Urinary Tract Infections in Pregnant Individuals

Publication Date: August 1, 2023
Last Updated: September 1, 2023

Asymptomatic Bacteriuria

Diagnosis of Asymptomatic Bacteriuria

Clinicians should screen for ASB with a urine culture once at a visit early in prenatal care. There is insufficient evidence to recommend for or against repeat screening during pregnancy after a negative initial culture result.

Treatment of Asymptomatic Bacteriuria

Clinicians should prescribe a 5–7-day course of targeted antibiotics to treat ASB with colony counts of 100,000 CFU/mL or higher. There is insufficient evidence to recommend for or against repeat screening after appropriate treatment of an initial episode of ASB.

Acute Cystitis

Diagnosis of Acute Cystitis

Clinicians should evaluate patients with symptoms of acute cystitis with a urine culture. UTI should be suspected based on the presence of symptoms, may be supported by a positive urinalysis result, and is confirmed by urine culture showing 100,000 CFU/mL or more.

Treatment of Acute Cystitis

Clinicians should treat acute cystitis in pregnant individuals with a 5–7-day course of a targeted antibiotic. If empiric therapy is started before culture and sensitivity results are available, amoxicillin or ampicillin regimens should be avoided due to high rates of resistance in Escherichia coli to these antibiotics in most areas.

There is insufficient evidence to guide management after acute cystitis treatment in pregnancy. Clinicians may consider repeating a urine culture 1–2 weeks after completing treatment for acute cystitis or evaluating only if symptoms recur.

There is insufficient evidence to guide management after recurrent UTI in pregnancy. After treating a recurrent acute infection, clinicians may consider initiating antimicrobial urinary suppression for the remainder of the pregnancy, preferably using a lower single daily dose of an antibacterial drug to which the bacterium isolated was susceptible.


Diagnosis of Pyelonephritis

Pyelonephritis should be suspected in the presence of fever of 38.0° C or higher and urine studies suggesting UTI, with additional symptoms of upper genitourinary tract infection (such as flank pain or costovertebral angle tenderness) supporting the diagnosis.

Treatment of Pyelonephritis

Clinicians initially should manage pyelonephritis in pregnancy in the inpatient setting. Empiric antibiotic therapy should have adequate renal tissue penetration and be targeted against the most likely pathogens. Antibiotic therapy should be adjusted as needed based on urine culture and sensitivity.

arenteral antibiotics should be continued until the patient is clinically improving. Patients should complete a total of 14 days of antibiotic therapy.
There is insufficient evidence to guide management after treatment of pyelonephritis in pregnancy. Clinicians may consider suppressive therapy for the remainder of the pregnancy, as for recurrent UTI.

Abbreviations: ASB, asymptomatic bacteriuria; UTI, urinary tract infection.

Recommendation Grading


  • ACOG: American Congress Of Obstetricians And Gynecologists
  • ARDS: Acute Respiratory Distress Syndrome
  • ASB: Asymptomatic Bacteriuria
  • UTI: Urinary Tract Infection


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



Urinary Tract Infections in Pregnant Individuals

Authoring Organization

Publication Month/Year

August 1, 2023

Last Updated Month/Year

September 5, 2023

Document Type


Country of Publication


Document Objectives

Urinary tract infection (UTI) is one of the more common perinatal complications, affecting approximately 8% of pregnancies. These infections represent a spectrum, from asymptomatic bacteriuria (ASB), to symptomatic acute cystitis, to the most serious, pyelonephritis. Overall, Escherichia coli is the most common bacterial pathogen isolated in urine samples from pregnant individuals. The presence of UTIs has been associated with adverse pregnancy outcomes, including increased rates of preterm delivery and low birth weight. Furthermore, serious maternal complications of pyelonephritis include sepsis, disseminated intravascular coagulation, and acute respiratory distress syndrome (ARDS). Given the frequency at which UTIs are encountered in pregnancy, the ability to recognize, diagnose, and treat them is essential for those providing care to pregnant individuals.

Target Patient Population

Pregnant individuals with suspected urinary tract infections

Target Provider Population

OBGYNs and other clinicians caring for pregnant individuals

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings


Intended Users

Nurse, nurse practitioner, physician, physician assistant


Diagnosis, Assessment and screening, Treatment

Diseases/Conditions (MeSH)

D014552 - Urinary Tract Infections


pregnancy, UTI, urinary tract infection, urinary tract infections

Source Citation

Urinary Tract Infections in Pregnant Individuals. Obstetrics & Gynecology 142(2):p 435-445, August 2023. | DOI: 10.1097/AOG.0000000000005269

Supplemental Methodology Resources

Data Supplement, Evidence Tables