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SIGN. Management of suspected bacterial urinary tract infection in adults: a national clinical guideline. Scottish Intercollegiate Guidelines Network. 2012 http://www.sign.ac.uk/guidelines/fulltext/88/index.html SIGN Flow diagram for pregnant women. Accessed 23.09.14. RATIONALE: MSU should be performed routinely at the first antenatal visit. If bacteriuria is reported, it should be confirmed with a second MSU. Dipstick testing is not sufficiently sensitive to be used for screening for bacteriuria in pregnant women.

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UKTIS. The treatment of infections in pregnancy. The UK Teratology Information Service. 2008. (Tel: 0844 892 0909, http://www.uktis.org/docs/antibiotics.pdf ) Accessed 23.09.14.

It is important to ensure adequate treatment of maternal infections in pregnancy as failure to treat may lead to adverse maternal and fetal effects as a consequence of uncontrolled infection or fever. When considering treatment with antibacterial agents during pregnancy, the following factors should be considered: the severity of the maternal infection, the effects of any fever present on the pregnancy, the effects of failing to treat the mother, and the potential fetotoxicity of the drugs to be used. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice.

Penicillins, along with cephalosporins, may be used in pregnancy if considered clinically appropriate. Exposure to penicillins at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy.
Penicillinsmay be used at any stage in pregnancy if considered clinically appropriate.
Cephalosporinsmay be used at any stage in pregnancy if considered clinically appropriate.
Gentamicinlimited data; systemic use may be considered if the clinical indication is strong. Topical use is not expected to be associated with an increased risk to the fetes.
Trimethoprimrisk of neural tube defects due to folate deficiency; folate supplementation is required if trimethoprim is prescribed in pregnancy.
Metronidazolelimited safety data; use may be considered if the clinical indication is strong.
Quinoloneslimited safety data; use may be considered if the clinical indication is strong. If a quinolone is required, ciprofloxacin is the agent of choice in the class.
Nitrofurantoinlimited safety data; rare but severe adverse effects have been reported.
Treatment with any antibiotic drug listed in this summary at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. For advice on specific antibiotics in pregnancy please see the individual monographs. If you are pregnant and require advice regarding exposure to antibiotics please contact your health care professional who can contact UKTIS on your behalf. If you have a patient with exposure to antibiotics and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0844 892 0909 to discuss the case with a teratology specialist.

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Ruxton CHS and Derbyshire E. Women’s diet quality in the UK. Nutrition Bulletin 2010;35:126-137. RATIONALE: Data from the National Diet and Nutrition Surveys show that women‟s dietary intake of iron, vitamin D, calcium and folate remain below recommended levels.

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Public Health England and the British Society for Antimicrobial Chemotherapy recommend that cefalexin is reserved for third-line use for the treatment of a UTI in a pregnant woman. Cefalexin has a good safety record in pregnancy. However, because it is a broad-spectrum antibiotic, it increases the risk of Clostridium difficile, and there have been reports of C. difficile in pregnant women.

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Rouphael NG, O’Donnell JA, Bhatnagar J, Lewis F, Polgreen PM, Beekman S, Guarner J, Killgore GE, Koffman B, Campbell J, Zaki SR, McDonald LC Clostridium difficile-associated diarrhoea: an emerging threat to pregnant women. Am J Obs Gynaecol 2008;198:e1-635.e6 RATIONALE: In this series of 10 cases, most were associated with antibiotic use. Seven of the women were admitted to intensive care. Three infants were stillborn and 3 women died.

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Grabe M, Bishop MC, Bjerkland-Johansen TE, Botto H, Cek M, Lobel B, Naber KG, Palou, J, Tenke, P, Wagenlehner F. Guidelines on Urological Infections. European Association of Urology 2009: 1-110. RATIONALE: Expert consensus is that 7 days of antibiotics should be used to treat urinary tract infections during pregnancy.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).