The unlikely link between UTIs and preterm births

Urinary tract infections, UTIs, caused by some types of bacteria and yeast affect men and women of all ages. Women, in general, are reported to suffer from at least one episode of UTI at some point in their life, and especially so when pregnant. One of the main reasons this commonly happens in pregnancy is due to the reduced immunity caused by accompanying hormonal and physiological changes. The urine chemical composition during pregnancy seems to contain more glucose and amino acids that create a conducive environment for microbial growth in urine.  UTIs are of great public health concern since they are common in pregnancy and can result into adverse outcomes to the mother and baby. A 2018 study by microbiologists who studied 210 pregnant women attending Nairobi’s Pumwani Maternity Hospital identified some predisposing factors for UTIs.

These include:

· Diabetes. The condition increases sugar levels in urine, creating a great environment for microbial growth

·  Regular sexual activity that introduces bacteria from the anal area to the genitals

· Low social economic status

· Multiparity. The more child births a woman has had, the higher the chances of infections

· Anatomical abnormalities

The burden of premature births

Scientists from the Centre for Women’s Infectious Disease Research at the Washington University describe UTIs as a preventable cause of pregnancy complications and a problem of global significance.

“Many countries with high rates of preterm birth and neonatal mortality also have rates of UTI in pregnancy that exceed rates seen in more developed counties,” reads a section of a report. In Kenya, the prevalence of UTIs in pregnant women is estimated to be at 15.7 per cent; which is actually within the 13 per cent – 33 per cent estimated global prevalence. However, Edwin Chemonges, a reproductive health nurse based in Kilifi, thinks the prevalence could be higher than that. “In my estimation, seven out of 10 women I get to assist in delivery give birth before 40 weeks of gestation. A keen look into their medical reports almost always reveals a common trend; the women who gave birth earlier than expected had chronic UTIs all through the pregnancy,” he says.

 How this happens

Preterm delivery is defined as birth before the completion of the 37th week of pregnancy. It is one of the major causes of neonatal deaths and accounts for significant health problems —such as growth retardation, low birth weight and anaemia — in premature infants who survive. When a pregnant woman has a urinary tract infection, invasion and multiplication of microorganisms on the vaginal and cervical area allows ascension of germs all the way to the placenta. The short urethra in women makes it easy for faecal microorganisms to colonise the urinary tract. Their increasing population triggers production of secretions as part of the immune response. These secretions stimulate the production of components (prostaglandins) that are known to induce uterine contractions and possibly cause preterm delivery.

Sexual partners play a role

Even though UTIs are not generally considered as sexually transmissible, the findings from the Pumwani study showed that besides poor hygiene, the male sexual partners were a factor in the spread of UTIs.  They found multiple sexual partners and frequency (more than two times a week) of sexual intercourse to be associated with UTIs.  The reason that more sex can lead to more UTIs is simply because the act itself causes the woman’s urethra to come in contact with bacteria from genitals and anus, and once that happens, the microbes can easily go up the system and cause infection. Male partners could also carry bacteria from one partner to another.  

Managing UTIs in pregnancy

UTIs manifest through symptoms such as burning sensation during urination, persistent urge to urinate, cloudy, strong smelling urine, pelvic pain, vaginal itching and discharge. Pregnant women are advised to seek medical attention whenever they show signs of UTIs. Urine examination is also mandatory during antenatal clinic visits. Self-medication is strongly discouraged due to possible antimicrobial resistance.

Due to their potential harm to mother and foetus, UTIs are managed more aggressively in expectant women by the use of antibiotics. Most expectant women experience UTIs especially in the second trimester.  Antibiotic use should generally be avoided during the first trimester to avert any risk of abnormalities happening during the unborn babies organ formation and development of the nervous system.

How to keep UTIs at bay

The often recommended measures include:

· Washing up before sex and urinating right after to flush out germs,

· Wearing absorbent cotton undergarments

·  Frequently changing undergarments

· Cleaning up from anterior to posterior after visiting the toilet greatly reduces the occurrence of UTIs.

· Researchers also advise on drinking plenty of water to relieve oneself more often and flush out bacteria before they set in.

· Stay clear of douches and scented feminine products that have potential to irritate the genitals.

Even though the use of probiotics such as cranberry juice or yoghurt have been suggested as alternative and more tolerable treatments to UTIs, studied can’t conclusively prove their efficacy in treating UTIs once infection has set it. The lack of establishment of dosage and time of usage make them less efficient to confer protection against UTIs.

 Nancy Nzalambi is a public health research scientist