MLB Weekly Digest September 3rd Edition - NGSC Sports
Urinary Tract Infections During Pregnancy: Symptoms, Treatment, And Common Questions
Urinary tract infections (UTIs), also known as bladder infections, are a very common type of bacterial infection.
One study suggested as many as 1 in 3 women will have a bladder infection at some point in their pregnancy. UTIs occur when bacteria enter into the usually sterile urinary tract and multiplies, causing painful urination and other symptoms. Certain factors during pregnancy make this occurrence more likely to happen. Here's what you need to know to keep you and your baby healthy.
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Why Are UTIs Common in Pregnant Women?When you're pregnant, the anatomy of your urinary tract actually changes. For instance, your kidneys become larger, and your growing uterus can compress your ureters and bladder. Because of this compression, fully emptying your bladder during pregnancy becomes more difficult. In addition, your progesterone and estrogen levels increase during pregnancy, which can weaken your bladder and ureters, per research.
Pregnancy also alters the makeup of your urine, according to the Children's Hospital of Philadelphia, reducing the acidity and increasing the amount of protein, hormones, and sugar in your urine. Research has found that excess sugar can encourage bacterial growth. All of the above contribute to a heightened chance of developing a UTI in pregnancy. And that is why it's recommended that all pregnant women receive a urinalysis and urine culture at 12 to 16 weeks, or during the first prenatal visit.
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UTIs by Pregnancy TrimesterYour risk of UTI goes up beginning at week 6 of your pregnancy; the chances you'll have a UTI vary by trimester.
First TrimesterAccording to the Centers for Disease Control and Prevention (CDC), about 41 percent of UTIs are diagnosed during the first trimester. Because getting a UTI during the first trimester is so common, the U.S. Preventive Services Task Force recommends that your healthcare provider obtain a urinalysis and urine culture at your first prenatal visit. That recommendation holds whether you present with UTI symptoms or not.
Second TrimesterAbout half as many pregnant women are diagnosed with a UTI during their second trimester compared with the first trimester, according to the CDC.
Third TrimesterCompared with the second trimester, the number of women who experience a UTI during the third trimester is almost halved. However, 80 to 90 percent of acute kidney infections in pregnancy (many caused by the progression of an untreated UTI) occur in the second and third trimesters, according to research. Thus, it's recommended to do a repeat urine culture during the third trimester, too.
Common UTI Symptoms in Pregnant Women"While mildly painful urination during pregnancy can often mean a yeast infection, not a UTI, it's always best to see your healthcare provider if you experience any symptoms," says Heather Bartos, MD, a gynecologist in Cross Roads, Texas. Among the telltale UTI signs and symptoms are:
In pregnancy, women are also more susceptible to asymptomatic bacteriuria, meaning you have significant bacteria in your urine, but your urinary tract is free of signs and symptoms. Experiencing no symptoms, however, does not mean that asymptomatic UTIs are benign.
"An asymptomatic UTI can lead to a symptomatic UTI or even a kidney infection [in pregnant women]," says Dr. Bartos. In fact, research has shown that if asymptomatic UTIs in pregnancy are left untreated, 30 percent of pregnant women will go on to develop a symptomatic UTI, and half of those women will eventually be diagnosed with acute pyelonephritis (a kidney infection). Up to 23 percent will have a kidney infection recurrence during the same pregnancy. It's important to note that classic UTI signs, like frequent and painful urination, may or may not occur with a kidney infection. Here are some signs to look out for:
Typical Signs of a Symptomatic UTI"UTIs can rapidly progress to kidney infections in pregnancy, which can be much more dangerous than a kidney infection in nonpregnant women," says Bartos. "Severe infections can lead to respiratory problems and sepsis, which can then lead to preterm labor or even the need to urgently deliver the baby."
Beyond a kidney infection, simply having a UTI during pregnancy appears to possibly be a contributing factor to low birth weight. According to a meta-analysis, women who have a UTI in pregnancy also have a 1.3 times higher risk of developing preeclampsia, a pregnancy complication characterized by high blood pressure. It's thought that a UTI may alter a pregnant woman's inflammatory response, which can spur preeclampsia.
Can Having a UTI While Pregnant Hurt the Baby?Possibly. "A UTI itself doesn't hurt the baby directly," says Bartos. "It's the failure to treat a UTI that can cause things like preterm birth or, rarely, infection of the amniotic sac." For example, research has shown that treating pregnant women who have asymptomatic UTIs decreases the incidence of preterm birth and low-birth-weight infants. That's why screening and prompt treatment are important.
Can a UTI Cause Contractions During Pregnancy?If a urinary tract infection is left untreated, it can progress to a kidney infection. And a kidney infection (pyelonephritis) during pregnancy can modestly increase your chances of early contractions and delivery. Research notes that women diagnosed with acute pyelonephritis in pregnancy have a 10.3 percent chance of preterm delivery compared with the 7.9 percent chance among women without a kidney infection during pregnancy.
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Do UTIs Differ by Trimester?At week 6, UTI risk starts to go up, with two-fifths of UTIs occurring during the first trimester. Because of the likelihood of getting a UTI during the first trimester, as noted above, the U.S. Preventive Services Task Force recommends that pregnant women have a urinalysis and urine culture at their first prenatal visit — whether they have UTI symptoms or not. In the second trimester, about half as many pregnant women are diagnosed with a UTI as in the first trimester, according to the CDC, and that number is almost halved again for the third trimester. However, 80 to 90 percent of acute kidney infections in pregnancy (many caused by the progression of an untreated UTI) occur in the second and third trimesters, per research, so pregnant women should have a repeat urine culture during the third trimester.
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What Are Pregnancy-Safe UTI Treatment Options?How do you treat a UTI when pregnant? It's similar to how you treat a UTI when not pregnant — with a few key differences. A short course of antibiotics is the standard treatment for asymptomatic and symptomatic urinary tract infections that occur during pregnancy. There are, however, two important contrasts in treating UTIs in pregnant women versus nonpregnant women. First, asymptomatic UTIs diagnosed during the first trimester are treated with antibiotics, according to the National Institute for Health and Care Excellence, whereas nonpregnant women's infections are often not treated in this manner, per UpToDate. (Outside of pregnancy, asymptomatic bacteriuria is usually not treated with antibiotics.) Also, the preferred antibiotic drugs used to treat UTI in pregnancy often differ than what would be used while not pregnant. For instance, the following antibiotics have not been associated with any birth defects, thus are likely safe to use at any point during pregnancy:
UTI history and resistance patterns must be considered before prescribing any of these drugs.
Because certain antibiotics are associated with a potential risk for birth defects (anencephaly, heart defects, and cleft palate) when taken during the first trimester, in most cases they are only considered a first-line treatment for UTIs occurring during the second and third trimesters.
Nitrofurantoin (Macrobid) may be used during the first trimester, but in general, medical treatment is avoided, though a bladder infection would be treated with antibiotics. Sulfamethoxazole and trimethoprim oral/injection (Bactrim) is considered appropriate during the first trimester only when no other suitable alternative treatment is available.
Be sure to double-check what your healthcare provider is prescribing.
Understanding Hyperthyroidism In Pregnancy
In pregnancy, hyperthyroidism is most often the result of Graves' disease. If untreated, hyperthyroidism may cause serious complications like early labor and stillbirth.
Hyperthyroidism in pregnancy is rare, affecting around 1–4 out of every 1,000 people during pregnancy. Early and accurate diagnosis and treatment are especially important for individuals with hyperthyroidism while pregnant to help avoid serious complications like premature delivery, maternal hypertension, and others.
Here's what you need to know about having hyperthyroidism during pregnancy.
Learn more about hyperthyroidism.
Hyperthyroidism means that your thyroid is producing too much thyroid hormone. Excess thyroid hormone can speed up your body's processes and stress your body.
In a pregnancy, the fetus relies on hormones produced by the mother's thyroid for the first 18–20 weeks. Appropriate levels of thyroid hormones from the mother are crucial in developing the baby's nervous system and brain. In later stages of pregnancy, excess thyroid hormones from the mother can lead to fetal hyperthyroidism and other complications.
Signs of hyperthyroidism in pregnancy can include:
Hyperthyroidism in pregnancy is most often the result of an autoimmune disease called Graves' disease. Antibodies cause your thyroid to make additional thyroid hormones in individuals with Graves' disease.
In rarer cases, extreme morning sickness (hyperemesis gravidarum) or thyroid nodules may be due to hyperthyroidism in pregnancy.
Potential complications of untreated hyperthyroidism during pregnancy for the mother include:
Complications in a baby may include:
Though it's rare, unmanaged hyperthyroidism during pregnancy can result in a miscarriage or stillbirth.
Doctors prescribe antithyroid medications like propylthiouracil and methimazole to treat hyperthyroidism in pregnancy.
In rare cases where an individual is allergic to medications or goiters are present, surgery may be necessary, but in most cases, surgery is not preferred.
Cases of hyperthyroidism in pregnancy related to hyperemesis gravidarum may only require treatment for dehydration and vomiting.
Hyperthyroidismin pregnancy is considered a high risk situation. It's important to monitor individuals with hyperthyroidism and their babies throughout the pregnancy and postpartum period.
Unmanaged hyperthyroidism can cause significant harm to mother and baby, so individuals with risk factors or who develop symptoms should be tested and begin treatment as quickly as possible.
To encourage good thyroid health during pregnancy, you'll need to consume extra iodine. You should talk with your doctor to ensure that your diet and supplements offer the correct amount of iodine to support you and your growing little one.
Many of the genetic diseases and autoimmune disorders that lead to hyperthyroidism in pregnancy can't be prevented. However, getting treatment for known conditions and making healthy lifestyle choices can help your overall health, including your thyroid.
Will hyperthyroidism improve after a mother gives birth?Hyperthyroidism may not improve after the baby arrives. Women with Graves' disease may see an improvement in the third trimester, but it may get worse again during the postpartum period.
Can a mother with Graves' disease nurse her newborn?Many birthing parents can safely nurse their babies while on antithyroid medications, though some hormones can pass through breast milk. It's always important to talk with your doctor about the safety of nursing when you are on medications.
Is an underactive thyroid (hypothyroidism) also dangerous in pregnancy?Although hypothyroidism is the opposite of hyperthyroidism, if left unmanaged both can cause miscarriage or stillbirth. It's important to talk with your doctor or midwife if you believe you have symptoms of either condition during pregnancy.
Hyperthyroidism means that your thyroid is producing too much thyroid hormone. In pregnancy, it is most commonly the result of Graves' disease and can be diagnosed with blood testing.
If you have hyperthyroidism during pregnancy, treatment is essential to help prevent serious complications for you and your baby. It's important to let your doctor or midwife know if you have any symptoms of hyperthyroidism.
After your pregnancy, you may still need medications to treat hyperthyroidism, depending on the cause.
Urinary Incontinence And Pregnancy
During pregnancy, many women experience at least some degree of urinary incontinence, which is the involuntary loss of urine. The incontinence may be mild and infrequent for some pregnant women. But it can be more severe for others. Age and body mass index are risk factors for pregnancy incontinence, according to one study.
Incontinence can continue after pregnancy and may not be present right after childbirth. Some women do not have bladder problems until they reach their 40s.
The kind of incontinence experienced during pregnancy is usually stress incontinence (SI). Stress incontinence is the loss of urine caused by increased pressure on the bladder. In stress incontinence, the bladder sphincter does not function well enough to hold in urine.
Urinary incontinence during pregnancy can also be the result of an overactive bladder. Women who have an overactive bladder (OAB) need to urinate more than usual because their bladders have uncontrollable spasms. In addition, the muscles surrounding the urethra -- the tube through which urine passes from the bladder -- can be affected. These muscles are meant to prevent urine from leaving the body, but they may be "overridden" if the bladder has a strong contraction.
The bladder sphincter is a muscular valve that lies at the bottom of the bladder. It works to control the flow of urine. In pregnancy, the expanding uterus puts pressure on the bladder. The muscles in the bladder sphincter and in the pelvic floor can be overwhelmed by the extra stress or pressure on the bladder. Urine may leak out of the bladder when there is additional pressure exerted -- for example, when a pregnant woman coughs or sneezes.
After pregnancy, incontinence problems may continue, because childbirth weakens the pelvic floor muscles, which can cause an overactive bladder. Pregnancy and childbirth also may contribute to bladder control problems because of the following conditions:
Behavioral methods such as timed voiding and bladder training can be helpful in treating urinary incontinence during and after pregnancy. These techniques are often used first and can be done at home. The changes in habits that behavioral methods involve do not have serious side effects.
To practice timed voiding, you use a chart or diary to record the times that you urinate and when you leak urine. This will give you an idea of your leakage "patterns" so that you can avoid leaking in the future by going to the bathroom at those times.
In bladder training, you "stretch out" the intervals at which you go to the bathroom by waiting a little longer before you go. For instance, to start, you can plan to go to the bathroom once an hour. You follow this pattern for a period of time. Then you change the schedule to going to the bathroom every 90 minutes. Eventually you change it to every two hours and continue to lengthen the time until you are up to three or four hours between bathroom visits.
Another method is to try to postpone a visit to the bathroom for 15 minutes with the first urge. Do this for two weeks and then increase the amount of time to 30 minutes and so on.
In certain cases, a woman may use a pessary, a device to block the urethra or to strengthen the pelvic muscles. In addition, medications also can be helpful in controlling muscle spasms in the bladder or strengthening the muscles in the urethra. Some drugs can help to relax an overactive bladder.
Kegel exercises are another method that can be used to help control urinary incontinence. These exercises help tighten and strengthen the muscles in the pelvic floor. Strengthening the pelvic floor muscles can improve the function of the urethra and rectal sphincter.
One way to find the Kegel muscles is to sit on the toilet and begin urinating. Then stop urinating mid-stream. The muscles that you use to stop the flow of urine are the Kegel muscles. Another way to help locate the Kegel muscles is to insert a finger into the vagina and try to make the muscles around your finger tighter.
To perform Kegel exercises, you should:
Do 10 Kegel exercises in the morning, afternoon, and at night. They can be done anytime -- while driving or sitting at your desk. Women who do Kegel exercises tend to see results in four to six weeks.
Talk to your doctor if you still have bladder problems six weeks after delivery. Accidental leaking of urine may mean that you have another medical condition. The loss of bladder control should be treated or it can become a long-term problem.
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