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Predictors of Symptomatic Urinary Tract Infection After 20 Weeks’ Gestation

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Abstract

OBJECTIVE:

To identify predictors of symptomatic urinary tract infection (UTI) after 20 weeks’ gestation.

STUDY DESIGN:

A retrospective cohort analysis was conducted of all deliveries at three North Carolina hospitals between 1990 and 1993. A total of 7403 deliveries remained after exclusions (pre-pregnancy diabetes, HIV-positive, structural urologic abnormalities, no prenatal care) and restrictions (black or white race, county of residence). Cystitis and pyelonephritis were identified by clinician diagnosis. Multiple logistic regression was conducted.

RESULTS:

Prior UTIs (both before and earlier in pregnancy), nonprivate clinics, and a history of chlamydia (white women only) doubled the risk of symptomatic UTIs after 20 weeks’ gestation. The strongest predictor of pyelonephritis was prior antenatal UTIs (adjusted incidence odds ratio = 5.3, 95% confidence interval of 2.6–11.0), followed by less education (<12 years), a history of chlamydia, nonprivate clinics, illicit drug use, sickle cell hemoglobinopathy, and being unmarried.

CONCLUSION: Medical history and demographic factors predict cystitis and pyelonephritis after 20 weeks’ gestation. Prospective studies of pyelonephritis predictors and screening strategies are warranted.

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Authors and Affiliations

  1. Departments of Epidemiology (L. M. P., D. A. S., I. H.-P., D. E. I.), School of Public Health, University of North Carolina, Chapel Hill, NC

    Lisa M Pastore PhD, David A Savitz PhD, Irva Hertz-Picciotto PhD & Debra E Irwin PhD

  2. Biostatistics (G. G. K.), School of Public Health, University of North Carolina, Chapel Hill, NC

    Gary G Koch PhD

  3. Department of Obstetrics and Gynecology (J. M. T.), School of Medicine, University of North Carolina, Chapel Hill, NC

    John M Thorp Jr. MD

Authors
  1. Lisa M Pastore PhD
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  2. David A Savitz PhD
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  3. John M Thorp Jr. MD
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  4. Gary G Koch PhD
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  5. Irva Hertz-Picciotto PhD
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  6. Debra E Irwin PhD
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Additional information

This work was financially supported by grant number R03 HS08901 fromthe Agency for Health Care Policy and Research, by a dissertation grantfrom the University of North Carolina at Chapel Hill Graduate School,and by National Institute of Child Health and Human DevelopmentCarolina Population Center training grant 2-T32-HD07168-16.

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Pastore, L., Savitz, D., Thorp, J. et al. Predictors of Symptomatic Urinary Tract Infection After 20 Weeks’ Gestation. J Perinatol 19, 488–493 (1999). https://doi.org/10.1038/sj.jp.7200264

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  • DOI: https://doi.org/10.1038/sj.jp.7200264

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