Overview

Pregnancy brings many changes to your body, including hormone changes and how your urinary system functions. These changes can increase the risk of developing a urinary tract infection, the most common bacterial infection during pregnancy. A UTI can be uncomfortable and may lead to complications if left untreated. The good news is that they are highly treatable. In this episode, we break down everything you need to know about UTIs during pregnancy, from symptoms and testing to prevention and treatment options. We also explore the evidence behind popular home remedies like cranberry juice and probiotics. Whether you’ve had a UTI before or want to be informed, this episode will help you feel confident in recognizing and addressing this common pregnancy concern.

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Urinary Tract Infections (UTIs)

Your urinary tract is vital in removing waste and excess water from your body. It includes the lower tract, which consists of the bladder and urethra, and the upper tract, which includes the kidneys and ureters. Your kidneys produce urine, which travels through the ureters to the bladder and is stored until it leaves the body through the urethra.

A urinary tract infection (UTI) occurs when bacteria enter the urinary tract and cause an infection. The location of the infection determines its classification. A lower UTI may involve the bladder (acute cystitis) or the urethra (urethritis). An upper UTI affects the kidneys and is called acute pyelonephritis. Lower UTIs are more common and generally less severe than upper UTIs, which can lead to more serious complications if left untreated.

Causes

Bacteria can enter the urinary tract in several ways. The most common causes include bathroom habits and sexual activity. One primary way bacteria are introduced is improper wiping after using the bathroom. Always wipe from front to back to prevent bacteria from the rectal area from contacting the urethra, where it can travel into the urinary tract and cause an infection.

Sexual activity is another common cause of UTIs. During intercourse, bacteria from the vaginal and rectal areas can be pushed into the urethra. Urinating after sex can help flush out bacteria and reduce the likelihood of infection. Spermicides and diaphragms can alter the balance of bacteria in the vaginal area, making infections more likely.

Bacteria That Cause UTIs

Escherichia coli (E. coli) is the bacterium responsible for 80-90% of UTIs. This normally lives in the intestines, but if it is introduced into the urinary tract, it can multiply and cause infection.

Group B Streptococcus (GBS) is another type of bacteria that naturally lives in the gastrointestinal tract and can be present in the vagina or rectum. According to the American College of Obstetricians and Gynecologists, 10-30% of pregnant women carry GBS. GBS can cause UTIs, though routine testing at 36–37 weeks is focused on vaginal and rectal colonization that may affect newborns. See this episode for more information on GBS, testing, and treatment.

There are additional bacteria that are less common causes of UTIs. If you develop a UTI, your doctor or midwife may order a urine culture to identify the specific bacteria and determine the most effective treatment.

UTIs During Pregnancy

Women are more prone to UTIs than men because they have a shorter urethra, allowing bacteria to reach the bladder more easily. Several changes during pregnancy further increase the risk. As the uterus expands, it puts pressure on the ureters, the tubes that carry urine from the kidneys to the bladder. This compression causes the urinary tract to widen, making it easier for bacteria to enter and travel. Increased progesterone levels cause smooth muscle relaxation, including in the ureters, which slows the urine flow and gives bacteria more time to multiply. Pregnancy also alters the immune system, making the body more vulnerable to infections. UTIs are the most common bacterial infection during pregnancy. According to the CDC, UTIs occur in about 8% of pregnant women. Other research shows a higher estimate at around 11-26%. Because UTIs during pregnancy can lead to complications if untreated, routine urine screening is often recommended to catch infections early.

Additional Risk Factors

In addition to pregnancy, several other factors can increase the risk of developing a urinary tract infection. Health conditions such as diabetes and obesity can make infections more likely. Sickle cell anemia affects blood flow to the kidneys and can also increase the risk. Being sexually active raises the likelihood of a UTI because bacteria can be transferred to the urethra during intercourse. A history of urinary tract surgery, an injury, or diseases that affect the nerves controlling the bladder can impact bladder function and make infections more common. The use of a catheter, which is often needed when receiving an epidural during labor, can introduce bacteria into the urinary tract. Having a history of UTIs also increases the chances of developing future infections.

Symptoms

Common symptoms of a UTI include a burning sensation when urinating, frequent urination, or feeling the urge to urinate but only passing a small amount. During pregnancy, it is normal to urinate more often due to hormonal changes and pressure on the bladder from the growing uterus, which can make it harder to recognize a UTI. Other signs of infection include dark, cloudy, blood-tinged urine or urine with a strong odor. More severe symptoms, such as chills, nausea, vomiting, fever, and pain in the kidneys, which is typically felt in the upper part of the abdomen or back, may indicate a kidney infection.

It is also possible to have a UTI without noticeable symptoms. Evidence shows that 20-30% of pregnant women with an asymptomatic UTI will develop acute pyelonephritis if the infection is left untreated. This is one of the reasons why urine tests are performed at some prenatal appointments, even if no symptoms are present.

Testing

If you have a urinary tract infection, high amounts of bacteria will be in your urine. Urinalysis is routinely performed in early and late pregnancy to screen for UTIs. To ensure an accurate test, your doctor or midwife will request a clean-catch urine sample, which helps prevent contamination from bacteria on the skin or in the vaginal area.

Your doctor or midwife will provide a sterile cup and a cleansing wipe to provide a clean-catch sample. First, use the wipe to clean the vaginal and genital area from front to back, avoiding the anus. Then, begin urinating into the toilet before positioning the sterile cup to collect the midstream urine sample. This method helps reduce bacteria from external sources that could interfere with test results.

A laboratory will analyze the urine sample for bacteria and the presence of red and white blood cells, which can indicate infection. In some cases, the lab may culture the bacteria to determine the specific type causing the infection, which helps guide the most effective treatment.

Risks of UTIs During Pregnancy

The American College of Obstetricians and Gynecologists recommends that if you are pregnant and suspect you have a UTI, you should contact your healthcare provider right away. Severe infections can cause complications for you and your baby, so early treatment is essential.

Much of the research on UTIs in pregnancy comes from decades-old studies, where complications such as low birth weight and preterm birth were linked to UTIs. However, a more recent study examining patients who developed kidney infections during pregnancy did not find higher rates of these adverse outcomes. Researchers speculated that improvements in prenatal care and the routine use of antibiotics may explain this difference. However, the study found an increased risk of complications such as anemia, sepsis, and respiratory issues, reinforcing the importance of treating symptomatic infections.

If left untreated, a UTI can spread from the bladder to the kidneys, leading to pyelonephritis, a more serious infection. A kidney infection during pregnancy can increase the risk of anemia, sepsis, and other serious health issues. There is also evidence that having a UTI during pregnancy may raise the risk of developing preeclampsia, a condition characterized by high blood pressure and organ dysfunction that can be dangerous for both the mother and baby. Prompt diagnosis and treatment help prevent these complications, making it essential to contact your doctor or midwife at the first sign of infection.

Treating UTIs

The good news is that antibiotics can effectively eliminate a urinary tract infection. If you are pregnant or trying to conceive, your care provider will consider this when prescribing any medications, including antibiotics, to ensure they are safe for you and your baby.

If your doctor or midwife prescribes antibiotics, taking the entire course of medication is important, even if you start feeling better before finishing it. Antibiotics begin working quickly, eliminating most of the bacteria responsible for the infection within a short period. However, stopping treatment early can leave behind bacteria not entirely eradicated. These surviving bacteria may cause the infection to return or, in some cases, become resistant to the antibiotic, making future infections harder to treat. Completing the entire course as directed helps eliminate all bacteria and reduces the risk of complications.

Antibiotic Side Effects

Antibiotics are crucial in preventing and treating infections. The downside of antibiotics is that they don’t only kill the bacteria causing the infection you are trying to treat; they also kill many beneficial bacteria in the body. While antibiotics are considered safe during pregnancy, there are some downsides to their use.

The side effects of antibiotics can vary depending on the specific medication, but some of the most common include nausea and vomiting. Antibiotics can also affect the gut microbiome, leading to digestive issues such as diarrhea, bloating, indigestion, abdominal pain, or loss of appetite. Yeast infections are another common side effect because antibiotics can disrupt the balance of bacteria in the vaginal microbiome, allowing candida to overgrow. If you are breastfeeding, antibiotics may increase the risk of thrush, a yeast infection in your baby’s mouth that can also affect your nipples.

How Antibiotics Impact Your Baby

If you take antibiotics during pregnancy, evidence shows they cross the placenta and reach your baby. In the case of a UTI, the benefits of antibiotics to prevent a potential infection likely outweigh the risks of temporary gut microbiome disruption. One of the most beneficial things you can do for your baby’s gut microbiome is to breastfeed. Breast milk provides nutrients and probiotics that help establish a healthy gut microbiome. For more in-depth information and research on antibiotics during pregnancy, birth, and breastfeeding, check out this episode.

Weighing the Risks and Benefits of Antibiotics

When considering the potential risks of taking antibiotics, it is also essential to weigh the risks of not treating a urinary tract infection. Left untreated, a UTI can lead to serious complications such as kidney infections, anemia, sepsis, or even preterm birth. Many antibiotics are considered safe during pregnancy and have been extensively studied. If you have concerns about antibiotics, please discuss them with your care provider. For more in-depth information on antibiotics during pregnancy, see this episode.

Home Remedies to Prevent and Treat UTIs

Antibiotics remain the first line of defense for effectively treating urinary tract infections and preventing complications. UTIs are common and place a significant burden on the healthcare system. The rise of antibiotic resistance has led researchers to explore alternative treatments. It is essential to speak with your doctor before attempting to manage a UTI on your own, especially during pregnancy. That said, let’s explore some of the popular home remedies for supporting urinary health or preventing and treating UTIs.

Cranberry Juice

Cranberry juice is a popular home remedy for preventing and treating UTIs. Over-the-counter supplements containing cranberry extract are also marketed for urinary tract health. The proposed mechanism behind cranberries’ effectiveness is that they may help prevent bacteria from adhering to the cells in the bladder, reducing the likelihood of infection. However, the evidence on cranberry products for UTI prevention is mixed.

Some small studies show cranberry juice is potentially effective at preventing UTIs in pregnancy. A Cochrane Review concluded that cranberry products cannot be recommended for UTI prevention based on the available research. In contrast, a meta-analysis found that cranberries may effectively prevent recurrent UTIs 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 enjoy the taste of cranberry juice, drinking it may not hurt, but there is no strong evidence proving it will help either. Be aware that most cranberry juice sold in stores is not 100% cranberry juice. 100% cranberry juice is very tart. Many brands, such as Ocean Spray, sell cranberry juice cocktails with high added sugar. If you are considering a cranberry extract supplement, it is best to check with your doctor or midwife before taking it.

Vitamin C

Overall, no strong evidence supports vitamin C in preventing UTIs. A small randomized controlled trial evaluated whether daily intake of 100 mg of ascorbic acid (vitamin C) prevented UTIs in pregnancy. There were 110 pregnant women, 55 in the trial and 55 in the control groups. The infection percentage was 12.7% in women given daily ascorbic acid compared with 29.1% in women in the control group.

Oranges, kiwis, and bell peppers are excellent sources of vitamin C. Your prenatal vitamin should also contain vitamin C.

Canephron

Canephron is an herbal medicine to prevent and treat UTIs and other urinary conditions. It is most commonly used in Europe and is available in other countries. Canephron contains extracts from three medicinal plants: centaury (Centaurium erythraea), which has anti-inflammatory and antimicrobial properties; lovage (Levisticum officinale), which acts as a natural diuretic, helping to increase urine flow; and rosemary (Rosmarinus officinalis), which has antioxidant and anti-inflammatory effects. Some studies have been conducted on Canephron in women with recurring UTIs or current infections.

A study in Germany compared Canephron to standard antibiotics for treating urinary tract infections. The results showed that patients taking Canephron had fewer recurrent UTIs and fewer additional antibiotics over the following year. They concluded that Canephron is an effective and safe option for treating UTIs and may be a useful alternative to antibiotics.

Canephron is less commonly used in the United States. Your care provider is unlikely to recommend this instead of antibiotics to treat an infection. If you get recurring UTIs, it could be a supplement to discuss with your doctor or midwife.

Probiotics

The predominant probiotic bacteria in the urinary tract is lactobacillus. This plays a role in maintaining a healthy microbial balance and potentially preventing harmful bacteria from taking hold. Some studies have examined whether taking probiotic supplements can help treat or prevent UTIs. While results have been promising, the evidence does not support probiotics as a recommended treatment or prevention method. A Cochrane Review found no significant reduction in the risk of recurrent UTIs between patients treated with probiotics and placebo or antibiotics. For a more in-depth analysis of the research available on probiotics and UTIs, see this article.

While some studies suggest probiotics may support urinary tract health, the current evidence does not strongly support their use for UTI prevention. More research is needed to determine their effectiveness, optimal strains, and dosage.

Hygiene Measures

A systematic review examined non-antibiotic measures to prevent urinary tract infections in pregnancy. Researchers evaluated five approaches, including hygiene measures, cranberry juice, immunization, ascorbic acid (vitamin C), and Canephron. While this review included studies evaluating vaccines to prevent UTIs, none have been approved for widespread use. The quality of the evidence varied considerably, and only hygiene measures were supported by evidence to be recommended in practice.

Hygiene measures included urinating after intercourse, washing genitals before or after sex, and wiping from front to back after using the bathroom. Since the primary cause of UTIs is introducing bacteria to your urinary tract, the best way to prevent UTIs is to practice good hygiene, especially when using the bathroom or after having sex.

Deciding Whether to Take a Supplement

Women have a 50% chance of developing a UTI at some point in their lives, and 20–30% will experience a recurrence. If you frequently get UTIs, you may be more inclined to try supplements that claim to support urinary health. While research on remedies like cranberry juice, vitamin C, Canephron, and probiotics is inconclusive, these options are generally low-risk. Before adding any supplement to your routine, discussing it with your doctor or midwife is always best to ensure it is safe for you.

Preventing UTIs

You can take several simple steps to reduce your risk of developing a urinary tract infection. Staying hydrated is one of the most effective ways to help flush bacteria out of your urinary tract. Drinking plenty of water throughout the day supports overall urinary health and reduces the chances of infection. If you need to urinate, do not hold it. Emptying your bladder regularly helps prevent bacteria from multiplying in the urinary tract. Always wipe from front to back after using the bathroom to avoid transferring bacteria from the rectal area to the urethra.

Sex can introduce bacteria into the urethra, increasing the risk of infection. Being mindful of hygiene during sexual activity can help prevent bacteria from spreading. If you use a lubricant, it should be water-based to avoid irritation. It is also a good practice to urinate after sex to help flush out any bacteria that may have entered the urethra.

The vagina is mostly self-cleaning and does not require special products to stay healthy. Avoid using douches, feminine deodorants, or harsh soaps, as these can disrupt the natural balance of bacteria and irritate the area. Wearing underwear with a cotton liner helps keep the area dry, as bacteria thrive in moist environments. Pregnancy naturally increases vaginal discharge, so using panty liners or changing underwear more frequently can help maintain dryness and reduce irritation.

Additional precautions may be helpful if you are prone to UTIs or experience them frequently. Avoiding tight pants, washing the vaginal area before sex, choosing showers instead of baths, and staying away from hot tubs or soaking in water for long periods may help reduce the risk of infection. Alcohol and caffeine should already be limited or avoided during pregnancy.

Talk to Your Doctor or Midwife

If you have a history of UTIs, discuss it with your doctor or midwife early in your prenatal care. If you suspect you may have an infection, do not hesitate to contact your provider right away. Early detection and treatment are important to avoid complications. If you have any questions or concerns about UTIs, the risks of infection, or treatments, please discuss them with your doctor or midwife.

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