63 The utility of routine point-of-care prenatal urine dipstick screening at a primary care clinic in Edmonton, Canada

Abstract

<h3>Objective</h3> The point-of-care urine dipstick has long been a standard at prenatal appointments to screen pregnant women for pre-eclampsia, gestational diabetes, and asymptomatic bacteriuria. However, this practice is based on little evidence, and the clinical utility of the point-of-care dipstick is unclear. Some guidelines now recommend against its use, including the 2017 US Preventive Services Task Force guidelines (pre-eclampsia screening); the 2015 National Institute for Health and Care Excellence (diabetes screening); and the 2020 Canadian Society of Obstetricians and Gynecologists Choosing Wisely (diabetes, pre-eclampsia, and asymptomatic bacteriuria). Our objective was to determine the benefits and the direct costs of routine urine dipsticks in a population of low-risk pregnant women affiliated with a primary care clinic in Edmonton, Alberta. <h3>Method</h3> Retrospective chart review. Women affiliated with the primary care clinic who had at least one prenatal appointment at the primary care clinic between October 1, 2020, and December 1, 2021, were included. Their electronic medical record was reviewed for urine dipstick results; if there were positive results for protein or glucose (&gt;negative), their chart was reviewed further for follow-up. Siemens Uristix Reagent Strips were used for urinalysis; glucose sensitivity 5.5–111 mmol/L, and protein sensitivity trace-20 g/L. The outcome was to assess the benefit of this intervention (diagnosis of pre-eclampsia, gestational diabetes, and asymptomatic bacteriuria) and the direct cost of this intervention to the clinic (urine dipstick equipment and clinic staff time). <h3>Results</h3> There were 135 low-risk pregnant women who attended at least one prenatal visit at the primary care clinic between October 1, 2020, and December 1, 2021; in total, these women had 327 urine dipsticks. Seven of the 327 urine dipsticks (n = 5 women) were positive for glucose (median 5.5 mmol/L, interquartile range 5.5–10 mmol/L). Two of these women had additional testing for diabetes (gestational diabetes screen), and both were negative. Seventy-eight of the 327 urine dipsticks (n = 61 women) were positive for proteinuria (median trace, interquartile range trace-trace). All these women had blood pressures ≤140/90. Ten of these women had additional testing for bacteriuria (urinalysis); two were positive, and both of these women were treated with a 5-day course of cefixime. The direct cost to the clinic of the 327 urine dipsticks was approximately $1300 CND. <h3>Conclusion</h3> There was minimal benefit of using routine point-of-care urine dipsticks in low-risk pregnant women affiliated with this primary care clinic. Two additional women (1.5% of women) were diagnosed with asymptomatic bacteriuria, but there is insufficient evidence to suggest that treatment of this in pregnancy is beneficial (2019 Cochrane systematic review). In addition, the use of point-of-care urine dipsticks incurred additional costs to the clinic. These results reinforce the recommendations against using point-of-care urine dipsticks to screen low-risk pregnant women. Clinics still using point-of-care urine dipsticks routinely to screen low-risk pregnant women should evaluate whether this is beneficial to their practice.