Urinary tract infection (UTI) in pregnancy | Pokenga pūaha mimi

• Urinary tract infections (UTIs) are common in pregnancy.
• They happen when any part of your urinary system – your kidneys, ureters, bladder and urethra – becomes infected by bacteria. 
• UTIs in pregnancy are more likely to cause complications. 
• You should have a urine culture test early in pregnancy (when first seen) to check for signs of a UTI, as they don't always cause symptoms.
• UTIs are easily treated with a course of antibiotics. Your healthcare provider will choose an antibiotic that's safe to use during pregnancy.
• If untreated, UTIs in pregnancy can increase the risk of complications for you and your pēpi. 

You are more prone to UTIs during pregnancy due to changes in your hormones which slow the flow of urine (pee or mimi). As a result, bacteria have more time to grow in your urine before being flushed out. Also, as the uterus grows, the increased weight can block the flow of urine from your bladder, causing an infection. 

Common symptoms of a urinary tract infection are:

• pain when you pass urine
• passing urine more often (urinary frequency)
• pain in the lower stomach area (abdomen)
• blood in your urine (haematuria)
• urine that looks cloudy or smells more than normal.

UTIs are diagnosed by doing a urine culture test that looks for bacteria, red cells and white cells in your urine (pee or mimi). This is usually done in the first trimester and is different to the urine test to see if you are pregnant. 

Your healthcare provider will send a sample of your urine to the laboratory to be tested. If bacteria are found in the urine, the sample will be cultured and tested for antibiotic sensitivities to check which antibiotics will work best.

What do my results mean?

• Asymptomatic bacteriuria: Where you have no symptoms and bacteria are found in your urine. 
• Cystitis or UTI: Where bacteria are found in your urine and you have lower urinary tract symptoms.
• Pyelonephritis: You usually have lower urinary tract symptoms, and also have flank/back pain and symptoms or signs of fever or feeling unwell, this may indicate upper urinary tract infection such as  pyelonephritis. 

Your healthcare provider will discuss your results and the appropriate treatment for your situation with you.

Asymptomatic bacteriuria

Not all urine infections cause symptoms. Sometimes you may have bacteria in your urine but not have any symptoms. This is called asymptomatic (having no symptoms) bacteriuria (but bacteria are found). If you're not pregnant this is usually harmless, but in pregnancy it needs treating.

• Asymptomatic bacteriuria occurs in 2 –10% of all pregnancies.
• If untreated, up to 40% of mothers may develop acute cystitis and up to 2–3% pyelonephritis.

Group B strep (GBS) is a common bacteria that can be found in the urine culture test and it may not cause any symptoms. It is significant in pregnancy because if it’s found in your urine, it’s also likely to be found in your vagina. This infection can be passed to your pēpi during a vaginal delivery. If you have GBS in your urine during pregnancy, it may be recommended that you have antibiotics during labour as well, to prevent your newborn pēpi becoming unwell from a GBS infection.

UTIs in pregnancy are treated with antibiotics, even if you have no symptoms. If left untreated, UTIs can progress to cause a serious kidney infection known as pyelonephritis. They have also been linked with higher rates of low birth weight of the baby and premature birth (baby is born much sooner than the expected date). 

• Your healthcare provider will choose an antibiotic that is safe to use during your stage of pregnancy. The most commonly recommended antibiotic is nitrofurantoin. Usually, a 7-day course of antibiotics is prescribed. You should finish the whole course to completely treat the infection and reduce the chance of it coming back.
• Your symptoms should begin to improve within a few days. If you still have symptoms for more than 2 days after starting treatment, or you get worse, see your healthcare provider as soon as possible.
• If you have developed pyelonephritis, it’s likely you’ll be admitted to hospital for monitoring and antibiotics via a drip. This is to make sure the infection is treated quickly and you don’t become more unwell.
• After finishing the antibiotics, you will need a further urine check 1 to 2 weeks later to check the infection has been treated properly.

You will then have urine tests each month while you’re pregnant to make sure the UTI doesn't come back.

• Take paracetamol for pain (use the lowest dose for the shortest possible time).
• Don't use any non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen in pregnancy.
• Drink plenty of water to avoid dehydration and help flush out the bacteria.
• No evidence has been found for taking products that alkalise your urine (eg, Ural®).
• Cranberry juice is not a recommended treatment as as clinical studies have not shown that it is effective.
• Results from research into D-mannose are also not convincing.

Apps reviewed by Healthify

You may find it useful to look at some Pregnancy apps.

Do

• Do wipe from front to back when you go to the toilet.
• Do try to fully empty your bladder when you pee.
• Do drink plenty of fluids.
• Do take showers instead of baths.
• Do wear loose cotton underwear.
• Do pee as soon as possible after sex.

Don't

• Don't use perfumed bubble bath, soap or talcum powder.
• Don't hold your pee in if you feel the urge to go.
• Don't wear tight, synthetic underwear, eg, nylon.
• Don't wear tight jeans or trousers.