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UTI in Pregnancy

What You Should Know

(Overview*)

During pregnancy the normal changes in the urinary tract that contribute to an increased susceptibility to bladder infections include:

1) the anatomical changes (due to the growth of uterus):

  • kidney enlargement,
  • compression of the ureters and bladder;

2) the functional changes:

  • the bladder does not empty completely;
  • the urine is not as acidic and it contains more sugars, protein, and hormones.

*Based on various sources.

Your Third Trimester

(Month 7 through Month 9 of Pregnancy)

Pregnant women, especially in the late stages of pregnancy, seem no more prone to a bladder infection than other women. However, if you experience an untreated urinary tract infection during the third trimester of pregnancy you are at greater risk of delivering a child who may suffer from mental retardation or developmental delay.

A bladder infection during pregnancy can also cause:

  • a low birthweight (a term used to describe babies who are born weighing less than 2,500 grams/5 pounds, 8 ounces);
  • premature labor that may result in premature birth (the earlier it happens, the greater the health risks for your baby);
  • kidney infection, also known as renal infection or pyelonephritis (when bacteria spread to the kidneys);
  • urosepsis – a condition where a urinary tract infection spreads from the urinary tract to the bloodstream.

Medical Diagnosis

Most women are tested at the first prenatal visit and during pregnancy, if needed. The only way to diagnose an infection is urine sample.

Urinary Analysis (U/A)

This test is commonly performed in the doctor’s office or in lab. It just takes a few minutes. A dipstick is placed in the urine sample and up to ten different substances can be detected.

Microscopic Urinalysis (U/A micro)

A doctor may also wait a few hours for the lab to run a microscopic urinalysis. A drop of urine is examined under a microscope. This test helps in the decision whether or not to start an antibiotic treatment while the urine culture is running.

Urine Culture

Urine culture is the most accurate test to determine for sure whether or not an infection is present. The lab puts the urine sample in an incubator. If any bacteria are in the sample, they will multiply and show up. However, it takes 24 to 48 hours for the bacteria to grow enough to be detected.

Antibiotic Susceptibility Testing (AST)

If only one type of bacteria grows in the culture, the lab can expose the bacteria to a variety of antibiotics to see to which ones the bacteria are most sensitive. This usually takes one day after the culture is positive. It helps to decide which antibiotic should be prescribed for the infection.

Types of Bladder Infections

Asymptomatic bacteriuria

It is a silent infection often caused by bacteria present in the woman’s system before pregnancy (a significant bacterial count, usually Ú105 or 106 organisms/mL). This type of infection occurs in about 6-7 percent of all pregnant women during their first prenatal visit.

Asymptomatic bacteriuria may have a role in preterm birth and may precede symptomatic urinary tract infection.

Symptomatic bacteriuria

If asymptomatic bacteriuria is left untreated, a symptomatic bacteriuria (with symptoms) may lead to a kidney infection. (Up to 30 percent of mothers develop acute pyelonephritis, if asymptomatic bacteriuria is untreated).

Acute urethritis or cystitis

Urethral and/or bladder infection cause symptoms including pain or burning with urination, frequent urination, feeling of needing to urinate, and fever.

Pyelonephritis

It is a kidney infection that causes symptoms including those of acute cystitis plus back pain. It may lead to preterm labor, severe infection, and adult respiratory distress syndrome. ARDS is characterized by diffuse pulmonary microvascular injury. Common symptoms include dyspnea, tachypnea, dry cough, retrosternal discomfort, and moderate to severe respiratory distress.

The common organisms causing urinary tract infection include E. coli, group B streptococcus (GBS), and sexually transmitted gonorrhea and chlamydia.

E. coli Infections

The most common microorganisms that cause the lower urinary tract infections during pregnancy (85-90 percent) are a few strains of E. coli (UPEC) normally present in the vagina and rectal area.

If E. coli bacteria get into the bladder or the urethra, the body has ways of fighting them off. They include the obvious methods of simply flushing them out with the urine. But these bacteria have evolved ways of anchoring themselves to the cells of the urinary tract.

The invading E. coli bacteria take advantage of receptors naturally found on the cells of the mucosal lining of the urinary tract. Receptors are like molecular “docking bays” for substances which the cells need for their normal growth and development.

E. coli use “grappling hooks”, called type I pili, to first hook on to these receptors, and then to invade the cell. Once inside the cell, E. coli can live and reproduce in safety, shielded from many of the body’s defensive immune responses.

When faced with a potentially pathogenic germ like E.coli, conventional, pharmaceutically-based medicine typically confronts the problem by throwing at the bugs the most potent poisons it can find, that is antibiotics.

This standard medical approach, however, does have some very serious drawbacks. And, it should be noted that this is not the only possible avenue of attack.

Group B Streptococcus Infection

Group B strep (GBS) is not a sexually transmitted disease. These are bacteria that can be found in the digestive tract, urinary tract, and genital area (vagina) of about 25 percent adult women. Although GBS infection usually causes no problems in healthy women before pregnancy, it can cause serious illness for the mother and baby during pregnancy and after delivery.

GBS affects 1 in every 2,000 babies in the United States alone. It is a serious concern, as 1 out of every 4 or 5 pregnant women carries these bacteria in their rectum or vagina.

Group B strep can cause a urinary tract infection and lead to preterm labor and birth. It should be noted that premature babies are more susceptible to GBS infection than full-term babies.

The bacteria can be cultured from a mother’s urine. Cultures are usually done between 35 and 37 weeks of pregnancy and may take a few days to complete. Cultures collected earlier in pregnancy do not accurately predict whether a mother will have GBS at delivery.

Chlamydia Infection

Chlamydia is a common sexually transmitted disease caused by a bacterium called Chlamydia trachomatis. In women, the chlamydia organism infects cells of the lining of the cervix, rectum, and eye.

Chlamydia infections are often asymptomatic. Consequently, they can be transmitted unknowingly to other people. However, when the symptoms do occur, their type and severity will depend on the site of the infection and the person’s response to it.

Women who do have symptoms of chlamydia infection may notice:

  • an increased vaginal discharge,
  • irritation of the area around the vagina,
  • burning pain with urination.

In pregnant women, chlamydia infection can be passed on to their newborn children, where it can cause eye infections and pneumonia.

To diagnose chlamydia, a special test must be done by a health professional. As this a serious condition, it requires prompt medical attention.

Pelvic inflammatory disease

If chlamydia infection is not detected and treated with antibiotics it can lead to pelvic inflammatory disease – a condition that signals the infection has spread to the uterus and fallopian tubes.

Doctors’ Choices of Antibiotics

Bactrim/Septra

(Trimethoprim/Sulfamethoxazole)

Trimethoprim and sulfamethoxazole are both compounds that block the internal production of folic acid (folate) needed by most bacteria to survive. These compounds, relatively safe for humans, are lethal to many bacteria.

Unfortunately, this inexpensive and quite effective, standard antibiotic for bladder infections is notorious for developing rash and allergies to it, frequently, life-threatening allergies. It is one of those famous sulfur drugs to which people have adverse reactions.

Other side effects have been reported in virtually every organ system in the body, including the kidneys. Sulfa drugs may precipitate in the urine, producing crystals that can cause bleeding, urinary obstruction, or kidney damage.

Generic Bactrim also tends to disrupt the intestinal bacteria more than other drugs, such as Macrobid, and cause stomach upset.

Keflex

(Cephalexin)

As an alternative to Bactrim/Septra, it seems to be more effective and even safer, although it carries risks of its own.

Cipro & Macrobid

(Fluoroquinolone & Nitrofurantoin)

Internists are most likely to prescribe fluoroquinolones, such as Cipro. Obstetricians are most likely to prescribe generic Macrobid. It tends to have minimal negative effect on the intestine, as most of this drug is concentrated in the bladder.

Limitations of the Antibiotics

Unfortunately, bacteria can survive after antibiotic treatment. For example, bladder infections caused by a common bacterium E. coli return in as many as 30 percent of women apparently “cured” by antibiotics.

Bacteria E. coli are able to survive antibiotic treatment for bladder infections by reverting to an inactive state. Although, within several days of antibiotic treatment, the number of bacteria reproducing drop to zero – NOT ALL the bacteria are killed. For example, after treatment with:

  • Cipro, about 3 percent of the bacteria may be still present in a dormant state;
  • Bactrim, about 7 percent of the bacteria may still linger.

Even after a month of antibiotic exposure, about 10 million of the original 1 billion bacteria may remain.

It is a well-known fact that antibiotic treatments do not successfully kill all the bacteria participating in the infection and may, in fact, encourage many of the bacteria to persist in a resting state.

Therefore, current standard drug treatments for bladder infections are not adequate and this phenomenon may account for many of the repeat urinary tract infections. In 15 percent of cases, bladder or kidney infections can become a recurring problem, or they can stop responding to the antibiotics.

Drawbacks of the Antibiotics

Although routinely used, antibiotic treatments have many drawbacks, such as:

  • They kill both the unwanted micro-organisms and wanted micro-organisms. (Research has shown that a singel course of ciproflaxin can disrupt a third of the microbe species naturally present in the gut, and other work has suggested that in some people, the microbiome might never really recover.)
  • The long-term or often repeated antibiotic use leads to major disturbance in normal body microflora, and sometimes to major disruption in health.
  • They often cause stomach upset, rash, and allergic reactions.
  • They often cause nasty yeast infections (as the friendly bacteria are killed off along with the bad bacteria, the antibiotic insensitive yeast can then grow out of control).

As it happens, all antibiotic therapies carry with them the risks of developing:

  • antibiotic-resistant bacteria,
  • gastrointestinal problems,
  • adverse effects, especially on the liver and kidneys.

Therefore, due to the hazards, especially of prolonged antibiotic therapy, the need for antibiotics used to clear up the infection should be reduced to the absolute minimum. Women who take antibiotics over a long period of time are at increased risk of heart attack or stroke, according to research carried out in nearly 36,500 women. In addition, as study published in 2017 found the antibiotics may raise the risk of bowel cancer.

Children whose mothers are prescribed antibiotics during pregnancy have been found to have up to 20 percent increased risk of being hospitalized for serious infections.

Natural Alternative Measures

Supplemental D-Mannose

Here’s the good news: Up to 90 percent of all E. coli urinary tract infections can be cured within 1 to 2 days with mannose – without killing a single bacterium!

For the great majority of bladder infections (over 85 percent), supplemental D-Mannose offers a safe, natural option with a simple, ingenious rationale, no known side-effects, and a great reported success rate.

In other words, the more natural way to eliminate E. coli infections from the urinary tract is to beat them at their own game. If they are going to cause trouble, bacteria usually have to find a way to adhere (stick) to the body tissue they are infecting.

In bladder infection, E. coli attach to cells lining the bladder and urinary tract using filmy, hair-like projections called fimbria on their cell walls.

At the tip of each fimbrium, or pilus, is a glycoprotein (a combination carbohydrate and protein) called a lectin that is programmed to bind to the first molecule of the sugar mannose that it encounters.

It turns out that molecules of mannose (produced inside urinary tract lining cells) naturally dot the surfaces of these cells. Here they act as “receptors,” inviting the fimbria of E. coli to attach, and allowing them to bind to the tissue in a tight, Velcro-like grip.

If not for this attachment to the cell’s mannose, any E. coli that had successfully ventured up the urethral river would be unable to stick to the slippery surface and would be washed right back out on the next tide of urination.

Many research reports have demonstrated its mode of action and effectiveness against E. coli. D-Mannose is just about as effective as antibiotic drugs.

Because supplemental D-Mannose is so effective and so benign, pregnant women who are susceptible to recurrent bladder infections, can safely take it as a preventive measure to head off future attacks.

Unlike virtually any conventional medication, D-Mannose has no known drawbacks. Even those who had remained infected after having been subjected to a wide range of potent, side-effect-inducing antibiotics have successfully rid themselves of chronic or acute infections using supplemental D-Mannose.

Supplemental Probiotics

We all know, more or less, what antibiotics are, but we still don’t know exactly what probiotics are, when they should be used, and who needs them. Let’s clear up a little bit of the confusion.

The term “probiotic” is used to describe the beneficial bacteria that inhabit the human intestinal tract. The word is derived from Greek and literally means “for life.”

Probiotics are found in fermented foods such as yogurt, sauerkraut, and kefir. Many of these foods rich in probiotics are still of great importance to the diets of most of the people in the world.

Scientists, however, have found a way to freeze-dry these beneficial bacteria and put them in capsules. The specific microorganisms found in these capsules are usually lactobacilli and bifidobacteria, which are the major probiotics found in the human intestinal tract.

One of the best-documented applications of probiotic supplements is in the prevention and treatment of urinary tract infections.

As the efficacy of probiotic supplements is based solely on the number of live organisms present, successful results are attained by taking the minimum of 50 billion viable bacteria per day.

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