Abstract
PurposeTo evaluate the utility of urine protein/creatinine ratio (uPCR) measurements among healthy parturients at term we performed a prospective cohort study at a community teaching hospital.MethodsSerial urine samples were collected. Ninety-three women contributed 284 urine samples. uPCRs were determined. Multiple imputation and paired sampled analysis was performed when appropriate.ResultsTwo-thirds (63/93) of women had at least one measured uPCR ≥ 0.3. One-third (31/93) had a uPCR ≥ 0.3 at admission, including 39.1% (9/23) of women not in labor. Median (IQR) uPCRs increased during labor and after delivery: latent phase/no labor, 0.15 (0.06–0.32); active phase, 0.29 (0.10–0.58); early postpartum, 0.45 (0.18–1.36) (all p < 0.04). Median uPCRs were significantly < 0.3 in the latent phase and significantly > 0.3 in the immediate postpartum period (p < 0.01). Women who labored before cesarean delivery had the highest early postpartum uPCRs: median (IQR) 1.16 (0.39–1.80). A negative urine dipstick protein result did not exclude uPCR ≥ 0.3. uPCRs were similar when compared by method of urine collection.ConclusionuPCR ≥ 0.3 is common among healthy women with uncomplicated pregnancies at term. uPCR increases during labor and is not a reliable measure of pathologic proteinuria at term or during the peripartum period.
Highlights
Proteinuria is an important criterion in diagnosing preeclampsia in pregnancy [1]
Median (IQR) urine protein/creatinine ratio (uPCR) increased during labor and after delivery: latent phase/no labor, 0.15 (0.06–0.32); active phase, 0.29 (0.10–0.58); early postpartum, 0.45 (0.18–1.36)
Women who labored before cesarean delivery had the highest early postpartum uPCRs: median (IQR) 1.16 (0.39–1.80)
Summary
Proteinuria is an important criterion in diagnosing preeclampsia in pregnancy [1]. A 24 hour urine collection remains the “gold standard” for the estimation of proteinuria during pregnancy. It is performed commonly at term to distinguish nonproteinuric gestational hypertension from preeclampsia. A 24 hour urine collection is time-consuming to collect and is difficult to collect during labor. For these reasons, attention has recently turned to the urine protein/creatinine ratio (uPCR) as a convenient alternative. The 2013 ACOG Task Force on Hypertension in Pregnancy included a random uPCR 0.3 as one of the diagnostic criteria for preeclampsia [1]. How the uPCR 0.3 threshold performs at term with or without labor has not been systematically examined
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