ACOG guideline update on managing UTIs in pregnancy:

UTI (urinary tract infection) is one of the most common perinatal complications. These infections range from ASB (asymptomatic bacteriuria) to symptomatic acute cystitis and, in the most severe form, pyelonephritis. Given the frequent occurrence of UTIs during pregnancy, the management of these infections is essential for pregnant women.

ASB

• A 5-7-day course of targeted antibiotics is recommended for the treatment of ASB with colony counts of ≥100,000 CFU/mL.

Acute cystitis

• Pregnant women with acute cystitis should receive treatment with a 5-7-day course of a targeted antibiotic. If empiric therapy is initiated before obtaining culture and sensitivity results, it is recommended to avoid Amoxicillin or Ampicillin regimens.
• A urine culture might be repeated 1-2 weeks after completing treatment for acute cystitis or considered only if symptoms recur.
• Following the treatment of a recurrent acute infection, antimicrobial urinary suppression might be initiated for the remainder of the pregnancy. It is preferable to utilise a lower single daily dose of an antibacterial drug to which the isolated bacterium was susceptible.

Antibiotic regimens for the treatment of ASB and acute cystitis

Drug	Dosage	Considerations
Nitrofurantoin	100 mg orally every 12 hours for 5-7 days	It can be used during the first trimester if no alternatives are available
Cephalexin*	250-500 mg orally every 6 hours for 5-7 days	-
Sulphamethoxazole-Trimethoprim	800/160 mg every 12 hours for 5-7 days	It can be used during the first trimester if no alternatives are available
	In areas with >20% resistance to Sulphamethoxazole -Trimethoprim, the treatment should not be initiated until culture results are available
Fosfomycin	3 g orally once	-
Amoxicillin*	500 mg orally every 8 hours for 5-7 days	It should not be initiated until culture results are available
	875 mg orally every 12 hours for 5-7 days
Amoxicillin-Clavulanate*	500 mg orally every 8 hours for 5-7 days	It should not be initiated until culture results are available
	875 mg orally every 12 hours for 5-7 days

*: For patients with a beta-lactam allergy, especially when other classes of antibiotics are not suitable, further investigation regarding the severity of allergic reactions is necessary. For patients at low risk for anaphylaxis, cephalosporins should be considered; however, individuals at high risk for anaphylaxis should be treated with an alternative regimen.

Pyelonephritis

• Pyelonephritis during pregnancy should initially be managed in the inpatient setting. Empiric antibiotic therapy should possess adequate renal tissue penetration and target the most likely pathogens. Antibiotic therapy should be adjusted as necessary according to urine culture and sensitivity results. Parenteral antibiotics should be continued until the patient shows clinical improvement. A total of 14 days of antibiotic therapy is recommended for patients.

Antibiotic regimens for the treatment of pyelonephritis

Drug	Dosage
Ampicillin + Gentamicin	2 g IV every 6 hours
	1.5 mg/kg IV every 8 hours 5 mg/kg IV every 24 hours
Ceftriaxone	1 g IV every 24 hours
Cefepime	1 g IV every 12 hours
Aztreonam (appropriate in patients with beta-lactam allergy)	1 g IV every 8-12 hours

• Suppressive therapy might be considered for the remainder of the pregnancy, similar to the approach for recurrent UTIs.

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Congenital syphilis is on the rise: What pregnant women need to know

Reasons for this exponential rise are complex. Limited access to preventive and prenatal care are factors driving the surge in congenital syphilis cases, along with other social determinants of health and substance use disorders as well as public awareness and public health funding gaps. The pandemic took a dramatic toll on public health, and many patients who lost jobs and income were left without health insurance and a direct link to health education. Discussing STIs can be uncomfortable for patients and their partners. But getting screened regularly – particularly with a new sexual partner and after unprotected sex – and seeking prenatal care as soon as pregnancy is suspected offers the best chance of healthier outcomes for the mother and baby. Screening for sexually transmitted infections is often free and can be accessed through primary care, prenatal care, or through sexual health clinics. How is congenital syphilis diagnosed? Congenital syphilis is a consequence of maternal syphilis, which is an infection that comes from sexual contact with an infected partner. Syphilis is often called “the great imitator” because its symptoms often mimic those of other diseases, although most infections do not cause noticeable symptoms at all. The only way to know for sure is to get a syphilis test, which involves a simple blood draw. Some signs the mother or her partner may be infected include: Firm, round, sores on mucosal surfaces like genital area or mouth Skin rashes over the torso, hands, or feet Bumps or growths in the genital area Swollen lymph nodes Fever, malaise, and fatigue Hair loss in patches If a pregnant woman is diagnosed with syphilis in the second or third trimester, we will use ultrasound to examine the fetus for signs of congenital syphilis, such as: Enlarged liver Enlarged placenta Signs of anemia Signs of heart failure Fluid in the abdominal cavity After birth, pediatric specialists make a diagnosis of congenital syphilis after a thorough evaluation of the baby. This evaluation may include physical examination, laboratory tests, radiologic studies (X-rays), and sometimes more invasive tests like lumbar puncture (spinal tap).

Teen pregnancy may be associated with risk of premature mortality in early adulthood

In a recent study published in JAMA Network Open, researchers examined the risk of early death beyond 12 years of age related to teenage pregnancies and gestational age Teen pregnancy is a leading cause of mortality among young girls in the United States, with direct fatalities primarily due to bleeding, hypertension, or sepsis. Adverse childhood experiences (ACEs) like maltreatment, family divorce, or financial loss are associated with later teen pregnancy, drug use, and suicide. However, research on teen pregnancies is scarce due to small sample numbers, self-documented outcomes, insufficient data on induced abortions, and limited information regarding the death cause. Population-based statistics from a universal healthcare system in Canada may capture all teenage pregnancies with low selection bias. RESULT: Among 2,242,929 adolescents, 7.3% (n=163,124) had a teenage pregnancy at 18 years of age (median), with 121,276 (74%) having one pregnancy and 41,848 (26%) having two or more. Those with adolescent pregnancies showed an increased likelihood of living in the lowermost statistical quintile for income and areas with lower high school graduation rates. Females with adolescent pregnancies had a higher percentage of self-injury histories in the 12-to-19-year period than adolescents without [5.0% (n=8,123) versus 1.5% (n=30,669)], but not comorbid conditions, including those related to mental or physical health. Of those who had adolescent pregnancies, 60,037 (37%) gave birth [including 99% (n=59,485) live births], 65% (n=106,135) had induced abortions, and 11% (n=17,945) had miscarriages or ectopic pregnancies. The median participant age after the follow-up period was 25 years for females without adolescent pregnancies and 31 years for participants with teenage pregnancies. There were 6,030 mortalities (1.90 for every 10,000 individual-years) among adolescents with no pregnancy history, 701 mortalities (4.10 in 10,000 individuals-years) among females who conceived once in their teenage, and 345 mortalities (6.10 in 10,000 individual-years) among females with multiple teenage pregnancies; AHR values were 1.5 and 2.1 for adolescents with single and multiple pregnancies, respectively. The AHR values were virtually unaltered in an additional examination of all-cause mortality beginning at 20. After correcting for time-varied psychiatric health characteristics from the 12-to-19-year period, the AHR values showed slight attenuation but statistical significance after one adolescent pregnancy (AHR, 1.3) or two or more teenage pregnancies (AHR, 1.8). In comparison to no adolescent pregnancy, the adjusted HR value for premature mortality was 1.4 in the case of the first teenage pregnancy resulting in termination and 2.1 for cases resulting in delivery or miscarriage. When comparing individuals with and without adolescent pregnancy history, the adjusted HR values for premature mortality from non-injury, unintentional harm, and intentional injuries were 1.3, 2.1, and 2.0, respectively. Noninjury-related premature mortality was more prevalent among persons with teen pregnancies (2.0 in 10,000 individual years) than unintentional (1.0 in 10,000 individual years) or purposeful (0.4 in 10,000 individual years) fatalities from injury. Those who had an adolescent pregnancy before the age of 16 had the highest rate of early mortality, with an AHR of 2.0. Noninjury-related premature mortality was more prevalent among persons with teen pregnancies (2.0 in 10,000 individual years) than unintentional (1.0 in 10,000 individual years) or purposeful (0.4 for every 10,000 individual years) fatalities from injury. Those who had an adolescent pregnancy before the age of 16 had the highest rate of early mortality, with an AHR of 2.0.