title: Urinary tract infection as a preventable cause of pregnancy complications: opportunities, challenges, and a global call to action.
abstract: The urinary tract is a common site of infection in humans. During pregnancy, urinary tract infection (UTI) is associated with increased risks of maternal and neonatal morbidity and mortality, even when the infection is asymptomatic. By mapping available rates of UTI in pregnancy across different populations, we emphasize this as a problem of global significance. Many countries with high rates of preterm birth and neonatal mortality also have rates of UTI in pregnancy that exceed rates seen in more developed countries. A global analysis of the etiologies of UTI revealed familiar culprits as well as emerging threats. Screening and treatment of UTI have improved birth outcomes in several more developed countries and would likely improve maternal and neonatal health worldwide. However, challenges of implementation in resource-poor settings must be overcome. We review the nature of the barriers occurring at each step of the screening and treatment pipeline and highlight steps necessary to overcome these obstacles. It is our hope that the information compiled here will increase awareness of the global significance of UTI in maternal and neonatal health and embolden governments, nongovernmental organizations, and researchers to do their part to make urine screening and UTI treatment a reality for all pregnant women.
authors.affiliation: Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Gilbert
authors.affiliation: Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States.
authors.forename: Valerie P
authors.initials: VP
authors.lastname: O'Brien
authors.affiliation: Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: Hultgren
authors.affiliation: Department of Obstetrics and Gynecology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States.
authors.forename: George
authors.initials: G
authors.lastname: Macones
authors.affiliation: Department of Medicine, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States.
authors.forename: Warren G
authors.initials: WG
authors.lastname: Lewis
authors.affiliation: Departments of Molecular Microbiology, Obstetrics and Gynecology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, Missouri, United States.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Lewis
keywords: Urinary tract infection; complications; pregnancy; prevention; women's health