Abstract
Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1). Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2). Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance. Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4). To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs. Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy. Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole. Given the potential risks associated with use of some of these antibiotics in early pregnancy and the potential for unrecognized pregnancy, women's health care providers should be familiar with the ACOG recommendations and consider the possibility of early pregnancy when treating women of reproductive age.
Highlights
Given the recommendations to avoid nitrofurantoin and trimethoprim-sulfamethoxazole in early pregnancy if possible, it is important that health care providers of various specialties be familiar with these recommendations and that they consider that they might be “treating for two” when prescribing antibiotic treatments for urinary tract infections to pregnant women and women who might become pregnant in the near future
Pregnant women reported at least one UTI from the month before conception through the third month of pregnancy, and two-thirds (66.6%) reported antibiotic treatment, similar to the prevalence observed in this analysis
A 2003 study that examined approximately 13,000 claims among women aged 18–75 years with acute cystitis enrolled in a preferred provider care organization during 1997–1999 [7] found that the antibiotics most commonly dispensed within 3 days of a nonrecurrent episode of cystitis were fluoroquinolones (32%), trimethoprim-sulfamethoxazole (37%), and nitrofurantoin (16%)
Summary
Antibiotics Dispensed to Privately Insured Pregnant Women with Urinary Tract Infections — United States, 2014. To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs. Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy. An algorithm using insurance claims data has been developed to identify pregnant women and estimate critical periods during pregnancy [5]. Claims from physician office, urgent care, emergency department, and other outpatient visits of pregnant women were examined to identify those with a diagnosis of a UTI from 90 days before LMP through the end of pregnancy (hereafter referred to as ‘outpatient UTIs’); diagnoses associated with laboratory claims without a clinic visit were excluded. Pregnancy in 2014 with su cient enrollment in plan with prescription drug coverage
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