Differential Diagnosis for Smelling Urine while Pregnant

• Single most likely diagnosis
  • Urinary Tract Infection (UTI): This is a common condition in pregnancy due to physiological changes such as urinary stasis and ureteral dilation, which can lead to bacterial growth and infection, causing a strong smell.
• Other Likely diagnoses
  • Gestational Diabetes: High glucose levels in the urine can cause it to smell sweet, and pregnancy increases the risk of developing gestational diabetes.
  • Dehydration: Not drinking enough water can lead to concentrated urine, which may have a stronger smell.
  • Dietary influences: Certain foods like asparagus, garlic, or onions can change the smell of urine.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Diabetic Ketoacidosis (DKA): Although less common, DKA can occur in pregnancy, especially with undiagnosed or poorly managed diabetes, leading to a sweet-smelling urine due to ketones.
  • Preeclampsia with renal involvement: While the primary symptoms of preeclampsia are hypertension and proteinuria, severe cases can affect kidney function, potentially altering urine smell.
• Rare diagnoses
  • Maple Syrup Urine Disease (MSUD): A rare genetic disorder that can cause urine to smell sweet, like maple syrup. It's extremely rare but could be considered in cases where other causes are ruled out, especially if there's a family history.
  • Phenylketonuria (PKU): Another rare genetic disorder that can cause a musty smell in urine due to the accumulation of phenylalanine. It's usually diagnosed in infancy but could be a consideration in undiagnosed cases.