Clinical Features of Urinary Infections in Pregnant Women with Type 1 Diabetes Mellitus

Abstract

Aim. To study clinical manifestations of urinary tract infections in pregnant women with type 1 diabetes mellitus (DM).Materials and methods. Pregnant women with urinary tract infections (UTIs) were examined: 110 with type 1 diabetes mellitus (main group) and 133 without diabetes mellitus (comparison group). The diagnosis of UTI was based on the clinical picture (for manifestation forms) and confirmed by a dual culture method using both the classical approach and DipStreak tests. The determination of the sensitivity of the isolated microorganisms to antibacterial drugs was carried out by the disk diffusion test on Mueller-Hinton agar using paper disks. Instrumental research included ultrasound of the kidneys, urinary tract and fetoplacental complex.Results. In the main group, UTIs were pyelonephritis, asymptomatic bacteriuria (AB) and low AB (102–104 CFU/ml) was detected in 38, 69 and 31 patients, respectively. In the comparison group, pyelonephritis, AB and low AB was detected in 41, 63 and 29 patients, respectively. In the main group, the classic course of pyelonephritis was observed in 44.7%, low-symptomatic — in 26.3%, “according to the type of carbohydrate metabolism decompensation” — in 21%, and the obstetric variant — in 7.9% of patients. In the comparison group, the classic version of pyelonephritis was in 70.7%, low-symptomatic — in 24.4%, asymptomatic — in 4.9%. Bilateral pyelonephritis in pregnant women with type 1 diabetes mellitus prevailed over unilateral: 65.8 vs 34.2%. During AB, in patients with type 1 diabetes mellitus, hyperglycemia was observed in 23.1% (n = 16), the threat of pregnancy termination in 53.6% (n = 37), and moderate preeclampsia in 17.4% (n = 12). In patients with low AB, glycemia above the target values was recorded in 16.1% (n = 5), the threat of pregnancy termination in 38.7% (n = 12), and moderate preeclampsia in 12.9% (n = 4).Conclusion. Based on the specifics of the clinical manifestations of UTIs in pregnant women with type 1 diabetes mellitus, the following types of pyelonephritis can be distinguished: classic, low-symptom, “decompensation of carbohydrate metabolism” and obstetric. The classical course of pyelonephritis in pregnant women with type 1 diabetes mellitus is statistically significantly less common (p <0.05) as compared with pregnant women without diabetes mellitus. The features of AB in pregnant women with type 1 diabetes mellitus are the development of hyperglycemia and obstetric complications.