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

Background: Urinary tract infections (UTIs) occur in 10-18% of United States pregnancies and may lead to maternal and neonatal complications. We examined differences in the incidence and treatment of UTI during pregnancy by race and ethnicity. Methods: We conducted a cohort study within an integrated health care system, including members aged 15-49 years with live births, stillbirths, spontaneous abortions, or terminations between January 2011 and August 2023. Self-reported race and ethnicity were documented in the electronic health record (EHR). UTIs were defined from diagnosis, medication, and laboratory data. We used modified poisson regression to estimate the cumulative incidence and adjusted risk ratios ([aRR]; with non-Hispanic [NH] White individuals as a reference) of the first UTI per pregnancy, adjusted for maternal age. Results: Among 63,029 pregnancies across eight racial and ethnic categories, 5,083 (8.1%) individuals experienced UTI during pregnancy. Cohort mean maternal age was 30.4 years and 75.9% of birth outcomes were live or stillbirths. UTI risk ranged from 7.2% among NH White individuals to 14.3% among NH Native Hawaiian/Pacific Islander [NHPI] individuals. Compared to NH White individuals, UTI risk was elevated among NH NHPI (aRR 1.80, 95% confidence interval [CI] 1.50-2.15), NH Black (aRR 1.32, 95% CI 1.19-1.46), NH Asian (aRR 1.13, 95% CI 1.04-1.24), and Hispanic (aRR 1.45, 95% CI 1.32-1.59) individuals. We observed no differences in UTI treatment by race or ethnicity. Conclusion: UTI burden during pregnancy is greater among racially minoritized groups, suggesting a need for more focus on upstream risk factors, screening, and alleviating the influence of structural racism on infection risk.