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Predictors of symptomatic urinary tract infection after 20 weeks' gestation
L M Pastore1, D A Savitz, J M Thorp
1Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.
Objective:
To identify predictors of symptomatic urinary tract infection (UTI) after 20 weeks' gestation.
Study Design:
A retrospective cohort analysis was conducted of all deliveries at three North Carolina hospitals between 1990 and 1993. A total of 7403 deliveries remained after exclusions (pre-pregnancy diabetes, HIV-positive, structural urologic abnormalities, no prenatal care) and restrictions (black or white race, county of residence). Cystitis and pyelonephritis were identified by clinician diagnosis. Multiple logistic regression was conducted.
Results:
Prior UTIs (both before and earlier in pregnancy), nonprivate clinics, and a history of chlamydia (white women only) doubled the risk of symptomatic UTIs after 20 weeks' gestation. The strongest predictor of pyelonephritis was prior antenatal UTIs (adjusted incidence odds ratio = 5.3, 95% confidence interval of 2.6-11.0), followed by less education (< 12 years), a history of chlamydia, nonprivate clinics, illicit drug use, sickle cell hemoglobinopathy, and being unmarried.
Conclusion:
Medical history and demographic factors predict cystitis and pyelonephritis after 20 weeks' gestation. Prospective studies of pyelonephritis predictors and screening strategies are warranted.