and mock What is a UTI? Urinary tract infection or UTI is a bacterial, non-contagious infection involving the urinary tract. Also referred to as bladder infection, it is quite common among pregnant women from early first trimester (4th week) through the second trimester (26th week) [1] . It may lead to various serious complications unless treated properly at an early stage. What Causes UTI during Pregnancy? In most cases, it is caused by the bacteria E. coli ( Escherichia coli ) [2] . The bacteria are normally found in your large intestines and stools. But sometimes, they get into the urethra (the tube responsible for carrying urine from the bladder to be eliminated from the body) and travel to the kidneys and bladder, causing the infection [3] . The infections are more common among women compared to men. This might be because of the shorter urethras in women, making it easier for the bacteria to reach the bladders [4] . Is UTI a sign of pregnancy? As mentioned above, urinary tract infections are quite common in early pregnancy. The initial mild symptoms like nausea and abdominal pain coincide with the common early pregnancy signs, making it even more difficult to detect the condition. But, that does not mean UTI is a sign of pregnancy as it can affect anyone. Some women believe the bacteria to cause a false positive or negative home pregnancy test; but in truth, the infection does not usually affect an HPT which depends on the presence or absence of HCG in the urine. Why is urinary tract infection more common in pregnant women? Changes occurring in the urinary tract during pregnancy increase the chances of developing infections at this period. Increased production of the pregnancy hormone progesterone relaxes the ureter muscles (tube responsible for carrying urine to the bladders), slowing down the urine flow, giving more time for bacteria to grow [5] . This often leads to UTI during the first trimester. With the advancement of your pregnancy, the growing uterus puts extra pressure on the urinary tract which may block urine drainage from the bladder, leading to the infection [1] . Risk Factors for UTI While Pregnant Apart from the pregnancy related factors, women with the following risk factors are also more at risk of developing the infection: Dehydration Carrying twins [6] Diabetes (chronic or pregnancy-induced) Kidney stones UTI (Urinary Tract Infection) symptoms in pregnancy The symptoms may differ from one woman to another depending on the location of infection [7] . Symptoms for infection in bladder (cystitis) Pelvic pain or discomfort Lower abdominal pain or contractions on one or both sides Lower back pain Uncontrollable urge to urinate Frequent urination A burning sensation or pain while urinating [8] Mild fever Blood in the urine (Hematuria) [9] Cloudy or foul smelling urine General malaise [10] Pain during intercourse Signs of UTI affecting the kidney High fever with temperature above 38 C [10] Constant back pain Severe pelvic pain along with pain in the sides Chills or shivers Nausea and vomiting [7] Diarrhea Feeling cold and hot by turns Abdominal tenderness [4] Asymptomatic infection (asymptomatic bacteriuria) during pregnancy Asymptomatic bacteriuria is experiencing no distinct symptoms of infection despite having bacteria in your urinary tract. It increases the chances of getting a UTI later in pregnancy by 40%. However, the risk goes down to 1% to 4% with proper treatment. UTI during pregnancy tests and diagnosis A urine sample is collected from you on your first prenatal visit to be tested for bacteria (urinalysis). A negative result considerably diminishes your risks of developing an infection in your pregnancy. But, women with positive results may require further testing. Other diagnostic procedures used for this purpose may include blood tests (cultures) and imaging tests (ultrasonography, intravenous pyelography) [12] . UTI test strips are also useful for detecting the infection at home when used under medical supervision [13] . Urinary tract infection in pregnancy differential diagnosis Ectopic pregnancy [20] Cervicitis (inflammation of uterine cervix) Group B streptococcal colonization [28] Interstitial Cystitis (a urinary tract disorder) Nephrolithiasis (a kidney disorder) UTI (urinary tract infection) treatment in pregnancy Treating infections affecting the bladder It is a curable condition, usually treated with a week-long antibiotic course [14] . You may need to stay at the hospital for 12-24 hours so your doctor can carry on a few tests for assessing the stage of infection. Tests like urinalysis, blood pressure measurement and ultrasound are performed to monitor the health of both the mother and child. Asymptomatic bacteriuria is treated in the similar manner with a short antibiotic course to keep it from advancing to UTI. Your symptoms may go away within a couple of days of starting the medicine; but, it is essential to complete the course to properly clear away the infection [15] . Antibiotics for UTI affecting the kidneys Hospitalization is required for managing the infection as treatment procedures include intravenous fluid administration along with antibiotics and monitoring tests. The length of hospital stay varies depending on the treatment. Usually, it lasts until 24-48 hours after the initial treatment is complete, bringing down your body temperature to normal . Nitrofurantoin (Macrobid, Niftas, Furadantin etc.) is a common antibiotic medication used for the treatment [16] . However, it is not recommended during the later weeks of the third trimester. Other UTI medicines like amoxicillin (Actimoxi) and ciprofloxacin (Cipro) are not prescribed [17] unless the potential benefits are greater than the possible risks. Over-the-counter medicines are also not recommended for pregnant women. Suppressive therapy with a low dose antibiotic is necessary for the remainder of pregnancy to prevent a recurring UTI [15] . Home remedies for UTI in pregnancy Mix 1 teaspoon baking soda in a glass of water and drink it once every day Drink 1-2 glasses of sugar-free cranberry juice every day (it prevents and slows down E.coli growth) [18] ( cranberry supplements are not recommended in pregnancy ) Add some apple cider vinegar to a glass of water, mix it well (you can also add some lemon juice and honey if preferred) and drink the mixture once a day. This natural remedy is useful for getting rid of many pregnancy related problems including UTI. Eat one cup of sliced pineapple (the bromelain enzyme in pineapples helps fight the bacteria) [19] Risks of having urinary tract infection in pregnancy It does not usually harm the mother or the baby when treated properly. However, an untreated infection may increase the chances of: Premature labor and delivery [22] Having a baby with low birth weight Sepsis [23] Pneumonia Miscarriage [21] Recent studies suggest that it may also increase the risk of having a child with conditions like autism [24] and cerebral palsy [25] . UTI prevention during pregnancy Drinking at least 4 liters (8 glasses) of water [7] Excluding packaged fruit juices, refined foods (pasta, bread), alcohol, sugar and caffeine from your regular diet Consulting with your doctor about taking nutrition supplements for vitamin C (250-500 mg), zinc (30-50 mg) and Beta-carotene (25,000-50,000 IU) Using the bathroom as soon as you feel an urge to urinate [8] Using clean toilet paper to keep the genital area dry and clean Avoiding soaking in the bathtub for over 30 minutes or 2 times a day (taking showers is recommended) Avoiding douches, strong soaps, shower gels, antiseptic creams, powders and feminine hygiene sprays (as these may increase the risk of infection by destroying the good bacteria) [7] Wearing loose clothing Urinating before as well as after intercourse Treating constipation properly as soon as possible [7] Following a diet containing lots of antioxidant-rich foods like blueberries, tomatoes and squashes [11] It is strongly recommended to take these measures and keep UTI from occurring as once present, there is no way to get rid of the bacteria without antibiotics. UTI ICD-9 and ICD-10 codes The ICD-9 code used for urinary tract infection is 599.0 [26] while its ICD-10 code is N39.0 [27] . 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