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ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 1055-1059

Prevalence of urinary tract infection among pregnant women and possible risk factors


Department of Family Medicine, Faculty of Medicine, Menoufia University, Shibin Elkom, Egypt

Date of Submission18-Jun-2015
Date of Acceptance13-Aug-2015
Date of Web Publication21-Mar-2017

Correspondence Address:
Nesreen A El-Hakeem Hammad
Berket El-Sabea, Menoufia, 32651
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202505

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  Abstract 

Objectives
The aim of this study was to estimate the frequency of urinary tract infection (UTI) during pregnancy and the possible risk factors.
Background
UTIs during pregnancy are among the most common health problems worldwide, especially in developing countries. It has several adverse outcomes not only on the mother but also on the fetus.
Patients and methods
A case–control study nested in a cross-sectional investigation was carried out on 250 pregnant women who were attending Berket El Sabae Family Health Center in Menoufia Governorate. Data were collected from the first of September to the end of November 2014. Each participant was assessed using a predesigned questionnaire, which included age, personal history, occupation, present history, past history, obstetric history, and personal hygiene. Urine sample was collected from the studied women for analysis. According to history and urine analysis women were divided into two groups: group I had UTI and group II did not have UTI.
Results
The result of this study revealed that the frequency of UTIs during pregnancy was 32%, with 63.3% of them having moderate infection. UTIs were more significant among women with an intermediate socioeconomic score (37.9%). The most important risk factors associated with UTI in the studied group were unsatisfied personal hygiene, positive history of diabetes mellitus, anemia, and past history of UTI.
Conclusion
This study concluded that about one-third of pregnant women had UTI with different degrees of severity. The most important risk factors associated with UTI during pregnancy were unsatisfactory personal hygiene, history of UTI, diabetes mellitus, and anemia. Therefore, the study recommends health education on personal sanitary hygiene and frequent complete urine analysis during pregnancy.

Keywords: antenatal care, personal hygiene, urinary tract infections


How to cite this article:
Shaheen HM, Farahat TM, El-Hakeem Hammad NA. Prevalence of urinary tract infection among pregnant women and possible risk factors. Menoufia Med J 2016;29:1055-9

How to cite this URL:
Shaheen HM, Farahat TM, El-Hakeem Hammad NA. Prevalence of urinary tract infection among pregnant women and possible risk factors. Menoufia Med J [serial online] 2016 [cited 2019 Sep 21];29:1055-9. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1055/202505


  Introduction Top


Urinary tract infection (UTI) is one of the most frequently encountered problems facing the family physician [1].

More than 50% of women suffer at least one incidence of UTI during their lifetime [2]. UTIs during pregnancy are among the most common health problems worldwide, especially in developing counties. In Egypt, the prevalence of UTIs during pregnancy ranges between 22 and 35% [3].

Several physiological, anatomical, and personal factors contribute to this problem during pregnancy, such as urethral dilation, increased bladder volume, and decreased bladder tone with urinary stasis. Also, some unsound personal hygiene increases the risk of infection [4].

UTIs have different presentations that range from symptomatic to asymptomatic [5]. Asymptomatic bacteriuria is defined as the presence of significant bacteriuria without the symptoms of an acute UTI. Symptomatic UTIs are divided into lower tract (acute cystitis) or upper tract (acute pyelonephritis) infections [6].

UTI can lead to serious obstetric complications, including poor maternal and perinatal outcomes such as intrauterine growth restriction, pre-eclampsia, cesarean delivery, and preterm delivery [7],[8]. Consequently, early diagnosis of UTI, proper management, and an appropriate therapeutic and preventive approach are very important measures to prevent complications during pregnancy [9].

Objectives

The aim of this study was to estimate the frequency of UTI among the studied pregnant women and assess the risk factors of UTI among them.


  Patients and Methods Top


All pregnant women attending Berket El Sabae family Health Centre, El Menoufia Governorate, for antenatal care from the first of September to the end of November were included in the study.

This was a case–control study nested in a cross-sectional investigation.

The sample size was calculated on the basis of the number of pregnant women attending the center during the previous 6 months and the prevalence of UTI among pregnant women from the previous studies (22–35%) using EPI-Info (Atlanta, Georia, USA) version. The sample size of pregnant women was estimated to be 240 and was rounded off to 250.

All pregnant women who participated in the study were evaluated with a predesigned questionnaire, which was distributed to them in Berket El Sabaa Family Health Center. This questionnaire consisted of three parts.

  • The first part included sociodemographic data involving the following: name, age, residence, educational level of the pregnant woman and of their husband, occupation of the pregnant woman and her husband, income, and the crowding index (number of persons per room) to assess the socioeconomic standard as per El-Gilany et al. [9].
  • The second part included questions on the following:
    • Present history: presence of symptoms of UTI (fever, dysuria, frequency, urgency, change of color of urine, nocturia, urinary incontinence, renal pain, and suprapubic pain)
    • Past history: past history of UTI during the present pregnancy, during previous pregnancies, or before pregnancy, as well as diabetes mellitus (DM) and anemia
  • The third part included the following: Questions on personal hygiene, such as the type of underwear and frequency of changing it, the number of showers taken per week, practice of vaginal douching, use of soap and water to wash the genitalia, manner of drying the genitalia, frequency of micturition, precoital wash, postcoital wash, precoital micturition, and postcoital micturaion.


Urine samples were obtained from each participant. On the basis of the result of the urine analysis and history, the participants were classified into two groups.

  • Group 1: those with UTI
  • Group 2: those without UTI.


The severity of UTI was determined on the basis of the number of pus cells (mild>10 mm 3 pus cells).

Statistical methodology

The data were collected, revised, tabulated, and analyzed with SPSS, version 20. Data expressed as number and percentage were analyzed with the χ2-test, whereas data expressed as mean and SD were analyzed with the Student t-test. Odds ratios and logistic regression analysis were applied for assessment of the possible risk factors. P values were set at 0.05; statistical significance was as follows: P > 0.05 = nonsignificant; P < 0.05 = significant; P < 0.01 = highly significant.

Ethical consideration

Human rights and ethical consideration were followed during the study with total confidentiality of any obtained data. The Menoufia Faculty of Medicine committee for medical research ethics reviewed and formally approved the study. An official permission letter was obtained from the authorities of the Menoufia Faculty of Medicine committee for medical research ethics and directed to the authorities of selected family health centers.


  Results Top


The total number of examined pregnant women was 250. The frequency of UTI among them was 32%; 63.3% had moderate infection [Figure 1] and [Figure 2].
Figure 1: Percentage of urinary tract infection (UTI) among the studied pregnant women.

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Figure 2: Severity of infection regarding urine analysis in the studied group. UTI, urinary tract infection.

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[Table 1] reveals a statistically significant difference (P < 0.05) between cases and controls regarding mother's job, father's job, residence, source of healthcare, and socioeconomic score.
Table 1 Comparison of sociodemographic characteristics between studied groups on the basis of urinary tract infection

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[Table 2] shows that there was significant relationship between chronic UTI infection and DM as 44.4% of women with UTI were diabetic and 60.7% of those with UTI were anemic. Our results show a significant relationship between those with UTI and those who did not regarding past history of UTI. Of pregnant women with UTI 58.3% had a past history of UTI and 41.7% did not.
Table 2 Comparison between the two groups regarding past history of urinary tract infection

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[Table 3] shows that women with UTI had poor personal hygiene such as not practicing vaginal douches, not using soap during vaginal douches, not douching after intercourse and drying from backward to forward.
Table 3 Risk factors according to personal hygiene

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  Discussion Top


UTI is defined as microbial invasion of any of the tissues of the urinary tract extending from the renal cortex to the urethral meatus. Obiogbolu et al. [10] stated that bacterial UTI represents the most common bacterial infection during pregnancy. Untreated UTI can be associated with serious obstetric complications according to Masinde et al. [11].

UTI is considered one of the most frequently encountered problems facing the family physician [1].

In this study the frequency of UTI among the studied women was 32%. This high percentage was explained in the study by Sheikh et al. [12], who reported that the physiological changes associated with pregnancy, such as the relaxation of the ureter under the effect of hormones, increase the urinary output, resulting in urinary stasis.

This result is similar to the 31.3% found in the study conducted in Zagazig University Hospital by Dimetry et al. [3], to the 30% found by Al Haddad [13] in Yemen [8], and the 28.8% found by Sheikh et al. [12] in Pakistan. However, it is lower in Khartoum (14%) [8], Tanzania (14.6%) [11], and Ethiopia (11.6%) [14]. The variation in UTI prevalance from one geographical location to another could be attributed to differences in UTI perception, mode of screening, and confounding risk factors such as age, parity, and pregnancy.

Regarding the residence of the pregnant women, this study shows that a significantly higher percentage of pregnant women who lived in urban areas suffered from UTI (43.6% in rural versus 56.4% in urban). This may be attributed to the nature of urban sanitation as well as lower concern with personal hygiene.

Regarding the educational level of pregnant women with UTI, [Table 3] shows that the highest percentage of pregnant women with UTI were in the middle educational level (diploma or equivalent). However, Sheikh et al. [12] found no significant effect of education on the incidence of UTI in their study conducted in Pakistan. On the other hand, Gunes et al. [5] found that UTI was significantly high among women who had less than secondary level education in their study conducted in Turkey (P < 0.05) and Dimetry et al. [3] found that the highest percentage of UTI among pregnant women was among those who were illiterate or of low education level (61.5%).

Regarding the occupation of pregnant women, our study showed that the highest proportion of UTI among pregnant women was found among housewives (58.2%). with significant difference between infected and noninfected women (P < 0.04). This may be because employed women cannot visit the health unit for antenatal care in the morning because of work. This finding is contradictory to the finding of Okonko et al. [15] in Nigeria, who found that the highest percentage of UTI among pregnant women (77.8%) was among civil workers, followed by teachers (70%) and business women (53.8%), and the lower percentages were among students (30.4%) and housewives (36.4%).

[Table 3] shows that anemia and DM are significant risk factors for developing UTI during pregnancy, with significant difference between infected and noninfected women (P = 0.000) [16].

Considering personal hygiene, our study shows that unsatisfactory personal hygiene had a significant role in developing UTI during pregnancy. Unsatisfactory personal hygiene practices such as using underwear made of material other than cotton, changing underwear once or fewer number of times a day, bathing less than four times per week, not practicing vaginal douching, not using soap for washing the genitalia, drying the genitalia from back to front, not washing during the precoital or postcoital period, not micturating precoital or postcoital can create a condusive environment for microbial growth.

This result was similar to that of Dimetry et al. [3] and Amiri et al. [17], who found that using underwear material other than cotton, not washing the genitalia before coitus or after coitus, not voiding urine after coitus, and washing the genitalia from back to front were risk factors for UTI during pregnancy.

However, Sheikh et al. [12] found that personal hygiene had no significant effect on the development of UTI in a study conducted in Pakistan.

[Table 3] shows that women with UTI had poor personal hygiene such as not practicing vaginal douching, not using soap during vaginal douching, not douching after intercourse, and drying from back to front.


  Conclusion Top


This study concluded that about one-third of pregnant women had UTI with different degrees of severity. The most important risk factors associated with UTI during pregnancy were unsatisfactory personal hygiene, history of UTI, DM, and anemia. Therefore, the study recommends health education on personal sanitary hygiene and frequent complete urine analysis during pregnancy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
John ED, Michael LL. Urinary tract infections during pregnancy. Am Fam Physician 2000; 61:713–721.  Back to cited text no. 1
    
2.
University of Maryland Medical Center (UMMC). Urinary tract infection – risk factors; 2011. Available at: http://www.umm.edu. [Accessed 24 July 2011].  Back to cited text no. 2
    
3.
Dimetry SR El-Tokhy HM Abdo NM Ebrahim MA, Eissa M. Urinary tract infection and adverse outcome of pregnancy. Egypt Public Health Assoc J 2007; 82:203–l8.  Back to cited text no. 3
    
4.
El-Sayed HE. Recurent urinary tract infection in pregnant and non-pregnant women [Thesis]. Cairo, Egypt: Cairo Univeristy; 1999.  Back to cited text no. 4
    
5.
Gunes G, Gunes A, Tekiner S, Karaoglu L, Kaya M, Pehlivan E. Bacteriuria and socioeconomic associations among pregnant women in Malatya, Turkey. Public Health 2005 19:1039–1041.  Back to cited text no. 5
    
6.
Schnarr J, Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Investig 2008; 38(Suppl 2): 50–57.  Back to cited text no. 6
    
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Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? J Matern Fetal Noenatal Med 2009; 22:124–128.  Back to cited text no. 7
    
8.
Hamdan HZ, Ziad AM, Ali SK, Adam I. Epidemiology of urinary tract infections and antibiotics sensitivity among pregnant women at Khartoum North Hospital. Ann Clin Microbiol Antimicrob 2011; 10:2.  Back to cited text no. 8
    
9.
El-Gilany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18:9.  Back to cited text no. 9
    
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Obiogbolu CH, Okonko IO, Anyamere CO, Adedeji AO, Akanbi AO, Ogun AA, et al. Incidence of urinary tract infections among pregnant women in Akwa Metropolis, Southeastern Nigeria. Sci Res Essays 2009; 4:820–824.  Back to cited text no. 10
    
11.
Masinde A, Gumodoka B, kilonzo A, Mshana SE. Prevalance of urinary tract infection among pregnant women at Bugando Medical Center, Mwanza, Tanzania. Tanzania J Health 2009; 11:154–159.  Back to cited text no. 11
    
12.
Sheikh MA, Khan MS, Khatoon A, Arain GM. Incidence of urinary tract infection during pregnancy. East Mediterr Health J 2000; 6:265–271.  Back to cited text no. 12
    
13.
Al-Haddad AM. Urinary tract infection among pregnant women in Al Mukkalla district, Yemen, East Mediterr Health J 2005; 11:505–511.  Back to cited text no. 13
    
14.
Assefa A, Asrat D, Woldeamanuel Y Hiwot Y, Afodella A, Melesse T. Bacterial profile and drug susceptibility pattern of urinary tract infection in pregnant women at Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia. Ethiop Med J 2008; 46:227–235.  Back to cited text no. 14
    
15.
Okonko IO, Ijandipe LA, Ilusanya AO, Donbraye OB, Ejembi J, Udeze AO, et al. Detection of urinary tract infection among pregnant women in Oluyoro Catholic Hospital, Ibadan, South-Western Nigeria. Malaysian J Microbiol 2010; 6:16–24.  Back to cited text no. 15
    
16.
Piatek J, Gibas-Dorna M, Budzynski W, Krauss H, Marzec E, Olszewski J, Zukiewicz-Sobczak W Urinary tract infection during pregnancy affects the level of leptin, ghrelin and insulin in maternal and placental blood. Scand J Clin Lab Invest 2014; 74:126–131.  Back to cited text no. 16
    
17.
Amiri FN, Rooshan MH Ahmady MH, Soliamani MJ. Hygiene practices and sexual activity associated with urinary tract infection in pregnant women. East Mediterr Health J 2009; 15:104–110.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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