Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2021; 11(01): e5-e14
DOI: 10.1055/s-0040-1721668
Case Report

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study

Rebecca J. Baer 
1   Department of Pediatrics, University of California San Diego, La Jolla, California
2   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
3   The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
,
Nichole Nidey
4   Department of Epidemiology, University of Iowa, Iowa City, Iowa
,
Gretchen Bandoli
1   Department of Pediatrics, University of California San Diego, La Jolla, California
,
Brittany D. Chambers
3   The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
5   Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
,
Christina D. Chambers
1   Department of Pediatrics, University of California San Diego, La Jolla, California
,
Sky Feuer
2   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
3   The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
,
Deborah Karasek
2   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
3   The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
,
Scott P. Oltman
3   The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
5   Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
,
Larry Rand
2   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
3   The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
,
Kelli K. Ryckman
4   Department of Epidemiology, University of Iowa, Iowa City, Iowa
6   Department of Pediatrics, University of Iowa, Iowa City, Iowa
,
Laura L. Jelliffe-Pawlowski
3   The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
5   Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective The aim of the study is to evaluate the risk of preterm birth (PTB, <37 weeks) and early term (37 and 38 weeks) birth among women with an emergency department (ED) visit or hospitalization with a urinary tract infection (UTI) by trimester of pregnancy.

Methods The primary sample was selected from births in California between 2011 and 2017. UTIs were identified from the ED or hospital discharge records. Risk of PTB, by subtype, and early term birth were evaluated by trimester of pregnancy and by type of visit using log-linear regression. Risk ratios were adjusted for maternal factors. Antibiotic usage was examined in a population of privately insured women from Iowa.

Results Women with a UTI during pregnancy were at elevated risk of a birth <32 weeks, 32 to 36 weeks, and 37 to 38 weeks (adjusted risk ratios [aRRs] 1.1–1.4). Of the women with a diagnostic code for multiple bacterial species, 28.8% had a PTB. A UTI diagnosis elevated risk of PTB regardless of antibiotic treatment (aRR 1.4 for treated, aRR 1.5 for untreated).

Conclusion UTIs are associated with early birth. This association is present regardless of the trimester of pregnancy, type of PTB, and antibiotic treatment.

Keywords

preterm birth - early term birth - urinary tract infection - bacterial species - trimester of infection

Supplementary Material



Publication History

Received: 01 April 2020

Accepted: 02 October 2020

Article published online:
13 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Delzell Jr JE, Lefevre ML. Urinary tract infections during pregnancy. Am Fam Physician 2000; 61 (03) 713-721
    PubMedGoogle Scholar
  • 2 Lucas MJ, Cunningham FG. Urinary infection in pregnancy. Clin Obstet Gynecol 1993; 36 (04) 855-868
    CrossrefPubMedGoogle Scholar
  • 3 Committee on Practice Bulletins—Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol 2012; 120 (04) 964-973
    CrossrefPubMedGoogle Scholar
  • 4 National Institute for Health and Clinical Excellence. Antenatal care. NICE clinical guideline. 2010 . Access December 09, 2019 at: https://www.nice.org.uk/guidance/qs22/documents/antenatal-care5
    PubMedGoogle Scholar
  • 5 U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: reaffirmation recommendation statement. Am Fam Physician 2010; 81 (04) 505
    PubMedGoogle Scholar
  • 6 Moore A, Doull M, Grad R. et al; Canadian Task Force on Preventive Health Care. Recommendations on screening for asymptomatic bacteriuria in pregnancy. CMAJ 2018; 190 (27) E823-E830
    CrossrefPubMedGoogle Scholar
  • 7 Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America, American Society of Nephrology, American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40 (05) 643-654
    CrossrefPubMedGoogle Scholar
  • 8 Agger WA, Siddiqui D, Lovrich SD. et al. Epidemiologic factors and urogenital infections associated with preterm birth in a midwestern U.S. population. Obstet Gynecol 2014; 124 (05) 969-977
    CrossrefPubMedGoogle Scholar
  • 9 Bánhidy F, Acs N, Puhó EH, Czeizel AE. Pregnancy complications and birth outcomes of pregnant women with urinary tract infections and related drug treatments. Scand J Infect Dis 2007; 39 (05) 390-397
    CrossrefPubMedGoogle Scholar
  • 10 Farkash E, Weintraub AY, Sergienko R, Wiznitzer A, Zlotnik A, Sheiner E. Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes. Eur J Obstet Gynecol Reprod Biol 2012; 162 (01) 24-27
    CrossrefPubMedGoogle Scholar
  • 11 Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome?. J Matern Fetal Neonatal Med 2009; 22 (02) 124-128
    CrossrefPubMedGoogle Scholar
  • 12 Schieve LA, Handler A, Hershow R, Persky V, Davis F. Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome. Am J Public Health 1994; 84 (03) 405-410
    CrossrefPubMedGoogle Scholar
  • 13 Chen YK, Chen SF, Li HC, Lin HC. No increased risk of adverse pregnancy outcomes in women with urinary tract infections: a nationwide population-based study. Acta Obstet Gynecol Scand 2010; 89 (07) 882-888
    CrossrefPubMedGoogle Scholar
  • 14 Morken NH, Gunnes N, Magnus P, Jacobsson B. Risk of spontaneous preterm delivery in a low-risk population: the impact of maternal febrile episodes, urinary tract infection, pneumonia and ear-nose-throat infections. Eur J Obstet Gynecol Reprod Biol 2011; 159 (02) 310-314
    CrossrefPubMedGoogle Scholar
  • 15 Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000; 342 (20) 1500-1507
    CrossrefPubMedGoogle Scholar
  • 16 Anderson BL, Simhan HN, Simons KM, Wiesenfeld HC. Untreated asymptomatic group B streptococcal bacteriuria early in pregnancy and chorioamnionitis at delivery. Am J Obstet Gynecol 2007; 196 (06) 524.e1-524.e5
    CrossrefPubMedGoogle Scholar
  • 17 Meis PJ, Michielutte R, Peters TJ. et al. Factors associated with preterm birth in Cardiff, Wales. I. Univariable and multivariable analysis. Am J Obstet Gynecol 1995; 173 (02) 590-596
    CrossrefPubMedGoogle Scholar
  • 18 Baer RJ, Norton ME, Shaw GM. et al. Risk of selected structural abnormalities in infants after increased nuchal translucency measurement. Am J Obstet Gynecol 2014; 211 (06) 675.e1-675.e19
    CrossrefPubMedGoogle Scholar
  • 19 Agency for Healthcare Resarch and Quality. Prevention Quality Indicators #12 (PQI #12) Urinary Tract Infection Admission Rate. 2015 . Accessed December 09, 2019 at: https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50-ICD10/TechSpecs/PQI%2012%20Urinary%20Tract%20Infection%20Admission%20Rate.pdf
    PubMedGoogle Scholar
  • 20 Jelliffe-Pawlowski LL, Baer RJ, Blumenfeld YJ. et al. Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth. BJOG 2015; 122 (11) 1484-1493
    CrossrefPubMedGoogle Scholar
  • 21 Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994; 84 (09) 1414-1420
    CrossrefPubMedGoogle Scholar
  • 22 Matuszkiewicz-Rowińska J, Małyszko J, Wieliczko M. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Arch Med Sci 2015; 11 (01) 67-77
    CrossrefPubMedGoogle Scholar
  • 23 Romero R, Grivel JC, Tarca AL. et al. Evidence of perturbations of the cytokine network in preterm labor. Am J Obstet Gynecol 2015; 213 (06) 836.e1-836.e18
    CrossrefPubMedGoogle Scholar
  • 24 Jafri S, Ormiston ML. Immune regulation of systemic hypertension, pulmonary arterial hypertension, and preeclampsia: shared disease mechanisms and translational opportunities. Am J Physiol Regul Integr Comp Physiol 2017; 313 (06) R693-R705
    CrossrefPubMedGoogle Scholar
  • 25 Schneeberger C, Geerlings SE, Middleton P, Crowther CA. Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst Rev 2012; 11: CD009279
    PubMedGoogle Scholar
  • 26 Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2007; (02) CD000490
    PubMedGoogle Scholar