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Overview

Physical and hormonal changes during pregnancy increase your risk for a urinary tract infection. UTIs are the most common bacterial infections during pregnancy. The American College of Obstetricians and Gynecologists recommends that if you are pregnant and think you may have a UTI, call your OBGYN right away because severe infections can cause problems for both you and your baby. The good news is that when caught early, antibiotics can eliminate a urinary tract infection. Learn the symptoms of a UTI during pregnancy, testing, prevention, treatment, and the evidence on home remedies.

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UTIs (Urinary Tract Infections)

Your urinary tract removes waste and water from your body. This system includes the lower tract of your bladder and urethra and the upper tract of your kidneys and ureters. Your two kidneys produce urine. You have two ureters that transfer the urine to your bladder, where you collect and store urine. Your urethra is a tube that carries urine from your bladder out of your body.

A urinary tract infection can happen when bacterial is introduced to your urinary tract and causes an infection. Depending on where the infection is, it can go by different names. A lower infection can include an infection of the bladder (acute cystitis) or an infection of the urethra (urethritis). An upper urinary tract infection occurs in your kidneys and is called acute pyelonephritis. Lower infections are more common and less severe than infections in the upper tract. 

Causes

There are many ways in which you can introduce bacteria into your urinary tract. The most frequent way this happens is when going to the bathroom or during sex. Anytime you go to the bathroom, you should be wiping from front to back to keep bacteria from coming into contact with your vagina. Sex and sexual activity can also introduce bacteria to your vagina.

Bacteria

The most common of many bacteria to cause UTIs is E. coli. Group B streptococcus is a bacteria that naturally live in the gastrointestinal tract and is present in the vagina or the rectum. According to the American College of Obstetricians and Gynecologists, the prevalence in pregnant women is between 10% and 30%. This bacteria can cause a UTI. If you are positive for GBS near your due date, there is a risk of your newborn becoming infected with GBS, which can be severe. In addition to treating a UTI caused by GBS, your care provider may recommend additional antibiotics during labor to prevent passing the bacteria to your baby. For more information on GBS, testing, and treatment, see this episode.

UTIs During Pregnancy

Women are more susceptible to UTIs than men because women have a shorter urethra, so there is less distance for bacteria to travel. Urinary tract infections are the most common bacterial infections during pregnancy.

Some of the changes during pregnancy also increase your risk for a UTI. According to the CDC, UTIs occur in about 8% of pregnant women. During pregnancy, your growing uterus puts pressure on the ureters, which are the tubes that carry urine from your kidneys to your bladder. This compression causes your urinary tract to dilate, making it easier for bacteria to enter and travel. Increased progesterone can cause smooth muscle relaxation. This can cause your ureters to relax, which can slow down the flow of urine from your kidneys to your bladder. You also have changes to your immune system during pregnancy that may make you more susceptible to infection. 

Risk Factors

In addition to pregnancy, there are other risk factors for getting a urinary tract infection. Some of the health factors that can increase your risk are diabetes and obesity. Sickle-cell anemia affects the blood flow to your kidneys and can increase your risk. If you are sexually active, you are at a higher risk because sex can transfer bacteria to your urethra. Previous surgery on your urinary tract or damage from an injury or disease to the nerves that control your bladder can also affect your risk level. Having a catheter, which is common with an epidural, can put you at risk for a UTI. If you have a history of UTIs, you are more susceptible to getting them in the future.

Symptoms

Common symptoms of a UTI are a burning sensation when you urinate, urinating more frequently, or feeling like you have to urinate but only a small amount coming out. You may be urinating more often during pregnancy due to physical changes and pressure on your bladder from your uterus. Other signs of a UTI are if your urine is dark, cloudy, blood-tinged, or has a strong odor. More severe signs of a kidney infection are chills, nausea, vomiting, fever, and pain in your kidneys, which you would feel in the upper part of your abdomen on your back.

It is possible to have a UTI and be asymptomatic. Evidence shows that up to 20% to 30% of mothers with an asymptomatic UTI will develop acute pyelonephritis without treatment. This is one of the reasons why your doctor or midwife will test your urine in some prenatal appointments, even if you are not showing any symptoms.

Testing

If you have an infection in your urinary tract, high amounts of bacteria will be present in your urine. Urinalysis is routinely done in early and late pregnancy to test for UTIs. Your doctor or midwife will need a clean capture or clean catch of your urine to get an accurate test. This ensures that other bacteria do not contaminate your urine sample. To get a clean capture, you will need a sterile cup and a wipe. To start, you wipe your vagina and genital area, from front to back, avoiding your anus. You want to void some urine into the toilet before catching it in the sterile cup. A laboratory will test your urine for bacteria, measured in colony-forming units per milliliter of urine, as well as red and white blood cells. The lab may also culture the bacteria to identify the type.

Preventing UTIs

There are simple steps you can take to reduce your risk of developing a urinary tract infection. Make sure you are drinking plenty of water to help flush out your urinary tract. This is one of many reasons why it is critical to stay hydrated.

If you need to urinate, don’t hold it, and go to the bathroom. You always want to wipe from front to back.

Sex can introduce bacteria. If you use a lubricant, it should be water-based. During sex be cautious about introducing bacteria to your vagina. It is also a good idea to go pee after having sex.

Your vagina is not high maintenance. It is mostly self-cleaning, and you do not need special products to clean your vagina. You should not use a douche or any type of feminine deodorant and avoid soaps that can irritate. You should be wearing underwear with a cotton liner. A moist environment is ideal for bacteria. You also have heavier discharge during pregnancy than when you are not pregnant. You may consider using panty liners or changing your underwear more often so that your underwear is dry.

If you are prone to UTIs or are getting them consistently, you may consider additional steps like not wearing tight pants, washing your vagina before sex, avoiding baths, and taking showers instead. Alcohol and caffeine should already be limited or eliminated during pregnancy. You may also consider avoiding citrus or spicy foods.

Treating UTIs

The good news is that antibiotics will eliminate a urinary tract infection. Not all antibiotics are safe to take during pregnancy. Tetracyclines can discolor your baby’s teeth. Streptomycin and kanamycin are also teratogenic, meaning they are known to cause congenital disabilities. If you are pregnant or trying to become pregnant and your care provider is aware of this, they would take that into account when prescribing you any medications, including antibiotics.

If your doctor or midwife prescribes antibiotics, it is important to take the entire prescription – even if you feel better after a short time. The antibiotic will go to work right away and knock out most of the bacteria causing the infection pretty quickly. The issue is that it will not kill all of the bacteria in this short time frame. If you stop taking antibiotics early, the bacteria that have survived thus far may cause the infection to come back or could even become resistant to the antibiotic.

Risks of UTIs During Pregnancy

The American College of Obstetricians and Gynecologists recommends that if you are pregnant and think you may have a UTI, call your OBGYN right away because severe infections can cause problems for both you and your baby, so it is important to treat UTIs early.

Infections can spread to your bladder and eventually your kidneys. An infection in your kidneys can cause complications like anemia or sepsis. There is also evidence that a urinary tract infection during pregnancy increases your risk of developing preeclampsia.

Weighing the Risks and Benefits of Antibiotics

Like any intervention, taking antibiotics is a matter of weighing the risks and benefits. The obvious benefit is that antibiotics will eliminate the infection, decrease risks to you and your baby, and alleviate any uncomfortable symptoms. If you consider the risks of taking antibiotics, you also need to weigh the risk of not treating an infection with antibiotics. There is a full episode on antibiotics with more in-depth information.

You can probably guess that if you take antibiotics during your pregnancy, they are also reaching your baby. A review that looked at the comparison of the drug concentration in maternal and fetal plasma indicates the baby’s exposure to antibiotics taken by a mother. While the comparisons in concentrations differed, all antibiotics looked at in this review did cross the placenta. Just because these drugs cross the placenta doesn’t necessarily mean they are harmful to your baby.

One of the challenges in looking at research on antibiotics and pregnancy is that it is impossible to control for infection. Researchers cannot ethically give antibiotics to mothers who are healthy and don’t have infections. Any outcomes from research on treating pregnant mothers with antibiotics for infection could also be due to the infection.

A lot of the research on UTIs during pregnancy is from decades ago. Complications like low birth weight and preterm birth were linked to UTIs long ago. One study of patients who developed a kidney infection did not find higher rates for these adverse outcomes. They speculated this might be due to improvements in care and the routine use of antibiotics. They did find complications like anemia and sepsis and breathing issues. There is an obvious benefit to treating symptomatic infection.

A Cochrane Review examined the evidence on treating asymptomatic UTIs with antibiotics. They found low-certainty evidence to support routinely treating asymptomatic UTIs with antibiotics to reduce the risk of kidney infection, low birth weight, and preterm birth. If you test positive for a UTI and do not have any symptoms, the official recommendation is to take an antibiotic. If you have any concerns or questions, please discuss them with your doctor or midwife.

Antibiotic Side Effects

Side effects of antibiotics will vary depending on the type of antibiotic. Some of the most common side effects are nausea and vomiting. You may also experience changes to your gut microbiome, which manifest as diarrhea, bloating, or indigestion. You may also experience abdominal pain or loss of appetite.

Yeast infections are common because antibiotics can increase candida in your vaginal flora. Yes, your vagina also has a microbiome. If you are breastfeeding, antibiotics can increase the risk for thrush, which is a yeast infection in your baby’s mouth that can also affect your nipples.

How Antibiotics Impact Your Baby

We know that antibiotics affect our microbiome and potentially the microbiome of our babies. One study investigated the relationship between maternal antibiotic exposure before and during pregnancy and the risk of childhood hospitalization with infection. The study found that antibiotic exposure before or during pregnancy was associated with an increased risk of childhood hospitalized infections.

If you are concerned about your baby’s microbiome and how that may potentially be affected by antibiotics, there are some things you can do to mitigate the risk. A baby is born vaginally is exposed to bacteria in the vaginal canal. Your baby’s intestines are sterile, and the bacteria they are exposed to at birth help to colonize their intestines. Babies born via cesarean have a different bacteria profile than those born vaginally. There is some research on vaginal seeding to restore the microbiota of babies born via cesarean. For more information on vaginal seeding and gentle cesarean, see this episode. Breastfeeding and skin-to-skin contact will share some of your beneficial bacteria with your baby after they are born and may improve their microbiome.

Home Remedies to Treat a UTI

There are some popular home remedies to treat urinary tract infections. If you suspect you may have a UTI, please talk to your doctor, especially before trying to treat it on your own at home. Antibiotics remain the first line of defense to treat a UTI, especially in pregnancy.

Cranberry Juice

Cranberry juice is a popular home remedy to treat or prevent UTIs. Cranberries are very tart, and most cranberry juice you see at the store is not 100% from cranberries. The popular brand OceanSpray is a cranberry juice cocktail juice with a lot of added sugar. If you buy 100% cranberry juice, it will be very tart. There are also some over-the-counter supplements with cranberry extract marketed for urinary tract health.

The mechanism thought to work is that cranberries prevent the bacteria from adhering to cells in the bladder. The evidence to back up the efficacy of cranberries to prevent UTIs is mixed. A Cochrane Review concluded that cranberry products cannot be recommended for the prevention of UTIs based on the evidence. A meta-analysis found that cranberry may be effective in preventing UTI recurrence in generally healthy women. The American College of Obstetricians and Gynecologists states that unsweetened cranberry juice and cranberry pills may decrease the risk of getting a UTI. The exact amount of juice or pills needed and how long you need to take them to prevent infection are being studied.

If you like the taste of cranberry juice and you are not consuming too much sugar by adding it to your diet, it may not hurt, but it may not help either. If you consider taking a supplement with cranberry extract, please run it by your doctor or midwife first.

Probiotics

UTIs are common and are a significant burden on the health care system. Plus, growing antibiotic resistance has spurred an investigation into other possible treatments for UTIs, including probiotics. The predominant probiotic naturally found in the urinary tract is lactobacillus. Some studies have investigated whether taking a probiotic can help treat or prevent UTIs. The results have been promising but do not overwhelming support recommending probiotics for this purpose. For a more in-depth analysis of the research available on probiotics and UTIs, see this article.

There is evidence that probiotics can positively impact bowel movements for people experiencing constipation. One study looked at the association between the consumption of milk-based probiotic products in pregnancy and the development of preeclampsia. The study found that milk-based probiotic foods containing lactobacilli decreased the risk for preeclampsia.

Some common side effects of probiotics are digestive issues, like gas, bloating, or constipation. These symptoms tend to go away in a few weeks. One way to limit the side effects is to start with a lower dose of probiotics and gradually increase to the suggested daily amount. Many supplements will include instructions to do this on the label. Everyone’s gut microbiome is different. If you take a probiotic that has side effects, you can always stop taking it. For more in-depth information on probiotics, see this episode.

Click here for my favorite probiotic. I chose this one based on many factors, including the strains of probiotics included in it, the brand, the price, the ranking on Labdoor.com, an independent third party that ranks supplements based on quality.  This probiotic includes all of the strains of bacteria that are evidence-based to help things like constipation and possibly lower the risk for group B strep. Garden of Life also has a probiotic marketed specifically for pregnancy, and you can check it out here. If you have any questions about taking a probiotic during pregnancy, please talk to your doctor or midwife.

Talk to Your Doctor or Midwife

Disclose any history of UTIs to your doctor or midwife early in your prenatal care. Please reach out to your care provider if you suspect you may have an infection. If you have any questions or concerns about UTIs or taking antibiotics to treat them, please have a conversation with your doctor or midwife. They are your trusted partner in ensuring you and your baby are healthy.

 

Thank you to the amazing companies that have supported this episode.

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