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Key takeaways
UTIs are relatively common in pregnant women due to hormonal changes, the growing uterus blocking urine flow, and a suppressed immune system, increasing the risk of kidney infections.
Pregnant women with UTIs should be treated promptly with pregnancy-safe antibiotics to avoid complications like preterm birth and low infant birth weight, as untreated UTIs can lead to serious kidney infections.
Symptoms of UTIs in pregnant women include painful urination, frequent urination, bloody urine, bladder spasms, cloudy or foul-smelling urine, and possibly uterine contractions, necessitating a urine test for diagnosis.
Preventative measures against UTIs during pregnancy include drinking plenty of water, emptying the bladder frequently, wiping front to back, wearing cotton underwear, and possibly consuming cranberry products, though their effectiveness is debated.
Most healthy pregnancies are full of aches, pains, and general discomforts, so when an infection happens, it makes pregnancy much more uncomfortable. But nine months is a long time to go without any illness, and most pregnant women experience some kind of infection during their pregnancy.
One of the most common types of pregnancy infection is a urinary tract infection, or UTI. It’s a myth that UTIs are more common in pregnant women compared to non-pregnant women. But, due to several changes that occur during pregnancy, expectant mothers are at an increased risk of a UTI becoming a kidney infection called pyelonephritis.
“Pregnant women have a higher rate of kidney infections when compared to nonpregnant women,” says Melissa Terry, MD, an OB-GYN at University of Missouri Health Care. “But the rate of less severe UTIs, like bladder infections, is very similar to that found in nonpregnant women.”
What does this all mean? For one, it’s not unusual to get a UTI while pregnant; in fact, it’s relatively common. But it’s important to recognize the signs and symptoms and get treated promptly with pregnancy-safe antibiotics, since UTIs in pregnancy can quickly turn into something more serious.
Here’s what you need to know about UTIs during pregnancy, from why they happen to how they’re diagnosed and treated.
Why do pregnant women get UTIs?
Even though UTIs aren’t necessarily more common during pregnancy, they’re fairly common in women in general. Unfortunately, there are multiple things working against you during pregnancy that make UTIs a normal occurrence.
Common causes of UTIs in pregnant women are:
- Hormonal changes (which can disrupt the vaginal microbiomeand the inhibit ureter function);
- The growing uterus can partially block the flow of urine from the kidneys to the bladder
- The immune system is suppressed during pregnancy (so as to not reject the growing fetus), which results in pregnant women being at an increased risk of all types of infection
There are also several risk factors of UTIs even among other pregnant women. Dr. Terry notes that the following types of expectant mothers are all at an increased risk for UTI:
- Women with known diabetes or gestational diabetes
- Women under the age of 20
- Smokers
- Women who carry the sickle cell disease trait
- Women who start their prenatal care later than the first trimester
- First-time mothers
On the positive side, women pregnant with multiples are not necessarily at an increased risk for UTI, says Dr. Terry, but they are at risk for more severe kidney infections earlier in pregnancy because of their comparatively larger uterus size.
Can a UTI hurt the baby while pregnant?
As long as it’s sufficiently and promptly treated, a UTI isn’t expected to hurt your baby during pregnancy. The potential risks to a mother and baby occur when a UTI is left untreated; in those cases, the infection can spread to the kidneys, a condition that warrants immediate medical attention.
Most cases of untreated UTIs are caused by asymptomatic bacteriuria. These bacterial infections are less likely to be treated, says Dr. Terry, because there are no obvious signs—like pain or bloody urine—prompting an expectant mother to call her doctor. You may discover you have asymptomatic bacteriuria at a routine prenatal appointment. Even without symptoms, this type of infection needs to be treated, though, just like a symptomatic UTI.
Although Dr. Terry says UTIs don’t cause birth defects or miscarriage, there are still complications that can arise from prolonged infections: Untreated bacteria in the urine is associated with preterm birth and low birth weight of the infant, and kidney infections during pregnancy carry this increased risk, too.
Kidney infections during pregnancy also increase the risk of poor maternal outcomes, says Dr. Terry: “These infections have significant risks to the mother, including sepsis or blood infection, anemia, and respiratory distress requiring hospital admission.”
UTI symptoms while pregnant
According to Dr. Terry, the symptoms of a UTI are generally the same in pregnant and nonpregnant women and can include:
- Painful urination, including a burning sensation
- Frequent urination
- Bloody urine
- Bladder spasms, which feel like a sudden urge to urinate or urine leakage (not associated with fetal movement on the bladder)
You may notice that your urine is cloudy or has a foul smell, or that you have a dull, aching sensation in your lower abdomen or lower back, per the American Urological Association (AUA). Pregnant women may also experience uterine contractions with a UTI, adds Dr. Terry.
Pregnant women who present with one or more of these symptoms will be asked to provide a urine test to their doctor. This urine sample is often collected in the office. Within a few minutes, the nurse will perform the urinalysis, and the doctor will interpret the sample on the spot. If the sample shows an abnormal amount of bacteria, red blood cells, or white blood cells in the urine, then a UTI is suspected. Your doctor may send the same urine sample to the lab for a urine culture to confirm which type of bacteria is causing the infection and to know which antibiotic is sensitive to the particular bacteria. The urinalysis and the urine culture are two important steps to confirm that an infection is present and which antibiotic is best.
How to treat a UTI while pregnant
UTIs can usually be treated at home with oral antibiotics, but kidney infections—especially during pregnancy—usually require admission to the hospital for intravenous antibiotics, says Dr. Terry. It’s important to distinguish between the two types of infection for treatment, so make sure to tell your doctor if you have any back pain, fever, nausea, or vomiting.
If you have a confirmed UTI, your doctor will prescribe an antibiotic treatment for about three to seven days, says Alisha Reed, Pharm.D., of The FLY Pharmacist.
There are several medications to treat a UTI, and many of them are considered safe to use during pregnancy. (It’s important to remember that no drug is 100% safe to take during pregnancy, but many drugs have been studied and used safely in clinical settings for many years.)
“There are some antibiotics that are safe to take during pregnancy [because the] benefits outweigh the risks,” Dr. Reed says. “Most commonly prescribed antibiotics include beta-lactams, [such as] cephalexin, amoxicillin, ampicillin, and fosfomycin.”
Some antibiotics are prescribed or avoided depending on what trimester of pregnancy you’re in; Dr. Reed says nitrofurantoin (Macrobid) and Bactrim are typically reserved for the second and third trimester and not recommended for the first.
Do I really need an antibiotic?
If you’re expecting and suspect a urinary tract infection, do not try supplements to treat a UTI— you and your unborn baby need antibiotics. While nonpregnant women or men with UTIs may attempt to forego antibiotics in favor of natural treatment options like cranberry supplements, probiotics, or vitamin C, this is not recommended for pregnant women. Without antibiotics it’s unlikely your infection will go away, especially since your immune system is compromised during pregnancy.
According to Dr. Reed, the increased risk of kidney infection makes antibiotics the best choice for treatment. The benefits of taking a pregnancy-safe antibiotic—and preventing a more serious infection—greatly outweigh any possible risks.
Once you begin a course of antibiotics, there are also ways to help alleviate your symptoms until your infection improves.
“You may use OTC urinary tract analgesics to manage the discomfort,” Dr. Reed says. “There isn’t much evidence to support that natural supplements can prevent UTIs, but you can try cranberry supplements or probiotics.” These OTC urinary tract analgesics are especially helpful the first day or two of an antibiotic course when women still experience dysuria, frequency and urgency because the antibiotics have not kicked in yet.
It’s also a good idea to increase your water intake and get plenty of rest. Pregnant women may take Tylenol for any lower abdominal or back pain associated with UTIs.
RELATED: Why you should take probiotics with antibiotics
How to avoid a UTI during pregnancy
UTIs during pregnancy are common, and with prompt treatment, aren’t usually a cause for concern for you or your baby. While many UTIs during pregnancy are caused by things out of your control, such as hormones and your growing uterus, there are a few things you can do to reduce the likelihood of getting a UTI during pregnancy. Try these tips:
- Drink plenty of water throughout the day
- Empty your bladder frequently and fully throughout the day
- Wipe front to back after urinating
- Wear cotton underwear that promotes airflow
- Wear loose, non-restricting undergarments and pants
- Keep undergarments clean and dry
- Wash your vaginal area with only water, no soaps or douches
- Urinate before and after intercourse
RELATED: What to do if you have recurring UTIs
The use of cranberry supplements and cranberry juice to prevent or treat UTIs is always a hotly debated topic among experts. Some studies have shown that cranberry products may help prevent UTIs, but can’t treat them once they have started. Other studies haven’t found enough evidence linking cranberry juice or supplements to UTI prevention, and it’s possible that the amount of juice you would need to drink to reap this benefit would be unreasonable.
It’s safe for pregnant women to drink cranberry juice, so working in one or two servings per day won’t hurt, but make sure you choose a juice without added sugar so you don’t derail your healthy pregnancy diet or put you at risk for gestational diabetes. If you’re interested in taking a cranberry supplement to prevent UTIs, talk to your doctor; while it’s generally considered safe during pregnancy, your doctor should always be informed of any supplements you’re taking while pregnant.