Associations of comorbidities, opioid use, and intimate partner violence, with urinary tract infections in pregnancy: implications for prevention and screening.

CONTEXT: Urinary tract infections (UTIs) in pregnant women may present as asymptomatic bacteriuria (ASB) to symptomatic bladder or kidney infections (cystitis and pyelonephritis, respectively). Identifying risk factors for a UTI may allow for improved screening techniques and help facilitate preventative medicine in at-risk populations from dangerous UTI-related sequelae.

OBJECTIVES

The objective of this study is to identify conditions associated with the increased risk of symptomatic UTIs in pregnancy.

METHODS

We utilized the pregnancy risk assessment monitoring system (PRAMS) Phase 8, which surveyed postpartum women from 2016 to 2021 to assess factors related to the occurrence of UTIs during pregnancy. PRAMS has respondents self-identifying ethnoracial groups, socioeconomic status (SES), and comorbidities, which we utilized to identify the associated risk of developing a UTI during pregnancy. Data within PRAMS' automated research file (ARF) regarding UTIs were only available from three states: Delaware, Michigan, and Mississippi.

RESULTS

The overall prevalence of symptomatic UTIs among pregnant individuals within these states was 14.8 %. From 2016 to 2021, we found significant differences in the rates of UTI occurrence from 2016 at 12.7 %, to highs of 16.4 % in 2018 and then 16.1 % in 2019. Rates from 2020 through 2021 were not significantly different than 2016 through 2021. Results also showed significant associations between depression (odds ratio [OR] = 2.18, 95 % confidence interval [CI]), intimate partner violence (IPV) (OR = 2.18, 95 % CI), and prescription pain relievers (OR = 2.65, 95 % CI) in the development of UTI during pregnancy. Maternal race affects the risk of occurrence. Compared to UTIs in White women, UTIs in Black (OR = 1.22, 95 % CI), American Indian (OR = 2.24, 95 % CI), and multiracial (OR = 1.17, 95 % CI) women occur more frequently in pregnancy. In contrast, Asian women are less likely to experience a UTI in pregnancy (OR = 0.45, 95 % CI) than white women.

CONCLUSIONS

Compared to reported UTIs rates from 2000 to 2002 of 17 %, our findings show that the occurrence of UTIs during pregnancy has decreased to 13 %. Given the relevant significant findings, increased screening for depression and IPV may be warranted for those presenting with UTI. In addition, increased screening for UTIs in Black, American Indian, and multiracial women can help prevent the development of serious sequelae of pregnancy-associated UTIs.