We truly have been incredibly blessed in that for the most part, our plans have gone relatively smoothly. So far, one of our biggest causes for concern is one of my 2 chronic health problems (the second being chronic low back pain). I get frequent Urinary Tract Infections (UTI’s). If you don’t know what a UTI is, I’m so jealous of you!! Basically, it is an infection that starts in your urethra (where you pee from), travels up into your bladder (causing cystitis), and sometimes can travel up into your kidneys (pyelonephritis). Symptoms include burning with urination, urgency and frequency to go, and sometimes flank pain and fever. I have been getting them since I was 12. I had a ton of testing done when I was younger, and have been followed by a urologist since then. About 2 years ago, my urologist put me on a prophylactic antibiotic (nitrofurantoin) which I took for about 6 months and did great on. I don’t think I had a single UTI the entire time (which is a record for me!). Since completing that, I probably got one every 2-3 months (which isn’t too bad). All that being said, UTI’s are even more common in the pregnant population, and I know from my medical background that many antibiotics are unsafe to take while pregnant, so this was definitely a cause of concern for me before even trying to conceive.
In December, 2016, I went in to see the urologist, just to see what he wanted us to do as we were planning to move in to this new TTC phase of our lives. I had been having intermittent flank pain (which for me was one of my most common symptoms) since about November and was very concerned that I was having a recurrent UTI’s again. He decided to re-run a handful of the tests that I had done when I was younger (voiding cystogram, renal US and pelvic US). And here was our biggest blip in the plan to date. We certainly didn’t want to be pregnant if we found out any of these tests were positive for something, but our insurance is pretty terrible and wouldn’t cover any of the tests, so we really didn’t want them done before the start of the new year. So I somehow arranged to have ALL of the tests and the follow up appointments with not only the urologist, but the OBG-YN as well within the first week and a half of January (crazy, I know). Going with the theme, I knew that I was supposed to ovulate January 7th (our last follow up was January 9th), so there was still a TINY chance that we could get pregnant that early. Luckily, all of the tests came back negative, we got the go ahead from both the urologist and the OBG, and pretty much no one seems to know, 1. why I get them so frequently or 2. why I have recurrent flank pain that is seemingly unrelated to my menstrual cycle or anything else. But oh well I guess. Can’t have an answer to everything! Needless to say, we did not conceive that first try in January, but it certainly didn’t stop us from trying!
Here is some good information on prevalence in the pregnant population and safe medications to take when prescribed by a doctor.
Urinary tract infections, or UTI’s are slightly more common in the pregnant population than the general population. Why you may ask? Well, a couple of reasons. First, your growing uterus sits directly on top of the bladder and may pinch off urinary flow, which can lead to infection. Second, progesterone slows all smooth muscles, which can slow down your urinary system and make it harder to fully empty your bladder, which can lead to infection. Thirdly, in about 80% of women, dilation of the urinary tract with slight hydronephorosis (swollen kidney due to increased fluid retention) is observed due to that increased progesterone, leading to increased infection rate, and finally, about 50% of women experience increased glucose in their urine, which makes it more susceptible to bacteria growth, leading to infection.
It is estimated that between 2-13% of pregnant women may experience asymptomatic bacteriuria (or an asymptomatic UTI). If left untreated, this may increase the risk from 4% to 40% of pyelonephritis (kidney infection) later in pregnancy. Observational studies have linked symptomatic UTI’s and increased risk for premature delivery and low birth weight, especially when the infection progresses to pyelonephritis. Most health practitioners screen regularly throughout pregnancy for bacteria growth in the urine, especially if you’ve had a UTI before.
A study that looked at 8037 women found that risk factors include those who have had a UTI prior to pregnancy, lower socioeconomic status, sexual activity, older age, multiparity, anatomical urinary tract abnormalities, sickle cell disease and diabetes.
As with most things during pregnancy, treatment remains controversial to a point, primarily revolving around the safety of nitrofurantoin and trimethoprim/sulfamethoxazole in the first trimester. Some studies have linked these drugs in the first trimester with increased risk of birth defects, however there was no definite link between just the drug and birth defects. A study in Norway looked at 180,120 pregnancies between 2004-2008 and found no association between nitrofurantoin use in the first trimester and malformations, stillbirth, neonatal death, low birth weight or preterm delivery. After this was published, the Committee of Obstetrics Practice of the American College of Obstetricians and Gynecologists released a statement that: 1) “When selecting an antibiotic for a true infection during the first trimester of pregnancy (that is, during organogenesis), health care providers should consider and discuss with patients the benefits as well as the potential unknown risks of teratogenesis and maternal adverse reactions; 2) “Prescribing sulfonamides or nitrofurantoin in the first trimester is still considered appropriate when no other suitable alternative antibiotics are available”; 3) “Pregnant women should not be denied appropriate treatment for infections because untreated infections can commonly lead to serious maternal and fetal complications”
Here’s a great chart that summarizes safe antibacterials during pregnancy.
Here is some other good information on diagnosis and treatment of asymptomatic bacteriuria v. pyelonephritis.
So what can I do to avoid UTI’s? Here are a few simple steps that you can follow during pregnancy and even after to keep yourself safe.
- Drink plenty of water
- Wipe from front to back
- Empty your bladder following sex
- If you use a lubricant during sex, choose a water based one
- Don’t ever douche
- Wash your and your partners genital areas with soap and water before sex
- Wear cotton underwear
- Take showers instead of baths
- Avoid clothing, soaps and other hygiene products that cause irritation to your genital area
- Never hold your bladder, when you have to go, go!
If you’re interested, this is a really cheap and easy test that I purchased from amazon….lets me test my urine whenever I want to make sure that I don’t have a UTI without knowing 🙂 Might be worth investing in the sterile cups as well. Useful to get accurate results!