Examining Racial and Ethnic Disparities in the Incidence and Treatment of Urinary Tract Infection During Pregnancy

Maternal mortality and morbidity in the United States continue to rise, with disparate burden experienced by socioeconomically disadvantaged and racial minority groups.1,2 Infections during pregnancy are a leading cause of morbidity during pregnancy, with urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) occurring in approximately 17-18% of pregnancies.3,4 We conducted a cohort study including pregnant members of an integrated healthcare system in Washington State aged 15-49 years with birth outcomes between 2011-2023. Race and ethnicity were self-identified by members and documented in the electronic health record. We identified the first urinary tract infection (UTI) per pregnancy using a combination of diagnosis code, medication, and laboratory data. We used maternal age-adjusted modified Poisson regression to estimate risk ratios comparing UTI incidence in different racial and ethnic groups to non-Hispanic (NH) White pregnant people. We analyzed 62,562 pregnancies (63.9% NH-White, 12.6% NH-Asian, 6.5% NH-Black, 1.4% NH-Native Hawaiian/Pacific Islander [NHPI], 0.8% NH-American Indian/Alaska Native [AIAN], and 7.9% Hispanic) and 4,704 UTIs. Mean maternal age was 30.4 years and 75.9% of outcomes were live births. We observed that 13.4% of NH Native Hawaiian and Pacific Islanders experienced a UTI during pregnancy, along with 10.4% of multiracial individuals, 10.1% of Hispanic individuals, 9.0% of NH Black individuals, 8.5% of NH American Indian and Alaska Native Individuals, and 7.0% of NH Asian individuals compared to 6.8% of NH White individuals. In age-adjusted models, UTI risk was higher among NH-NHPI individuals (adjusted risk ratio [aRR] 1.80, 95% CI 1.49-2.16) compared to NH-White, and also elevated in NH-Black (aRR 1.29, 95% CI 1.16-1.44), NH-Asian (aRR 1.14, 95% CI 1.04-1.25), and Hispanic (aRR 1.41, 95% CI 1.28-1.56) individuals, compared to NH-White. Individuals treated with an antibiotic for UTI during pregnancy were most commonly treated by nitrofurantoin (37% of UTIs) and first-generation cephalosporin (26.7% of UTIs). RR of UTI among Asian individuals compared to NH White were higher in our cohort than in previous studies.3,4 There were no differences in treatment specific to different racial and ethnic groups. Our results show greater burden of UTI incidence during pregnancy among racial and ethnic minority groups and clearly show the need for additional research than effectively further disaggregate race data to understand the true magnitude of disparities. There is a need to highlight the risk factors with further research on prevention options to decrease the burden of UTI during pregnancy, including through timely access to prenatal care for prompt treatment of UTI to prevent progression to adverse outcomes.