Antibiotics and treating UTIs in pregnancy

Posted on 10 August 2017

Urinary tract infections (UTIs) are a fairly common condition during pregnancy but, left untreated, can lead to complications. At the same time, not all antibiotics are safe during pregnancy. We look at treating UTIs in pregnancy.

UTIs in pregnancy are quite common, occurring in one to two percent* of pregnancies, according to Dr Deon Van Zyl, obstetrician and gynaecologist at Mediclinic Panorama. Up to 70%** of those are as a result of the E.coli bacteria.

Women are generally more susceptible to bladder infections, or UTIs, than men due to our difference in genital anatomy. ‘Men have to generate pressure to urinate,’ says Dr Van Zyl, whereas women, who sit down to urinate, do not. ‘They’re relaxed which unfortunately means they don’t always empty their bladders.’

Urine that stays behind in the bladder causes bacteria to stay behind, increasing the risk of bladder infections.

Pregnancy is a condition that suppresses our immunity in order to allow the foetus to thrive. ‘Because your baby has cells that it gets from dad, your body is suppressing your immunity so that you don’t reject the baby. In other words: have a miscarriage,’ explains Dr Van Zyl.

Opportunistic infections, like UTIs, then have an opportunity to be aggravated.

Diagnosing UTIs

Early symptoms(3) of a UTI may include:

• a burning or pulling sensation when you urinate
• a frequent or intense urges to urinate
• passing small amounts of urine

Symptoms of a more pronounced infection may include:

• severe back pain near the ribs
• pain in your lower abdomen
• vomiting, nausea and/or fever
• a change in the colour or appearance of your urine

Early detection and treatment is vital to protect both the mother and unborn child.

‘Basically, any infection that’s not cleared up can worsen and this can lead to a miscarriage in early pregnancy,’ says Dr Van Zyl.

But he also cautions that pregnant mothers have lost their lives to bladder infections left completely untreated. Because their immune systems are being suppressed, they are at greater risk of become septic.

An untreated UTI can lead to a kidney infection and even kidney failure – which can put the heart and lungs under extra strain.

According to Dr Van Zyl, UTIs are cautiously treated with certain antibiotics during pregnancy.

Consult your obstetrician before commencing treatment to:

1. Confirm the diagnosis.

Even though the urinary dipstick and symptoms suggest a UTI, a culture is sent away to rule out any atypical organisms, or kidney stones, which present similarly to a UTI.

2. Ensure the antibiotic prescribed is safe in pregnancy.

There is a whole group of antibiotics that pregnant women should not take.

3. Ensure the antibiotic is prescribed accurately.

Sometimes, a bladder infection is treated with a broad spectrum antibiotic which may not be as effective as the type your obstetrician will prescribe.

4. To avoid complications of urinary tract infections.

Leaving a bladder infection untreated in a pregnancy can cause preterm labour.

References

(1) Uriniray Tract Infections During Pregnancy, Clinical Obstetrics and Gynaecology of North America 2001, vol 28, page 581

(2) Acute Pyelonephritis, Obstetrics and Gynaecology 2005, vol 105, page 18

 (3) https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults/symptoms-causes