Association of Urinary Tract Infection With Preeclampsia During Pregnancy

INTRODUCTION Urinary tract infections (UTIs) are a significant clinical concern, representing one of the most common bacterial infections in women, particularly during pregnancy. Globally, UTIs account for a substantial proportion of healthcare visits and are implicated in severe complications, including maternal and neonatal morbidity. The physiological and anatomical changes that occur during pregnancy, such as urinary stasis, hormonal influences, and alterations in the immune system, increase susceptibility to both asymptomatic bacteriuria and symptomatic UTIs. These infections can escalate to severe outcomes if untreated, with potential risks to maternal and fetal health, including preterm labor, low birth weight, and perinatal mortality. Concurrently, preeclampsia, a hypertensive disorder of pregnancy, which 0.2 to 9.2% of pregnancies, remains a leading cause of maternal and fetal complications. With its multifactorial etiology involving placental ischemia, systemic inflammation, and endothelial dysfunction, preeclampsia poses a critical challenge in obstetric care.

The relationship between UTIs and preeclampsia is an area of considerable clinical interest yet remains controversial. While some studies have highlighted an association between maternal infections, including UTIs, and an increased risk of preeclampsia, others have yielded conflicting results. Factors such as immune system dysregulation, systemic inflammation, and endothelial dysfunction, which are central to preeclampsia, may be exacerbated by UTIs. Despite extensive research, inconsistencies in prevalence estimates, study designs, and patient populations have hindered a definitive understanding of this association. One study found that 40% and 17.5% patients developed preeclampsia with and without UTI exposure respectively (p value 0.036). The relative risk (RR) was 2.47 (95%CI 1.1789 to 5.1777) with p value of 0.0166. Another study showed that UTI increases the risk of preeclampsia the OR was significant, but RR was not significant. [OR=1.86, (95% Confidence: 2.235-1.608) (p<0.043), RR 1.2028 (95%CI 0.9018 to 1.6041, p = 0.2089).

The results of a study showed that among 393 pregnant women enrolled, 110 (28.0%), had significant bacteriuria and women with preeclampsia had 7.7 odds of having significant bacteriuria (p-value <0.001). Radu, V. D., et al. found that there was no association of UTI and preeclampsia (aOR 2.07 with 95% CI 0.63-6.65, P value = 0.22). These knowledge gaps underscore the need for region-specific studies to assess whether UTIs contribute to preeclampsia and how they might influence maternal and perinatal outcomes, particularly in populations with distinct socioeconomic, healthcare, and environmental factors.

This study aims to investigate the association between UTIs and preeclampsia during pregnancy in Pakistan, where both conditions significantly contribute to maternal and neonatal morbidity and mortality. Pakistan's high burden of maternal infections and hypertensive disorders of pregnancy necessitates targeted research to identify preventable risk factors and improve clinical outcomes. 3, 6 By exploring the interplay between UTIs and preeclampsia, this research seeks to provide evidence-based insights that can inform public health strategies, enhance prenatal care protocols, and ultimately reduce the adverse effects of these conditions on maternal and fetal health in this region.

OBJECTIVE To find association of urinary traction infection with preeclampsia in pregnancy.