2. Acute urethritis or cystitis: urethral or bladder infection that causes symptoms including pain or burning with urination, frequent urination, feeling of needing to urinate, and fever.

3. Pyelonephritis: a kidney infection that causes symptoms including those of acute cystitis plus flank (back) pain. Pyelonephritis may lead to preterm labor, severe infection, and adult respiratory distress syndrome.

The most common microorganisms that cause bladder infection during pregnancy is uropathogenic Escherichia coli bacteria, E. coli for short, normally present in the vagina and rectal area.

Other organisms causing urinary tract infection may include:

• group B streptococcus (GBS), and
• sexually transmitted gonorrhea and chlamydia.

Diagnosis of bladder infection in pregnancy include urine testing and urine culture for bacteria. Most women are tested at the first prenatal visit and during pregnancy, if needed.

UTI in Pregnancy: E. coli Infections

If E. coli bacteria get into the bladder or the urethra, the body has ways of fighting them off - including the obvious methods of simply flushing them out with the urine. But these bacteria have evolved ways of anchoring themselves to the cells of the urinary tract.

The invading E. coli bacteria take advantage of receptors naturally found on the cells of the mucosal lining of the urinary tract. Receptors are like molecular "docking bays" for substances which the cells need for their normal growth and development.

Like pirates in an old movie, E. coli use "grappling hooks", called type I pili, to first hook on to these receptors, and then to invade the cell. Once inside the cell, E. coli can live and reproduce in safety, shielded from many of the body's defensive immune responses.

When faced with a potentially pathogenic germ like E.coli, conventional, pharmaceutically based medicine typically confronts the problem by throwing the most potent poisons it can find at the bugs - antibiotics.

While there is nothing essentially wrong with killing disease-causing bacteria, this approach does have some very serious drawbacks. Happily, antibiotic "bacteria-cide" is not the only possible avenue of attack. (Exactly how does this it will be explained later).

UTI in Pregnancy: Group B Streptococcus Infection

Group B streptococcus is a concern as one out of every four or five pregnant women carries GBS in her rectum or vagina.

In the pregnant mother, GBS can cause a urinary tract infection and lead to preterm labor and birth - premature babies are more susceptible to GBS infection than full-term babies.

Group B streptococcus diagnosed can be cultured from a mother's urine. Cultures are usually done between 35 and 37 weeks of pregnancy and may take a few days to complete. Cultures collected earlier in pregnancy do not accurately predict whether a mother will have GBS at delivery.

UTI in Pregnancy: Chlamydia Infection

• the cervix
• rectum, and
• eye.

Persons with chlamydia infections often have no symptoms. Consequently, they may transmit the infection to other people without knowing it. However, when the symptoms do occur, their type and severity will depend on the site of the infection and the person's response to it.

Women who do have symptoms of chlamydia infection may notice:

• an increased vaginal discharge,
• irritation of the area around the vagina, or
• burning pain with urination.

To diagnose chlamydia, a special test must be done by a health professional. This serious condition requires prompt medical attention.

Chlamydia infection is easily treated with an antibiotic medication. However, if it is not detected and treated, chlamydia infection can lead to complications, such as pelvic inflammatory disease, a condition that signals the infection has spread to the uterus and fallopian tubes.

Symptoms of pelvic inflammatory disease include:

• lower abdominal pain,
• painful intercourse,
• irregular periods,
• spotting and
• fever.

PLEASE NOTE : In pregnant women, chlamydia infection can be passed on to their newborn children, where it can cause:

• eye infections and
• pneumonia.

UTI in Pregnancy: Medical Diagnosis

urine sample is the only way to diagnose an infection.

Urinary Analysis (U/A)
This test is commonly performed in the doctor's office or in lab. It just takes a few minutes - a dipstick is placed in the urine sample and up to ten different substances can be detected.

If the U/A is normal, and the symptoms are mild, then you can probably wait for the next few days. To be sure, a doctor can send a urine culture to the lab (see below). Therefore, you should call your doctor's office after one or two days to check the results. If positive, do not wait and call the next day again to check the sensitivity of the antibiotics (see below).

If the U/A is positive for infection, and the symptoms are moderate to severe, probably a urine culture will be sent to the lab to confirm. A doctor will start an antibiotic treatment now to avoid allowing the infection to get worse.

If the U/A is positive, but the symptoms are mild, a doctor may not start an antibiotic treatment while the urine culture is being done (since a positive U/A does not necessarily mean there is an infection).

Microscopic Urinalysis ((U/A micro)
A doctor may also wait a few hours for the lab to run a microscopic urinalysis - a drop of urine is examined under a microscope - to help in the decision whether or not to start an antibiotic treatment while the urine culture is running.

Urine Culture
With no dobubt, urine culture is the most accurate test to determine for sure whether or not an infection is present.The lab puts the urine sample in an incubator. If any bacteria are in the sample, they will multiply and show up. However, it takes 24 to 48 hours for the bacteria to grow enough to be detected.

Antibiotic susceptibility testing (AST)
If only one type of bacteria grows in the culture, the lab will expose the bacteria to a variety of antibiotics to see to which ones the bacteria are sensitive. This usually takes one day after the culture is positive. It helps to decide which antibiotic is best for the infection.

UTI in Pregnancy: Doctors' Choices of Antibiotics

As urinary tract infections are extremely common, particularly in women, doctors in the United States write 2.45 million antibiotic prescriptions to treat them each year.

Almost all antibiotics will work for urinary tract infection. However, over the past 10 years, fewer doctors prescribe, for exapmle, a 10-day course of generic Bactrim or Septra, recommended by the Infectious Disease Society of America.

Bactrim and Septra
Septra and Bactrim are both brand names for a combination antibiotic called trimethoprim-sulfamethoxazole.

Trimethoprim and sulfamethoxazole are both compounds that block the internal production of folic acid (folate) needed by most bacteria to survive. These compounds, relatively safe for humans, are lethal to many bacteria.

Unfortunately, this inexpensive and quite effective, standard antibiotic for bladder infections is notorious for developing rash and allergies to it, frequently, life-threatening allergies. It is one of those famous sulfur drugs to which people have adverse reactions.

Other side effects have been reported in virtually every organ system in the body, including the kidneys. Sulfa drugs may precipitate in the urine, producing crystals that can cause bleeding, urinary obstruction, or kidney damage.

Generic Bactrim also tends to disrupt the intestinal bacteria more than other drugs, such as Macrobid, and cause stomach upset.

Keflex and Macrodantin
These alternatives to Septra and Bactrim are commonly used both for the active treatment and long-term prevention of urinary tract infections. They seem to be more effective and even safer than Septra, although each carries risks of its own.

As you can see, in prescribing antibiotics, the risks and benefits must be always balanced!

Cipro and Marcrobid
The majority of doctors opt for newer (and more expensive) antibiotics, such as Cipro (a type of fluoroquinolone) or an often-prescribed drug, generic Marcrobid.

An often-prescribed by obstetricians generic Marcrobid tends to have minimal negative effect on the intestine, as most of this drug is concentrated in the bladder.

This trend may be due to doctors, adopting a new drug, believing it is the better drug. Therefore, it runs counter to the formal recommendations for drugs to be used first, such Bactrim, in the treatment of urinary tract infections.

There are also differences between the medical specialties in prescribing antibiotics:

• internists are most likely to prescribe fluoroquinolones, such as Cipro, and
• obstetricians are most likely to prescribe nitrofurantoin, such as Marcrobid.

UTI in Pregnagncy: Limitations of the Antibiotics

Unfortunately, bacteria can survive after antibiotic treatment. For example, bladder infections caused by a common bacterium E. coli return in as many as 30 percent of women apparently "cured" by antibiotics.

Bacteria E. coli are able to survive antibiotic treatment for bladder infections by reverting to an inactive state.

Although, within several days of antibiotic treatment, the number of bacteria reproducing drop to zero - NOT ALL the bacteria are killed.

For example, after treatment with ciprofloxacin

• about 3 percent of the bacteria may be still present in a dormant state.

After treatment with trimethoprim-sulfamethoxazole

• about 7 percent of the bacteria may still linger.

Even after a month of antibiotic exposure, about 10 million of the original 1 billion bacteria may remain.

It is a well-known fact that antibiotic treatments:

• do NOT successfully kill all the bacteria participating in the infection and
• may, in fact, encourage many of the bacteria to persist in a resting state.

Therefore, current standard drug treatments for bladder infections are not adequate and this phenomenon may account for many of the repeat urinary tract infections (in 15 percent of cases, bladder or kidney infections can become a recurring problem, or they can stop responding to the antibiotics).

UTI in Pregnancy: Drawbacks of the Antibiotics

Although routinely used, antibiotic treatments have many drawbacks, such as:

• antibiotics successfully kill both the unwanted micro-organisms and wanted micro-organisms;
• long-term or often repeated antibiotic use leads to major disturbance in normal body microflora, and sometimes to major disruption in health;
• antibiotics, such as Bactrim, may cause stomach upset, rash, and allergic reactions;
• many women to end up with nasty yeast infections; as the friendly bacteria are killed off along with the bad bacteria, the antibiotic insensitive yeast can then grow out of control.

Therefore, due to the hazards, especially of prolonged antibiotic therapy, the need for antibiotics used to clear up the infection, should be reduced, as ALL antibiotic therapies carry with them the risks of developing

• antibiotic-resistant bacteria,
• gastrointestinal problems, and
• adverse effects, especially on the liver and kidneys.

UTI in Pregnancy: D-Mannose

Pathogenic E. coli bacteria's pili "grappling hooks" are composed of long, fibrous chains of molecular "glue" called adhesion. The effective binding of these adhesion molecules depends on the chemical attraction between them and the residues of a simple carbohydrate called D-Mannose on the cell surface receptors of the urinary tract host cells.

The chemical attraction between E. coli bacteria adhesions and D-Mannose is their strength - but it also provides a point of vulnerability. If you can interfere with the binding of adhesions to the D-Mannose residues in the receptors of your urinary tract cells, then you can also prevent pathogenic E. coli from getting a foothold for adherence and infection.

One way to do this is by using D-Mannose itself. When isolated urinary tract cells are "bathed" in D-Mannose, it acts as molecular "chaff." The bacterial adhesions bind to the D-Mannose in their environment - not to the D-Mannose residues on the cells. This gums up their pili and prevents them from hooking onto urinary tract cells.

The "molecular mechanism" of the action of D-mannose on E. coli is scientifically proven. There is no argument at all about this among researchers who have studied it. Tens of thousands of women working with natural medicine doctors have successfully applied this science to their own bladder infections.

Considerable circumstantial evidence, combined with common sense and several of clinical experience, makes a compelling case for the therapeutic value of D-mannose.

Laboratory Studies
In one laboratory study, for example, rats' urinary tracts were inoculated with E. coli. Within one day, those rats also given D-mannose were found to have significantly lower levels of bacteria in their urine.

In another study, administering a mannose-like substance (niethyl a-D-mannopyranoside) to E. coli-infected mice led to a 90 percent reduction in bacterial attachment to the urinary tract.

Research in humans shows that ingesting D-mannose significantly elevates blood mannose levels, a prerequisite if urinary levels are to rise.

Epidemiological Evidence
Perhaps the best available evidence, though, comes from the experience of people who have used it. Natural medicine-oriented physicians have been recommending D-mannose to people with bladder infection since the mid-1980s with great success.

In one case, a 5-year-old girl had almost continuous bladder infections for her entire life that had failed to respond to every antibiotic therapy her physicians tried (72 doctors in all!). At the end of their rope, her doctors were now considering a kidney transplant, since her kidneys were starting to fail due to years of chronic infection. Since urine culture showed her bladder infection was due to E. coli, she was started on D-mannose (1 tsp in a glass of water every 2-3 hours). Within 48 hours, her infection had vanished, and her kidneys were saved!

D-Mannose: Natural Antibiotic Alternative

Up to 90 percent of all E. coli urinary tract infections can be cured within 1 to 2 days with this simple sugar and a close cousin of glucose. Even more remarkably, D-mannose accomplishes this feat without killing a single bacterium! (Exactly how does this it was explained earlier).

Another, more natural way to eliminate E. coli infections from the urinary tract is to beat them at their own game.

If they are going to cause trouble, bacteria usually have to find a way to adhere (stick) to the body tissue they are infecting. In bladder infection, E. coli attach to cells lining the bladder and urinary tract using filmy, hair-like projections called fimbria on their cell walls.

At the tip of each fimbrium is a glycoprotein (a combination carbohydrate and protein) called a lectin that is programmed to bind to the first molecule of the sugar mannose that it encounters.

It turns out that molecules of mannose (produced inside urinary tract lining cells) naturally dot the surfaces of these cells. Here they act as "receptors," inviting the fimbria of E. coli to attach, and allowing them to bind to the tissue in a tight, Velcro-like grip.

If not for this attachment to the cell's mannose, any E. coli that had successfully ventured up the urethral river would be unable to stick to the slippery surface and would be washed right back out on the next tide of urination.

Tastes Good!
As a bonus, D-mannose actually tastes good. Where a "spoonful of sugar" helped the medicine go down in Mary Poppin's day, with D-mannose, a spoonful of sugar is the medicine.

Effective and Safe! Because it is so effective and so benign, women (even pregnant women) who are susceptible to recurrent bladder infections, can safely take D-mannose as a preventive measure to head off future attacks. Suitable for Children D-mannose is also ideally suited for children with bladder infections. Because it tastes so good (it is a sugar, after all!), children actually enjoy taking it.

Effective As Antibiotics
Although D-mannose is still virtually unknown to many practitioners of conventional medicine, many research reports have demonstrated its mode of action and effectiveness against E. coli, the microorganism that causes most bladder infections.

Moreover, several years of clinical experience have shown that it is just about as effective at curing bladder infections caused by E. coli as antibiotic drugs.

No Known Drawbacks
At first glance, D-mannose may sound too good to be true: a "medicine" that's highly effective, perfectly safe, pleasant to use and available without a doctor's prescription. Yet, it is true!

Unlike virtually any conventional medication, and many natural or alternative treatments as well, D-mannose has no known drawbacks.

Excellent Reported Success Rate
The response is uniformly excellent from urinary tract infection (UTI) sufferers and their caregivers alike.

For the great majority of bladder infections - over 85 percent - D-Mannose offers a safe, natural option with a simple, ingenious rationale, no known side-effects, and a great reported success rate. Therefore, many of our clients and customers have been reporting the successful results in using D-Mannose to rid themselves of infection.