Urinary tract diseases in women of older reproductive age: tactics at the stage of pre-pregnancy preparation and during pregnancy

After 35 years old, the frequency of extragenital pathology, often combined, significantly increases in women. During pregnancy, these conditions can significantly complicate its course and worsen perinatal outcomes. The article is a review of scientific publications that highlight the issues of urinary tract diseases (UTDs) in women.The frequency of UTDs, both infectious (asymptomatic bacteriuria (ASB), cystitis, pyelonephritis) and non-infectious genesis (dysuria, urolithiasis (UL), crystalluria), increases with the age of pregnant women: from 2–5% (in women under 30 years old) to 9–15% (at the age of 35–40 years and older). Urinary tract infections (UTIs) in pregnant women increase the risk of complications for the mother and child. In the postpartum or postoperative period, such women are at high risk of infectious complications and exacerbations of the underlying disease. This possible development requires doctors to take a conscious preventive approach to UTIs in women of older reproductive age already at the stage of pre-pregnancy preparation.According to the latest guidelines of the European Association of Urologists on Urological Infections (2024), one of the most common conditions in adults is ASB, which corresponds to commensal colonization. In the updated document, a meta-analysis of the available evidence showed that the treatment of ASB in pregnant women was effective. Ukrainian regulatory documents also emphasize the need to examine pregnant women in the first trimester for ASB, with clear diagnostic and treatment criteria.Another common problem is uncomplicated cystitis. Urine culture is recommended in the following situations: suspected acute pyelonephritis; symptoms that do not disappear or recur within 4 weeks after completion of treatment; women who have atypical symptoms; and/or pregnant women. Escherichia coli (E. coli) occupies a priority place in the etiology of UTIs (found in 75–90% of positive urine cultures). Such a high frequency of its cultivation is associated with a wide range of virulence factors.Inappropriate antibiotic use and their over-the-counter sale accelerates the development of resistant strains. The prevalence of multidrug-resistant bacteria is increasing significantly, which pose a particularly serious danger to patients in hospitals and medical and rehabilitation centers. This group, in addition to E. coli, includes microorganisms of the ESKAPE group. They can cause severe and often fatal infections, including bloodstream infections and pneumonia.Another significant problem in the state of UTDs during pregnancy may be UL and crystalluria as its predictor. The prevalence of UL is 10.6% in men and 7.1% in women. The dominant risk factors for the development of UL in pregnant women are changes in water-salt balance: increased excretion of uric acid, Ca, Na and more intensive absorption of Ca in the gastrointestinal tract against the background of increased vitamin D content. As a result, urinary stasis occurs, an increased uric acid concentration and adhesion of salt crystals, which lead to the formation of stones. Against the background of these changes, protective mechanisms of the urinary system in the form of hypercitraturia, hypermagnesuria and increased urine volume are activated in pregnant women.Key areas for managing UTDs in pregnant women include: detailed history taking; specific examination in the presence of UTDs diseases in the anamnesis; consultation with a nephrologist/urologist and specialized treatment (if necessary); use of preventive measures (diet, combined herbal preparations, preparations based on cranberries with lactobacteria, etc.). Prevention of UL should begin with the impact on the main risk factors for its development: changes in urine acidity, urinary proteolysis and effects on enzymes. Important measures for the prevention of stone formation are hydration correction, a diet with reduced protein and salt content and sufficient fiber and calcium intake, and lifestyle changes.For the prevention of UL / crystalluria and inflammatory diseases of the urinary tract, a dietary supplement is quite effective and safe for pregnant women, which includes a combination of 7 concentrated plant extracts that have a multidirectional effect, but work synergistically. For women with acute and recurrent cystitis, it is also recommended to use a complex dietary supplement, the effect of which is provided by two active synergistic elements – cranberry fruit extract and Lactobacillus acidophilus.In addition to specific preventive and diagnostic measures in the pre-pregnancy period and during pregnancy, women with UTDs should also take generally accepted measures, including the supplementation of vitamins and microelements in accordance with the current regulatory documents of the Ministry of Health of Ukraine (folate, iron, magnesium, iodine, polyunsaturated fatty acids, vitamin D, etc.). However, for women with crystalluria and UL the level of phosphorus in the blood before prescribing vitamin D should definitely determined.