Urinary Tract Infection During Pregnancy

Urinary tract is comprised of multiple organs and components, with each part playing a vital role in the filtration, metabolism, absorption and secretion of urine. The key components of urinary system include;

• Kidney: it is a bean shaped organ which is located in the lower lumbar region of the abdomen. The function of kidneys is to filter the blood and remove the toxins from the body. After filtration, the vital nutrients and metabolites are reabsorbed into the circulation while the toxins are moved to the distal parts of the urinary tract with excess water and metabolites.
• Ureters: These are specialized tube like structures which serves as a conduit for the passage of urine from the kidneys to the urethra for excretion.
• Bladder: it is a balloon like muscular structure in which the urine is stored.
• Urethra: it a specialized tube like structure that serves as a conduit for the final expulsion of urine from the body during the process of micturition.

Although the urinary tract is generally sterile (i.e. no microorganisms are present); however, under certain circumstances, the microorganisms may gain access into the urinary system to cause inflammation and infection of the tubules; thereby presenting as UTI (or urinary tract infection).

Pregnancy and Urinary Tract Infection

Pregnancy is a classic example of physiological hormonal and biochemical aberration during which the pregnant mommies become more vulnerable to develop certain infections or ailments; for example, lower back pain, hemorrhoids, varicose veins, deep venous thrombosis and urinary tract infection.Research and clinical data indicates that:

• The prevalence of asymptomatic bacteriuria (presence of bacterial agents in the urine without any symptoms of infection) in pregnant females is approximately 11% (1)
• About 28 to 41% pregnant females develops at least one episode of urinary tract infection during pregnancy (2)

What Causes UTI During Pregnancy?

The primary pathophysiological factors that may lead to urinary tract infection during pregnancy are:

• Changes in the PH of Female Genital Tract: Under normal physiological circumstances, the pH of urinary and vaginal tract serves as the primary inhibiting force that restricts the growth of bacterial agents; however, with changes in the pH due to pregnancy related hormones, the risk of UTI increases significantly
• Changes in the Urinary Mechanics: The risk of ascending infection (i.e. involvement of urinary bladder and kidneys) increases significantly due to pregnancy mediated shift of the bladder as a result of uterine expansion.
• Length of Urethra: Females have a shorter urethra (unlike males) which generally makes it easier for bacterial agents to contaminate the urinary tract via ascending infection.

Most cases of UTI in pregnancy are attributed to Escherichia coli (gram negative bacteria) and Enterococcus spp (2). Urinary tract infection is an uncomfortable condition in any situation; but if you are pregnant, the risk of complications and concerns is even higher; such as preterm labor, septicemia or overall poor health.

Symptoms of Urinary Tract Infection

Symptoms of urinary tract infection are characteristic for:

• High grade fever that is often accompanied with rigors and chills
• Tenderness that is especially pronounced along the lower abdominal region
• Nausea and vomiting.
• Burning micturition
• Pain in pelvis
• Pain in rectum
• Cloudiness of urine (that may or may not be associated with appearance of blood and foul smell in the urine)

Risk Factors of Urinary Tract Infection During Pregnancy

There are several different varieties of urinary tract infections during pregnancy, depending upon the site or severity of involvement; such as nephritis (infection of kidneys), cystitis (infection of bladder) etc. Any factor which alters the normal physiology of the urinary tract, either through an obstruction or due to inflammation, can increase the risk of UTI during pregnancy. Primary risk factors that may significantly aggravate the risk of urinary tract infection during pregnancy are:

• Blockages and obstructions: A positive history of anatomical or physiological obstruction in the urinary tract (such as urinary stone, stricture etc.) can compromises the flow of urine and may lead to the growth/ colonization of bacterial agents.
• Genital hygiene: Females who wipe from back to front (anal region to urethra) are more vulnerable to develop urinary tract infection due to contamination of fecal matter and microorganisms in the genital or urinary tract.
• Genital hygiene products: Females who use genital hygiene products, especially douches or bubble baths are also likely to develop vaginal irritation and urinary tract infection due to biochemical changes that favors the growth or bacterial agents. Likewise, frequent use of low quality condoms (for the prevention of sexually transmitted infections in case of chance encounters) also increases the risk of UTI in pregnant females).

Treatment of Urinary Tract Infection

The most widely accepted treatment of urinary tract infection during pregnancy is antibiotics.It is important to complete the course of antibiotics to minimize the risk of recurrence of infection or development of resistant strains.

Prevention of Urinary Tract Infection

Due to physiological factors, women are more vulnerable to get urinary tract infection during pregnancy which warrant initiation of preventive strategies to minimize the chances of infection. Most effective tips are:

• Maintain optimal hydration in the body by increasing the total water intake (although it is fairly difficult for females to rush to the bathroom every now and then due to increased frequency of urination).
• Maintain maximal genital and urinary hygiene; such as avoid chance encounters, do not wipe from behind to the front and limit the use of intense chemicals on the urogenital region.
• Do not forcefully hold your urine. Take frequent bathroom breaks (which is normal during pregnancy due to pressure of expanding uterus on the bladder).
• Try to wear comfortable undergarments and change your intimate apparel at least once a day.

References:

1. Haider, G., Zehra, N., Munir, A. A., & Haider, A. (2010). Risk factors of urinary tract infection in pregnancy. J Pak Med Assoc, 60(3).
2. Masinde, A., Gumodoka, B., Kilonzo, A., & Mshana, S. E. (2009). Prevalence of urinary tract infection among pregnant women at Bugando Medical Centre, Mwanza, Tanzania. Tanzania journal of health research, 11(3).
3. Okonko, I. O., Donbraye-Emmanuel, O. B., Ijandipe, L. A., Ogun, A. A., Adedeji, A. O., & Udeze, A. O. (2009). Antibiotics sensitivity and resistance patterns of uropathogens to nitrofurantoin and nalidixic acid in pregnant women with urinary tract infections in Ibadan, Nigeria. Middle-east journal of scientific research, 4(2), 105-109.
4. Hamdan, H. Z., Ziad, A. H. M., Ali, S. K., & Adam, I. (2011). Epidemiology of urinary tract infections and antibiotics sensitivity among pregnant women at Khartoum North Hospital. Annals of clinical microbiology and antimicrobials, 10(1), 2.