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UTIs and Yeast Infections during Pregnancy

A couple of weeks after 29-year-old Roberta Saal of Milford, Connecticut gave birth to her third child, she was readmitted to the hospital with a urinary tract infection. “It started almost like a yeast infection with itching and pain during urination,” Roberta says. “But then everything just progressed really quickly.”

After her delivery, Roberta had been prescribed medication for continual vaginal bleeding. While at the doctor’s office for follow-up, she described some new symptoms: a high fever and intense back pain that hampered her walking. He immediately sent her to the hospital, where she remained for more than a week on intravenous antibiotics to heal the urinary tract infection (UTI) that had spread to her kidneys.

Most women would opt for a pregnancy with the fewest daily challenges and the least amount of discomfort possible. Unfortunately, bacteria that cause infection in the urinary tract or vaginal area can sometimes pose added stress on the expectant mother. While yeast infections and UTIs are both commonly related to pregnancy, a yeast infection remains harmless to the fetus, while a UTI can lead to complications if left untreated.

Yeast Infections

Many women have already experienced the irritation of vaginal candidiasis, or yeast infections, prior to pregnancy. They know how to recognize the common indicators such as a white or yellowish discharge, redness, itching or irritation, and burning during urination or intercourse. They are also familiar with the array of over-the-counter anti-fungal creams (Miconazole, Tioconazole, Butoconazole and Clotrimazole) or vaginal suppositories that treat it. While these creams can be used during pregnancy, the oral treatment, Diflucan®—a single-dose medication—has not yet been tested for safety during pregnancy and should be avoided.

The Center for Disease Control (CDC) reports that 80 percent of all women will experience a vaginal yeast infection at least once in life. The bad news for expectant women is that they’re even more susceptible to yeast infections because of increased levels of estrogen. “Some women will have their first yeast infection during pregnancy,” says Dr. Leigh Beasley, medical director of Pickens County Health Department, in Pickens, South Carolina, adding that the infections most often appear during the second trimester.

Doctors don’t routinely check for yeast infections during pregnancy, Dr. Beasley explains. If a yeast infection is left untreated, the worst possible scenario for a pregnant woman would be the transference of the infection into the baby’s mouth during delivery, also known as “thrush.” If thrush occurs, the yeast infection could then attach itself to the mother’s breast during breastfeeding, causing the mother pain, she says. If this happens, the baby and the mother can be treated with the topical medication Nystatin®.

Urinary Tract Infections

Fifteen percent of women experience UTIs during their lives, according to research done by John E. Delzell, Jr. and Michael L. Lefevre, medical professionals and professors at the University of Missouri-Columbia School of Medicine. These doctors report that the incidence can reach eight percent in pregnant women and may recur in about four to five percent. “Urinary tract infections are one of the most common medical conditions encountered in pregnancy,” says Dr. Bryann Bromley, Associate Professor of Obstetrics and Gynecology at Harvard Medical School.

Urinary tract infections can occur anywhere along the urinary tract—from the urethra to the kidneys. Escherichia coli (E. coli), or gastrointestinal bacteria, cause 90 percent of these infections. “Pregnant women are more prone to UTIs because of physiologic changes to the urinary tract in pregnancy”, adds Dr. Bromley.

Symptoms vary among women and can range from burning during urination; frequent urination; pain in the side, back, abdomen or pelvic area; pressure in the lower pelvis; and possible blood or odor in the urine.

Dr. Beasley, who oversees the prenatal care of 350 women per year, has her patients urinate in a cup during each visit to test for protein, glucose, and infection. Bladder infections are the most common urinary tract infections. Among pregnant women, an infection tends to progress quickly to the kidneys. Approximately one to two percent of pregnant women will develop a kidney infection while pregnant, says Dr. Bromley, adding that if left untreated, a kidney infection could result in the premature birth of the baby, growth restriction of the baby in the uterus, and fetal death—so it’s important to take a UTI seriously.

A number of antibiotics, such as Nitrofurantoin, Sulfanomides, Amoxicillan, and Cephalosporins can be used for treatment. Pregnant women with infection usually stay in the hospital for seven days for intravenous antibiotic treatment, although Dr. Beasley treats them for 24 hours in the hospital and then sends them home with follow-up oral medication.

Prevention

The American Academy of Obstetricians and Gynecologists offers the following suggestions to prevent urinary tract infections:

  • Drink a lot of water to flush bacteria out of the urinary tract.
  • Drink cranberry juice or eat blueberries to help prevent growth of bacteria.
  • Empty the bladder whenever you sense the urge (also before and after intercourse).
  • Wear cotton underwear, which doesn’t trap moisture.
  • Keep the vaginal region clean. Wipe from front to back after urination or a bowel movement. Wash near the rectum and vagina every day (also before and after intercourse).

The above tips also apply to the prevention of yeast infections. In addition, the American Pregnancy Association recommends avoiding douches, deodorized sanitary pads and tampons, and bubble baths, as well as cutting down on sugar intake, while adding yogurt with acidophilus to the diet.

Despite the likelihood of catching one or both of these infections during numerous pregnancies, some women have managed to dodge them completely. Robin Gilman, a 45-year-old mother of ten children, living in Ottawa, Canada, has never suffered from a UTI. She contracted a yeast infection only once, during her second pregnancy. She seems to defy all rules of prevention by forgetting to drink enough water and by eating sweets. Robin guesses that some people are just more prone to these kinds of infections or that it might run in families. Her mother also never suffered from any infections.

According to Dr. Bromley, some women may be more prone to UTIs, particularly women with sickle cell trait—carriers of a blood disease mostly found among African Americans. Otherwise, there is no study that shows it’s hereditary, says Dr. Beasley. Robin’s experience is fairly standard. “The majority of women go through pregnancy without any infections.”

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