GPAtlas🧭 When to suspect
Urinary tract infection is the commonest bacterial infection of pregnancy; E. coli causes around 90% of cases.
The physiological changes of pregnancy – ureteric dilatation, urinary stasis and an enlarging uterus – make ascending infection more likely.
The stakes are higher: an untreated bladder infection can progress to pyelonephritis, carrying real risks of preterm labour, sepsis and fetal harm.
Pregnancy reverses the usual primary-care instinct.
• In a non-pregnant woman we leave asymptomatic bacteriuria alone; in pregnancy we treat it.
• Eradication substantially reduces the risk of pyelonephritis (roughly one in three untreated women would otherwise develop it) and of preterm birth and low birth weight.
• The other rule that changes is duration: pregnancy needs a full 7-day course, not the 3 days used outside pregnancy.
| Presentation | Key features | Core action |
|---|---|---|
| Asymptomatic bacteriuria (ASB) | Positive urine culture, no urinary symptoms | Treat with a 7-day course (reduces pyelonephritis and preterm birth) |
| Symptomatic lower UTI (cystitis) | Dysuria, frequency, urgency, suprapubic pain | Send midstream urine (MSU), treat immediately for 7 days, test of cure |
| Acute pyelonephritis | Loin pain, fever ≥ 38°C, rigors, nausea/vomiting | Admit for IV antibiotics and obstetric/fetal monitoring |
A note on screening:
• Routine booking screening for asymptomatic bacteriuria by urine culture is no longer a universal NICE recommendation (it was removed from antenatal care guidance in 2021).
• The UK National Screening Committee does not endorse a national programme.
• Screening remains common practice in many UK antenatal pathways, and wherever ASB is detected it should be treated.
Source: NICE NG109 · NICE NG201
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