From the Guidelines
Yes, a urinary tract infection (UTI) during pregnancy is considered a complicated UTI. This classification is crucial because pregnancy alters the management and treatment of UTIs, necessitating prompt treatment to prevent complications such as pyelonephritis, preterm labor, and low birth weight 1. The physiological changes during pregnancy, including dilated ureters, decreased bladder tone, and increased urinary stasis, increase the risk of infection and potential complications.
Key considerations in the management of UTIs during pregnancy include:
- Prompt treatment with pregnancy-safe antibiotics such as amoxicillin, amoxicillin-clavulanate, cephalexin, or nitrofurantoin (avoiding nitrofurantoin in the third trimester) 1
- A typical treatment course lasting 7-14 days, rather than the shorter courses used for uncomplicated UTIs
- The importance of completing the full antibiotic course prescribed by the healthcare provider to ensure effective treatment and prevent recurrence
- The need for healthcare providers to screen for asymptomatic bacteriuria at prenatal visits and treat all UTIs during pregnancy, even without symptoms, due to the increased risk of complications 1
The evidence from the Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults supports the treatment of asymptomatic bacteriuria during pregnancy to decrease the risk of subsequent pyelonephritis and other complications 1. The treatment of UTIs during pregnancy is critical to prevent morbidity, mortality, and to improve quality of life for both the mother and the fetus.
From the Research
Definition of Complicated UTI
A urinary tract infection (UTI) in pregnancy is considered complicated due to the increased risk of maternal and fetal complications.
Risk of Complications
- UTIs during pregnancy can lead to serious maternal and fetal complications, such as preeclampsia, preterm birth, intrauterine growth restriction, and low birth weight 2, 3.
- Asymptomatic bacteriuria (ASB) can progress to acute pyelonephritis if left untreated, increasing the risk of complications 2, 3.
- The risk of complications is higher in pregnant women due to physiological changes that increase the risk of UTI 4.
Management of UTI in Pregnancy
- All types of UTIs during pregnancy, including asymptomatic infections, require treatment 2, 4.
- Antibiotic prophylaxis may be necessary in some patients 2.
- The choice of antibiotic therapy should be based on local susceptibility patterns and the severity of the infection 5, 6.