Pregnancy increases the risk of UTIs: why and what you can do

Asymptomatic bacteriuria (ASB) in pregnancy, though silent in its presentation, is a clinically significant condition with profound implications for maternal and child health. Unlike symptomatic urinary tract infections (UTIs) that present with burning, urgency, and discomfort, ASB involves the presence of bacteria in the urine without these typical indicators. This 'quiet' nature often leads to its oversight, yet its potential consequences are severe, making it a critical public health concern, especially in countries like India.

The background context for ASB in pregnancy lies in the unique physiological changes a woman's body undergoes during gestation. Hormonal shifts, particularly increased progesterone, cause relaxation of the smooth muscles of the urinary tract, leading to ureteral dilation and reduced bladder tone. This, combined with the mechanical compression of the growing uterus on the bladder and ureters, can result in urinary stasis – a slower flow of urine. Stasis provides an opportune environment for bacteria to multiply and ascend the urinary tract. Furthermore, changes in urine composition (e.g., increased glucose and amino acids) and a transient state of immunosuppression during pregnancy can also contribute to bacterial growth and colonization. Globally, ASB affects approximately 2-10% of pregnant women, with higher prevalence reported in certain populations, including those with lower socioeconomic status or pre-existing conditions like diabetes.

What happens if ASB is left untreated during pregnancy is a cascade of serious complications. The most common and severe maternal complication is pyelonephritis, a kidney infection, which can lead to fever, pain, and potentially progress to maternal sepsis – a life-threatening systemic infection. For the fetus, ASB significantly increases the risk of preterm labour, leading to premature birth, and low birth weight babies. Both preterm birth and low birth weight are major contributors to neonatal morbidity and mortality, imposing long-term health challenges for the child and significant emotional and economic burdens on families and the healthcare system. The insidious nature of ASB means these severe outcomes can develop without any prior warning symptoms.

Key stakeholders in addressing ASB include pregnant women themselves, who need to be aware of the importance of antenatal care and screening. Healthcare providers – encompassing doctors, nurses, and Auxiliary Nurse Midwives (ANMs) – are crucial for implementing screening protocols, accurate diagnosis, appropriate antibiotic treatment, and patient education. Government health agencies, particularly the Ministry of Health and Family Welfare (MoHFW), are responsible for formulating national health policies, developing guidelines for antenatal care (ANC), ensuring the availability of diagnostic facilities and essential medicines, and funding public health programs like the National Health Mission (NHM). Pharmaceutical companies play a role in the research, development, and supply of effective antibiotics. Finally, families and communities are vital in supporting pregnant women, encouraging adherence to medical advice, and fostering a healthy environment.

For India, addressing ASB is of immense significance. With a large population and a substantial number of annual pregnancies, maternal and child health indicators are critical measures of national development. India continues to strive to reduce its Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR). The complications arising from untreated ASB directly hinder progress towards these goals. Economically, the costs associated with managing severe complications like maternal sepsis, preterm births, and neonatal intensive care unit (NICU) admissions are substantial, placing a strain on both public health budgets and individual families. Socially, poor maternal and child health outcomes can perpetuate cycles of poverty and disadvantage, affecting the overall well-being and productivity of the nation. Effective management of ASB can contribute significantly to achieving the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being).

The historical context reveals that while antenatal care has evolved, the systematic screening for ASB gained prominence as medical understanding of its risks increased. Early efforts in maternal health focused on obvious complications, but as diagnostic tools improved, the importance of 'silent' conditions became clearer. India's public health journey, from the Bhore Committee Report (1946) to the present-day National Health Mission, reflects a growing emphasis on comprehensive maternal and child health services.

Looking ahead, future implications involve strengthening universal screening for ASB as an integral part of routine antenatal care across all public and private health facilities. This requires robust laboratory infrastructure and trained personnel. There's a need for continued research into effective and safe antibiotics, especially in the face of rising antibiotic resistance, which poses a significant global threat. Enhanced health education campaigns can empower women to understand the importance of ANC and report any concerns. Policy-wise, conditions like ASB are integrated into broader maternal health initiatives such as the Janani Shishu Suraksha Karyakram (JSSK), which provides cashless services to pregnant women, and the Pradhan Mantri Matru Vandana Yojana (PMMVY), offering financial assistance. The focus will be on seamless implementation and monitoring of these programs to ensure equitable access and quality care.

Several constitutional provisions and policies underpin the state's commitment to maternal and child health. Directive Principles of State Policy (DPSP) like **Article 42** mandate the state to make provision for just and humane conditions of work and for maternity relief. **Article 47** places a duty on the state to raise the level of nutrition and the standard of living and to improve public health. The **National Health Policy (NHP) 2017** explicitly aims to achieve the highest possible level of health and well-being for all, with a special focus on vulnerable groups, including pregnant women. The **National Health Mission (NHM)**, launched in 2005, is the flagship program consolidating various health initiatives, including the Reproductive and Child Health (RCH) Programme, which specifically addresses maternal health concerns like safe pregnancy and delivery. These policies and constitutional mandates provide the framework for addressing conditions like ASB and ensuring better health outcomes for mothers and children in India.