How to treat a UTI in pregnancy

If you don’t treat a urinary tract infection (UTI) when you’re pregnant, there is a higher risk of pre-term labour and having a baby with a low birth weight.

Why are UTIs so common in pregnancy?

A UTI is an infection in the urinary tract, which includes the urethra, bladder, ureters, and kidneys. It is diagnosed with a lab test called a urine culture. Dr Zeenat Khan, a gynaecologist at Mediclinic Morningside, [CR1] [BR2] says the body changes during pregnancy make women more likely to get UTIs. During pregnancy, the immune system also becomes weaker, making it harder to fight infections.

In addition, the tubes that carry urine from the kidneys to the bladder (ureters) relax and widen, which can make it easier for infections to develop. According to Dr Khan, there are three types of UTIs:

1. Asymptomatic bacteriuria (ASB)
2. Lower urinary tract infection (acute cystitis)
3. Upper urinary tract infection (acute pyelonephritis).

“An infection may start lower down in the urinary tract but ascends because the physiological changes make it easier for this process to take place. There is a higher incidence of pyelonephritis in pregnant women than non-pregnant women,” she explains.

If not treated, one type of infection can lead to another, especially if you’re a pregnant woman.

Causes and symptoms of UTIs in pregnancy

UTIs are caused by bacteria, most commonly E. coli bacteria from the digestive system.

With ASB, there are more bacteria than usual in the urine, but there are no symptoms. In contrast, acute cystitis can cause pain when urinating, belly pain, and a frequent or urgent need to pee, says Dr Khan.

“With pyelonephritis, the infection has ascended the urinary tract towards the kidneys and patients may present with fever, backache, severe abdominal pain and vomiting.” These patients are normally admitted to hospital.

Treatment of UTIs in pregnancy

To check for ASB, a lab test called urine microscopy, and a culture is done to see if bacteria are growing. If the bacteria count is high (above 105 CFU/ml), your doctor will treat it to prevent a more serious infection. Dr Khan says both cystitis and pyelonephritis (kidney infections) need antibiotics for treatment.

“The antibiotic is chosen based on which works best against the bacteria found in the test and which are safe for pregnancy. Broad-spectrum antibiotics, such as Augmentin, can be used while waiting for the culture result. Other antibiotics commonly used to treat UTIs include nitrofurantoin, but it’s normally only given to pregnant women in their first trimester.”

If UTIs aren’t treated during pregnancy, there is a higher chance of having the baby too early or with a low birth weight, says Dr Khan. Pyelonephritis, a more serious kidney infection, may require hospital care and can lead to sepsis, a dangerous condition that can harm multiple organs.

The link between GBS infection and UTIs in pregnancy

A frequently occurring bacteria that can cause UTIs in pregnant women is Group B Streptococcus (GBS) species infection. GBS is usually located in the genital area and can sometimes migrate to the urinary tract, leading to a UTI.

“Group B strep can also cause neonatal infections, which can have severe consequences for the fetus,” Dr Khan says. “If a pregnant woman has this infection, we will always treat her with antibiotics through an IV drip during labour, even if she has no symptoms and no matter how many bacteria are present.”

Prior to labour, Group B strep is usually not treated with antibiotics unless the woman has symptoms. If she does, she will be given an oral antibiotic that works best against the bacteria.

The symptoms of GBS infection are like the three types of UTIs and can include the urge to urinate frequently, a burning sensation while urinating, pelvic pain, and sometimes fever.

Preventing UTIs in pregnancy

UTIs are common during pregnancy, and about 2-7% of pregnant women have bacteria in their urine without any symptoms, says Dr Khan. “Some doctors screen for it at 12-16 weeks by sending a urine sample off for culture as a preventative step. For the remainder of the pregnancy, we don’t routinely do urine culture tests unless the patient has symptoms,” she explains.

Dr Khan says the most important thing women can do to avoid getting a UTI during pregnancy is maintain good hygiene.

“After going to the toilet, make sure to wipe from front to back to avoid contamination of the faeces into the urinary tract,” she says. You should also urinate straight after sexual intercourse to flush out any bacteria that may have entered the urethra.

Pregnant women with weakened immune systems should take care to manage their conditions to prevent a UTI. This means diabetics should control their blood sugar through diet, exercise, and medication, while HIV-positive women should keep their viral load low by taking their prescribed medications.

“Sometimes, though, a UTI is unavoidable,” says Dr Khan. She adds that drinking plenty of fluids can help prevent them.