Kalinderi K, Delkos D, Kalinderis M, Athanasiadis A, Kalogiannidis I. Urinary tract infection during pregnancy: current concepts on a common multifaceted problem. J Obstet Gynaecol. 2018 May. 38 (4):448-453. [QxMD MEDLINE Link].
Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014 Mar. 210 (3):219.e1-6. [QxMD MEDLINE Link].
Habak PJ, Griggs, Jr RP. Urinary Tract Infection In Pregnancy. 2021 Jan. [QxMD MEDLINE Link]. [Full Text].
Beydoun SN. Morphologic changes in the renal tract in pregnancy. Clin Obstet Gynecol. 1985 Jun. 28 (2):249-56. [QxMD MEDLINE Link].
Glaser AP, Schaeffer AJ. Urinary Tract Infection and Bacteriuria in Pregnancy. Urol Clin North Am. 2015 Nov. 42 (4):547-60. [QxMD MEDLINE Link].
Valkenburg-van den Berg AW, Sprij AJ, Dekker FW, Dörr PJ, Kanhai HH. Association between colonization with Group B Streptococcus and preterm delivery: a systematic review. Acta Obstet Gynecol Scand. 2009. 88 (9):958-67. [QxMD MEDLINE Link].
Alvarez JR, Fechner AJ, Williams SF, Ganesh VL, Apuzzio JJ. Asymptomatic bacteriuria in pregestational diabetic pregnancies and the role of group B streptococcus. Am J Perinatol. 2010 Mar. 27(3):231-4. [QxMD MEDLINE Link].
Hollowell JG. Outcome of pregnancy in women with a history of vesico-ureteric reflux. BJU Int. 2008 Sep. 102(7):780-4. [QxMD MEDLINE Link].
Ghafari A, Sanadgol H. Pregnancy after renal transplantation: ten-year single-center experience. Transplant Proc. 2008 Jan-Feb. 40(1):251-2. [QxMD MEDLINE Link].
Amiri FN, Rooshan MH, Ahmady MH, Soliamani MJ. Hygiene practices and sexual activity associated with urinary tract infection in pregnant women. East Mediterr Health J. 2009 Jan-Feb. 15 (1):104-10. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Guidelines for Perinatal Care. AAP, Elk Grove Village, IL; ACOG, Washington DC: American Academy of Pediatrics, American College of Obstetricians and Gynecologists; 2017. 8th ed:
Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012 Mar 15. 366 (11):1028-37. [QxMD MEDLINE Link].
Versi E, Chia P, Griffiths DJ, Harlow BL. Bacteriuria in pregnancy: a comparison of Bangladeshi and Caucasian women. Int Urogynecol J Pelvic Floor Dysfunct. 1997. 8(1):8-12. [QxMD MEDLINE Link].
Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome?. J Matern Fetal Neonatal Med. 2009 Feb. 22(2):124-8. [QxMD MEDLINE Link].
Sheiner E, Mazor-Drey E, Levy A. Asymptomatic bacteriuria during pregnancy. J Matern Fetal Neonatal Med. 2009 May. 22(5):423-7. [QxMD MEDLINE Link].
Whitehead NS, Callaghan W, Johnson C, Williams L. Racial, ethnic, and economic disparities in the prevalence of pregnancy complications. Matern Child Health J. 2009 Mar. 13(2):198-205. [QxMD MEDLINE Link].
Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005 Jan. 105(1):18-23. [QxMD MEDLINE Link].
Yan L, Jin Y, Hang H, Yan B. The association between urinary tract infection during pregnancy and preeclampsia: A meta-analysis. Medicine (Baltimore). 2018 Sep. 97 (36):e12192. [QxMD MEDLINE Link]. [Full Text].
Baer RJ, Nidey N, Bandoli G, Chambers BD, Chambers CD, Feuer S, et al. Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study. AJP Rep. 2021 Jan. 11 (1):e5-e14. [QxMD MEDLINE Link]. [Full Text].
Easter SR, Cantonwine DE, Zera CA, Lim KH, Parry SI, McElrath TF. Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia. Am J Obstet Gynecol. 2016 Mar. 214 (3):387.e1-7. [QxMD MEDLINE Link].
Cunningham FG, Lucas MJ. Urinary tract infections complicating pregnancy. Baillieres Clin Obstet Gynaecol. 1994 Jun. 8 (2):353-73. [QxMD MEDLINE Link].
Olson E, Gupta K, Van Der Pol B, Galbraith JW, Geisler WM. Mycoplasma genitalium infection in women reporting dysuria: A pilot study and review of the literature. Int J STD AIDS. 2021 Jul 6. 9564624211030040. [QxMD MEDLINE Link].
Albright CM, Ali TN, Lopes V, Rouse DJ, Anderson BL. Lactic acid measurement to identify risk of morbidity from sepsis in pregnancy. Am J Perinatol. 2015 Apr. 32 (5):481-6. [QxMD MEDLINE Link].
[Guideline] U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008 Jul 1. 149(1):43-7. [QxMD MEDLINE Link].
Lifshitz E, Kramer L. Outpatient urine culture: does collection technique matter?. Arch Intern Med. 2000 Sep 11. 160 (16):2537-40. [QxMD MEDLINE Link].
Kodikara H, Seneviratne H, Kaluarachchi A, Corea E. Diagnostic accuracy of nitrite dipstick testing for the detection of bacteriuria of pregnancy. Public Health. 2009 May. 123(5):393-4. [QxMD MEDLINE Link].
Gilstrap LC 3rd, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am. 2001 Sep. 28(3):581-91. [QxMD MEDLINE Link].
Vazquez JC, Abalos E. Treatments for symptomatic urinary tract infections during pregnancy. Cochrane Database Syst Rev. 2011 Jan 19. CD002256. [QxMD MEDLINE Link].
Widmer M, Lopez I, Gülmezoglu AM, Mignini L, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev. 2015 Nov 11. (12):CD000491. [QxMD MEDLINE Link].
Millar LK, Wing DA, Paul RH, Grimes DA. Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial. Obstet Gynecol. 1995 Oct. 86(4 Pt 1):560-4. [QxMD MEDLINE Link].
Ailes EC, Gilboa SM, Gill SK, Broussard CS, Crider KS, Berry RJ, et al. Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. Birth Defects Res A Clin Mol Teratol. 2016 Nov. 106 (11):940-949. [QxMD MEDLINE Link]. [Full Text].
Committee on Obstetric Practice. Committee Opinion No. 717: Sulfonamides, Nitrofurantoin, and Risk of Birth Defects. Obstet Gynecol. 2017 Sep. 130 (3):e150-e152. [QxMD MEDLINE Link].
Bozkurt Y, Penbegul N, Soylemez H, Atar M, Sancaktutar AA, Yildirim K, et al. The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients. Urol Res. 2012 Jan 4. [QxMD MEDLINE Link].
[Guideline] Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar 1. 40(5):643-54. [QxMD MEDLINE Link].
Lichtenberger P, Hooton TM. Antimicrobial prophylaxis in women with recurrent urinary tract infections. Int J Antimicrob Agents. 2011 Dec. 38 Suppl:36-41. [QxMD MEDLINE Link].
Sun Y, Vestergaard M, Christensen J, Nahmias AJ, Olsen J. Prenatal exposure to maternal infections and epilepsy in childhood: a population-based cohort study. Pediatrics. 2008 May. 121(5):e1100-7. [QxMD MEDLINE Link].
Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de Miranda E, et al. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis. 2015 Nov. 15 (11):1324-33. [QxMD MEDLINE Link].
Easter SR, Cantonwine DE, Zera CA, Lim KH, Parry SI, McElrath TF. Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia. Am J Obstet Gynecol. 2016 Mar. 214 (3):387.e1-7. [QxMD MEDLINE Link].
Schneeberger C, Geerlings SE, Middleton P, Crowther CA. Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst Rev. 2015 Jul 26. CD009279. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Twenty-nine-year-old pregnant woman with history of reflux uropathy and ureteral reimplantation at age 21 months presents with right-side flank pain and proteinuria. Renal cortical thinning suggests chronic hydronephrosis.
Color-flow Doppler highlights normal flow in right kidney of 29-year-old pregnant woman with history of reflux uropathy and ureteral reimplantation at age 21 months who presents with right-side flank pain and proteinuria.
25-year-old pregnant woman with right lower quadrant pain and hematuria has proximal ureteral obstruction consistent with urolithiasis. After 25 minutes, intravenous pyelography reveals dense right nephrogram and no filling of right collecting system. Left side shows unremarkable nonhydronephrotic collecting system. This is consistent with right ureteral lithiasis.

of 3

Table.

Table.

Table 1. Treatment Regimens for Pregnant Women with Asymptomatic Bacteruria or UTI

Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5-7 days or
Amoxicillin 875 mg orally twice daily (alternative: 500 mg orally three times daily) for 5-7 days or
Amoxicillin-clavulanate 500/125 mg orally three times daily for 5-7 days (alternative: 875/125 mg orally two times daily for 5-7 days) or
Cephalexin 500 mg orally four times daily for 5-7 days or
Fosfomycin 3 g orally as a single dose with 3-4 oz. of water

Back to List

Author

Raisa O Platte, MD, PhD Urogynecology Associate, Department of Obstetrics and Gynecology, Geisinger Health System

Raisa O Platte, MD, PhD is a member of the following medical societies: American Medical Association, AAGL, American Urogynecologic Society, International Continence Society

Disclosure: Nothing to disclose.

Coauthor(s)

Krystal Reynolds, DO, MHSA Resident Physician, Department of Obstetrics and Gynecology, Spectrum Health, Michigan State University College of Human Medicine

Krystal Reynolds, DO, MHSA is a member of the following medical societies: American Congress of Obstetricians and Gynecologists, American Medical Association, Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Antares.

Additional Contributors

J Stuart Wolf, Jr, MD, FACS David A Bloom Professor of Urology, Associate Chair for Urologic Surgical Services, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: Catholic Medical Association, Endourological Society, Engineering and Urology Society, Society of Laparoendoscopic Surgeons, Society of University Urologists, Society of Urologic Oncology, American College of Surgeons, American Urological Association

Disclosure: Nothing to disclose.

Emilie Katherine Johnson, MD, MPH Head of Clinical Research, Attending Physician, Division of Urology, Ann and Robert H Lurie Children’s Hospital of Chicago; Assistant Professor of Urology, Assistant Professor, Center for Healthcare Studies, Institute for Public Health and Medicine Northwestern University, The Feinberg School of Medicine

Emilie Katherine Johnson, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, National Medical Association, Society of Women in Urology

Disclosure: Nothing to disclose.

Acknowledgements

Gamal Mostafa Ghoniem, MD, FACS Professor of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, International Continence Society, International Urogynaecology Association, and Society of Urodynamics and Female Urology

Disclosure: Astellas Honoraria Speaking and teaching; Coloplasty Consulting fee Board membership; Uroplasty Consulting fee Consulting

Leticia A Jones, MD Clinical Instructor, Department of Obstetrics and Gynecology, Indiana University Hospital, Clarian Health Partners

Leticia A Jones, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Henry E Ruiz, MD Chief, Reconstructive Urology and Urodynamics, Urology Associates of South Texas, PA and Radiation Oncology Center

Henry E Ruiz, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick J Woodman, DO, Assistant Director, Urogynecology (FPMRS) Fellowship, Associate Clinical Professor, Indiana University School of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Methodist Hospital

Patrick J Woodman, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists; American College of Surgeons; American Osteopathic Association; American Urogynecologic Society; Association of Professors of Gynecology and Obstetrics; Indiana State Medical Association; International Continence Society

Disclosure: Nothing to disclose.

Sections Urinary Tract Infections in Pregnancy
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
Tables
References

Urinary Tract Infections in Pregnancy Questions & Answers

References

Tables

Contributor Information and Disclosures

What would you like to print?