GPAtlas🧭 When to suspect
Urinary tract infection is the commonest bacterial infection of pregnancy. The physiological changes of pregnancy – ureteric dilatation, urinary stasis and an enlarging uterus – make ascending infection more likely, and the stakes are higher: an untreated bladder infection can progress to pyelonephritis, carrying real risks of preterm labour, sepsis and fetal harm. E. coli causes around 90% of cases.
Pregnancy reverses the usual primary-care instinct. In a non-pregnant woman we leave asymptomatic bacteriuria alone; in pregnancy we treat it, because 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 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) and the UK National Screening Committee does not endorse a national programme – but it 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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