Study of Relationship Between Anemia and Urinary Tract Infection in Pregnant Women
Study of Relationship Between Anemia and Urinary Tract Infection in Pregnant Women
Study of Relationship Between Anemia and Urinary Tract Infection in Pregnant Women
Abstract: Background: Pregnancy is a state of decreased immunity .Physiological changes occurring in the
pregnancy make women susceptible to urinary tract infection (UTI), more so in anemic pregnant women. The
global prevalence of bacteriuria in pregnancy ranges from 4% to 23% in various studies. Maternal anemia has
been associated with both asymptomatic bacteriuria and pyelonephritis. Materials and Method: This cross
sectional study was conducted to determine the relationship of UTI with anemia in pregnant women attending
antenatal clinic in tertiary centre, KIMS Hubli. A total of 100 pregnant women were enrolled in this study. The
sample was divided into two study groups cases and controls. The cases group had Hb level of <10 gm% and
control group had Hb level >/= 10gm%. Hemoglobin estimation was done by sahli's method. Anemia was
classified accordingly. UTI was diagnosed using mid stream urine (MSU) culture, using >105 colony forming
unit per millilitre as significant level of bacteriuria. Result: The overall prevalence was found to be 26%. There
was a high prevalence of UTI of about 40% in anemic pregnant women (whose Hb was <10 gm %) as
compared to 12% in non anemic pregnant women (whose Hb was 10 gm %). The mean blood Hb was
significantly lower in UTI case (8.2%). There was high prevalence in 21-25yrs age group and also in 2nd
trimester (75%). Multiparity is associated with increased UTI in pregnancy. E.coli was most frequently isolated
pathogen (61%). Conclusion: We can conclude that there is an association between UTI and anemia of different
causes during pregnancy. There was a high risk of having anemia amongst the complicated pregnancy with UTI
in association with their parity, age and gestational age.
Keywords: Bacteriuria, Pyelonephritis, Amaemia, Hemoglobin.
progesterone and estrogen levels increase during pregnancy reduces the incidence of these
pregnancy and these will lead to decreased complications and lowers the long-term risk
ureteral and bladder tone. Dilatation of renal of sequelae following asymptomatic
pelvis along with the elongation and dilatation of bacteriuria.
the ureters above the pelvic brim ocuurs due to
compression of ureters by gravid uterus. Material and Methods
Increased plasma volume during pregnancy leads
Study design: This hospital based cross
to decrease urine concentration and increased
sectional study was conducted in a tertiary
bladder volume. The combination of all these
centre, KIMS Hubli between October 2015
factors leads to urinary stasis and uretero-vesical
and December 2015. This was a case control
reflux [4]. In addition glycosuria and
study conducted to determine the relationship
aminoaciduria provide an excellent culture
of UTI with anemia in pregnant women.
medium for bacteria in areas of urinary stasis.
Additionally, the apparent reduction in immunity
Study Population: 100 pregnant women
of pregnant women appears to encourage the
attending antenatal clinic were randomly
growth of both commensal and non-commensal
recruited into the study.
microorganisms [5].
Data collection: Antenatal women who
Female gender itself is a risk factor because of
presented at the antenatal clinics of the above
short urethra, its proximity to vagina and anus
mentioned hospital during the study period
and inability of women to empty their bladder
were randomly recruited into the study.
completely. High incidence is seen in lower
Verbal informed consent was obtained from
socioeconomic group. Sexual activity and certain
each women before the commencement of the
contraceptive methods are also said to increase
research. Socio- demographic data such as
the risk. The anatomical relationship of female's
age, parity and duration of gestation were
urethra and the vagina makes it liable to trauma
collected from the pregnant women using
during sexual intercourse as well as bacteria been
standard questionnaires and kept confidential
massaged up the urethra into the bladder during
during the research. Hemoglobin estimation
pregnancy/ childbirth [8]. Abnormalities of
was done by Sahli's method.
urinary tract or stones, diabetes mellitus, sickle
cell traits, immunosuppression and past history of
Early morning clean-catch midstream urine
UTI, low socioeconomic status tend to increase
was collected from each pregnant women into
the risk [9].
a wide-mouthed sterile screw capped
container. Urine was cultured on to a Blood
The global prevalence of bacteriuria in pregnancy
agar & a MacConkey agar plate using the
ranges from 4% to 23% in various studies.
standard loop technique. After overnight
Maternal anemia has been associated with both
incubation at 370 C for 24 hours, colony
asymptomatic bacteriuria and pyelonephritis.
counts yielding bacterial growth of >105 /ml
Urinary tract infection during pregnancy
was taken as being significant in both
contributes significantly to maternal and perinatal
symptomatic and asymptomatic pregnant
morbidity. Abortion, low birth weight, maternal
women. Centrifuged urine deposit was
anemia, hypertension, preterm labour, and
examined microscopically at high
chronic pyelonephritis are related to urinary tract
magnification for pus cells, red blood cells,
infection during pregnancy. E. coli remains the
epithelial cells, casts, crystals, yeast-like cells.
predominant organism implicated in urinary tract
Pus cells 5/HPF were also considered
infection in pregnancy, though recent reports
significant for infection.
show changes in pattern of the infection.
Data analysis: Data was computed to extract
Recent studies in Nigeria show an increasing
relevant descriptive statistics for each
involvement of Klebsiella Spp, Staphylococcus
parameter. Data was analysed using statistical
aureus, Proteus spp., and Pseudomonas spp in
software SPSS version 19.0 at a significance
urinary tract infection in pregnancy. Studies have
level, p=0.05.
also shown that treatment of bacteriuria during
Results
Table-2: Case control difference in mean
blood Hb concentration
Table-1: Frequency distribution of study groups
by age, parity and gestational age Blood Hb Cases Controls
Age in years Cases Controls concentration (gm/dl) n=50 N=50
16-20 4 5 Range 6.4-9.9 10-12.
21-25 22 20
Mean 8.2 11.2
26-30 16 17
31-35 7 6
36-40 1 2
Table-3: Prevalence of UTI (urine culture
Parity positivity) among two study groups
Nullipara 16 14
Cases (n=50) Controls (n=50)
1-2 24 25
Hb<10gm% Hb>/=10 gm%
3-4 10 11
No positive 20 6
Gestational Age
(trimester of pregnancy) % positive 40% 12%
First 5 6
Second 15 16
Third 30 28
Total 50 50
Table-4: Case-control difference in prevalence of UTI in relation to the age, parity and Gestational age
Cases Controls
Age groups No examined No positive % positive No examined No positive % positive
16-20 4 1 5% 5 0 0%
21-25 22 10 50% 20 3 50%
26-30 16 5 25% 17 2 33.3%
31-35 7 3 5% 6 1 16.66%
36-40 1 1 5% 2 0 0%
Parity
Nullipara 16 4 20% 14 1 16.6%
1-2 24 8 40% 25 2 33.3%
3-4 10 8 40% 11 3 50%
Gestational age
First 5 2 10% 6 1 16.6%
Second 15 3 15% 16 1 16.6%
Third 30 15 75% 28 4 66.6%
References
1. Theodor M. Prevalence and antibiogram of urinary tract 6. Loh KY, Silvalingam N. Urinary tract infections in
infections among prison inmates in Nigeria. The pregnancy. Malaysian family physician. 2007;
Internet Journal of Microbiology, 2007; 3(2):12-23. 2(2):54-57.
2. Brook GF, Butel JS, Moses SA. Jawetz Melmick and 7. Parveen K, Momen A, Begum AA, Begum M.
Adelberg's Medical Microbiology. 22nd edition. Prevalence of urinary tract infection during
McGraw-Hill, New York, 2001; 637-638. pregnancy. Journal of Dhaka National Medical
3. Bacak SJ, Callaghan WM, Dietz PM, Crouse C. College & Hospital. 2012; 17(2):8-12.
Pregnancy associated hospitalizations in the United 8. Obiogbolu CH, Okonko IO, Anyamere CO,
States, 1999-2000. American Journal of obstetrics and Adedeji AO, Akanbi AO, Ogun AA, Ejembi J.
Gynecology. 2005; 192(2):592-597. Incidence of urinary tract infections (UTIs) among
4. Delzell JE, Lefevre ML. Urinary tract infections pregnant women in Akwa metropolis, Southeastern
duringpregnancy. American Family Physician. 2000; Nigeria. Scientific Research and Essays. 2009;
61(3):713-721. 4(8):820-824.
5. Orenstein R, Wong ES. Urinary tract infections in 9. Walls J. Urinary Tract Infections, Calculi and
adults. American Family Physician. 1999; 59(5):1225- Tubular Disorders. Springer Science & Business
1237. Media, 2012 Dec 6.
10. Fatima SS, Al Mussaed E. Bacterial Identification and of the American Geriatrics Society. 2004;
Drug Susceptibility Patterns in Pregnant and Non 52(5):719-724.
Pregnant UTI Patients. Springer, 2017 Sep 27.
11. Penninx BW, Pahor M, Cesari M, Corsi AM, Woodman Cite this article as: Bembalagi S and Sojitra MP. Study
RC, Bandinelli S, Guralnik JM, Ferrucci L. Anemia is of relationship between anemia and urinary tract
associated with disability and decreased physical infection in pregnant women. Al Ameen J Med Sci 2018;
performance and muscle strength in the elderly. Journal 11(1):71-75.
*All correspondences to: Dr. Shobha Bembalagi, Professor and HOD, Department of Obstetrics and Gynaecology, Karnataka Institute of
Medical sciences, P.B. Road, Vidyanagar, Hubballi-580022, Karnataka, India. Email: [email protected]