UTI associated with increased risk of preeclampsia

1. Women with urinary tract infection (UTI) in the first or third trimester of pregnancy were more likely to develop preeclampsia.

2. UTI was associated with increased levels of placental growth factor (PIGF), which subsequently decreased among women who developed preeclampsia.

Evidence Rating Level: 2 (Good)           

Study Rundown: Preeclampsia is a disorder characterized by new onset hypertension and proteinuria or end-organ dysfunction after 20 weeks gestation. The condition complicates 5% of pregnancies worldwide and is associated with increased maternal and neonatal morbidity and mortality. Risk factors include nulliparity, preeclampsia in a prior pregnancy and extremes of age. To date, there are limited tests and predictive tools to identify women who are likely to develop preeclampsia. It’s been hypothesized that preeclampsia is more likely in settings of systemic inflammation, and prior studies have shown an association between several systemic maternal infections and preeclampsia. Unusual expression of angiogenic factors, including PIGF and soluble fms-like tyrosine kinase (sFLT), has been implicated in the pathophysiology of preeclampsia. In the present work, the authors evaluated the associations between PIGF, sFLT, UTI, and preeclampsia and found that PIGF levels rise in women who develop UTI but fall in those who develop preeclampsia, consistent with previously described patterns, and also that UTI is associated with increased odds of preeclampsia.

Strengths of this study included prospective design, large sample size, and measurement of both biochemical and clinical outcomes. Limitations included multiple comparisons and limited power of sub-analyses. Further evaluation into the mechanisms of this association, including assessment of whether UTI treatment modifies this risk, are needed to inform care of pregnant women experiencing UTI.

Click to read the study in AJOG

Relevant Reading: Circulating angiogenic factors and the risk of preeclampsia

In-Depth [prospective cohort]: This study evaluated the relationships between systemic inflammation, UTI and preeclampsia in 2607 women with singleton or twin pregnancies. PIGF and sFLT, 2 angiogenic markers, were used as indicators of inflammation. UTI was diagnosed when patients had symptoms and either a positive urinalysis or urine culture. The primary outcome of interest was occurrence of preeclampsia.

Women who developed UTI during pregnancy, specifically during the first and third trimesters, were more likely to experience preeclampsia (OR 2.9, CI 1.8-4.6). They were also more likely to have early preeclampsia requiring delivery prior to 34 weeks gestation (OR 5.5, CI 2.3-12.7). Among women with UTI, PIGF levels were elevated.

Image: PD

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