausea and vomiting
• Back pain

In the first trimester, a urine test is typically part of the recommended health check-ups. Asymptomatic bacteriuria (a UTI without symptoms) can be diagnosed with two urine samples. Regular screening for UTIs is advised since untreated infections can escalate to cystitis or pyelonephritis and lead to complications for both mother and baby. Pregnancy complications from untreated UTIs include anemia, hypertension, and chorioamnionitis (inflammation of the membranes surrounding the fetus).

If bacteria spread throughout the body, it can lead to a severe infection known as sepsis, which may cause organ failure. This poses risks to the baby, including premature birth and low birth weight, among others. Therefore, maintaining proper hygiene and staying adequately hydrated during pregnancy is essential for preventing UTIs.

To prevent UTIs, pregnant women can take these steps:

• Drink 2 liters or about 8 glasses of water daily
• Avoid holding in urine; go when you feel the need
• After using the bathroom, gently clean the vaginal area from the front (the pubic region) to the back (toward the anus) to maintain proper hygiene.
• Wear breathable cotton underwear and change when uncomfortable
• Avoid tight clothing
• Non-antimicrobial options like cranberry juice may help prevent E. coli from attaching to the urinary tract\

Reference:

1. Wismayanti, Zeissa Rectifa. UTIs in Pregnancy, Common but Preventable. Interview, November 2023.
2. Centers for Disease Control and Prevention (CDC). Urinary tract infections (UTIs) - ACOG. (https://www.acog.org/womens-health/faqs/urinary-tract-infections). Accessed on 23 November 2024.
3. American College of Obstetricians and Gynecologists (ACOG). Urinary tract infections in pregnant individuals. (https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals). Accessed on 23 November 2024.
4. Centers for Disease Control and Prevention (CDC). Characteristics of women with urinary tract infection in pregnancy. (https://stacks.cdc.gov/view/cdc/115866). Accessed on 23 November 2024.