Abstract
BackgroundAntibiotics are standard treatment for asymptomatic and symptomatic urinary tract infections (UTIs) in pregnancy. Their overuse, however, can contribute to antimicrobial resistance (AMR) and expose the foetus to drugs that might affect its development. Preventative behaviours are currently the best option to reduce incidences of UTIs and to avoid the use of antibiotics in pregnancy. The aim of this study was to explore women’s experiences of UTIs in pregnancy to develop an understanding of their concerns and to optimise and encourage behaviours that facilitate appropriate use of antibiotics.MethodsAn online pregnancy forum in the United Kingdom (UK) was used to collect data on women’s discussions of UTIs. A total of 202 individual threads generated by 675 different usernames were selected for analysis. The data was organised using NVivo 11® software and then analysed qualitatively using inductive thematic analysis.ResultsWomen’s perceptions of UTIs and antibiotic use in pregnancy were driven by their pre-natal attachment to the foetus. UTIs were thought to be common and high risk in pregnancy, which meant that antibiotics were viewed as essential in the presence of suspected symptoms. The dominant view about antibiotics was that their use was safe and of little concern in pregnancy. Women reported an emotional reaction to developing a UTI. They coped by seeking information about behaviour change strategies to assist with recovery and through emotional support from the online forum.ConclusionsWomen face dual risks when they experience UTIs; the risk from the infection and the risk from antibiotic treatment. Pre-natal attachment to the foetus is highlighted in the decision making process. The focus is on the shorter term risk from UTIs while undermining the longer term risks from antibiotic use, especially the risk of AMR. A balanced view needs to be presented, and evidence-based infection prevention strategies should be promoted, to women to ensure appropriate antibiotic use in pregnancy, to address the global challenge of AMR.
Highlights
Antibiotics are standard treatment for asymptomatic and symptomatic urinary tract infections (UTIs) in pregnancy
Asymptomatic bacteriuria (ASB) is diagnosed and treated through routine screening during the first trimester [4] which is in contrast to non-pregnant women where asymptomatic infections are not treated with antibiotics [5]
A systematic review by the authors of the current study reported that preventative hygiene behaviour, such as washing the genitals after sexual intercourse, is the only evidence-based intervention linked to a reduced incidence of UTIs in pregnancy and the most effective method of avoiding antibiotics [13]
Summary
Antibiotics are standard treatment for asymptomatic and symptomatic urinary tract infections (UTIs) in pregnancy. Their overuse, can contribute to antimicrobial resistance (AMR) and expose the foetus to drugs that might affect its development. Asymptomatic bacteriuria (ASB) is diagnosed and treated through routine screening during the first trimester [4] which is in contrast to non-pregnant women where asymptomatic infections are not treated with antibiotics [5]. ASB is treated in pregnancy because studies have shown that bacterial colonisation of the urinary tract in pregnancy can cause adverse health outcomes e.g. there are risks of kidney infection, intra-uterine growth retardation and pre-term birth [6, 7]. Kazemier et al (2015) [8] found no association between ASB and growth retardation or pre-term birth and an association was observed between ASB and kidney infection, the absolute risk was found to be low
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