Hypertensive disorders of pregnancy and urinary tract infections: an underestimated association in comprehensive maternal care

Abstract

Hypertensive disorders of pregnancy (HDP) affect up to 10% of pregnancies and are associated with substantial maternal and fetal morbidity. Beyond their well-known vascular and endothelial effects, HDP may also increase susceptibility to urinary tract infections (UTIs) through immunologic and hemodynamic mechanisms. Preeclampsia, in particular, disrupts immune regulation and alters urinary composition, creating a more favorable environment for bacterial colonization by Escherichia coli and other pathogens.  Several studies have reported a higher prevalence of bacteriuria and symptomatic UTI in women with preeclampsia, potentially related to physiological changes of pregnancy, impaired host defenses, or increased exposure to invasive medical procedures. Diagnosis can be challenging because UTI symptoms frequently overlap with manifestations of HDP, which may contribute to delays in treatment.  Given these risks, systematic screening for bacteriuria and strengthened preventive strategies are recommended. A deeper understanding of this bidirectional relationship between HDP and UTIs is essential to optimizing prenatal care and reducing maternal-fetal complications, especially in vulnerable populations.