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Introduction

Urinary tract infections (UTIs) are common in pregnancy due to physiologic and anatomic changes that predispose pregnant individuals to bacterial colonization.  UTIs in pregnancy cause symptoms similar to those of UTIs among nonpregnant individuals but can lead to serious maternal morbidity and adverse pregnancy outcomes.

Pathogenesis and microbiology

The development of UTIs typically follows an ascending path:

  • Colonization of the urethral area by uropathogens, usually from fecal flora.
  • Ascension of bacteria through the urethra into the bladder (ie, cystitis).
  • Further ascension via the ureters to the kidneys (ie, pyelonephritis).

Bacteria use a variety of virulence factors, including uroepithelial adhesion (eg, pili and fimbriae [Escherichia coli]), urine alkalinization to promote growth (eg, urease [Proteus mirabilis and others]), biofilm formation, toxin production, and evasion of host immune responses.  As in nonpregnant patients,

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