From the Guidelines
Yes, urinary tract infections (UTIs) during pregnancy should be treated.
Rationale
- The Infectious Diseases Society of America recommends screening pregnant women for asymptomatic bacteriuria with a urine culture “at least once” in early pregnancy and treating them if the results are positive 1.
- The U.S. Preventive Services Task Force concludes that in pregnant women, there is high certainty that the net benefit of screening for asymptomatic bacteriuria is substantial 1.
- Some key points to consider when treating UTIs during pregnancy include:
- Screening: Pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy 1.
- Treatment: The duration of antimicrobial therapy should be 3–7 days 1.
- Benefits: Antimicrobial treatment of asymptomatic bacteriuria during pregnancy decreases the risk of subsequent pyelonephritis and the frequency of low–birth weight infants and preterm delivery 1.
- Guidelines: The American Academy of Family Physicians, the Infectious Diseases Society of America, and the American College of Obstetricians and Gynecologists all recommend screening for asymptomatic bacteriuria in pregnant women 1.
From the Research
Treatment of Urinary Tract Infections (UTI) during Pregnancy
- UTIs are a common health problem that can have serious consequences if left untreated during pregnancy, including pyelonephritis, preterm labor, or Group B Streptococcal infection in the newborn 2.
- All clinical types of UTI, including asymptomatic bacteriuria (ASB), cystitis, and pyelonephritis, require treatment during pregnancy to prevent maternal and fetal complications 3.
- International guidelines recommend a single screen-and-treat approach to ASB, but recent studies have questioned this approach, and the best use of antimicrobials is still being debated 4.
Antibiotic Treatment for UTIs during Pregnancy
- The preferred antimicrobials for the management of pyelonephritis are amoxicillin combined with an aminoglycoside, third-generation cephalosporins, or carbapenems 4.
- For ASB, a short course of β-lactams, nitrofurantoin, or fosfomycin is recommended 4.
- International guidelines agree on several key points regarding antibiotic use for UTIs during pregnancy, but there are areas of discordance, such as the use of fluoroquinolones in lower or upper UTI 5.
Importance of Treating UTIs during Pregnancy
- UTIs are the most common bacterial infections during pregnancy and can lead to perinatal and maternal complications if left untreated 6.
- Treating UTIs during pregnancy is crucial to optimize maternal outcome, ensure safety to the fetus, and prevent complications that can lead to significant morbidity and mortality in both the fetus and the mother 6.