Screening for protein in urine during pregnancy is a part of your routine prenatal care (1) . During pregnancy, your urinary protein excretion gets doubled and can reach up to 300mg/24 h against 150mg/24 h in non-pregnant individuals.
According to the American College of Obstetrics and Gynecology (ACOG), if your urinary protein excretion exceeds beyond 300mg in the 24-hour collection, has a protein/creatinine ratio ≥0.3mg/mg, or gives 2+ or more reading on urine dipstick testing, it can be defined as proteinuria or high protein in urine during pregnancy (2).
Read on to know the causes of increased urinary protein excretion during pregnancy, its risk factors, symptoms, and how it can be treated in a pregnant woman.
What Causes High Protein In The Urine During Pregnancy?
- Pregnancy itself is a cause of proteinuria. During pregnancy, your urinary protein excretion increases up to two times due to an increased blood volume. The larger blood volume may subsequently lead to a relative decrease in concentrations of serum creatinine and urea, with an increase in protein excretion (4).
- A pre-existing chronic kidney disease (CKD),chronic hypertension, or type 1 or 2 diabetes mellitus may also cause chronic proteinuria in the early stages of pregnancy (within 20 weeks of gestation) (1).
- Urinary tract infection(UTI) during pregnancy can also cause a transient increase in urine protein levels; hence, the term transient proteinuria (1).
- Preeclampsia can lead to proteinuria in the later stages of pregnancy. The condition is associated with gestational hypertension; hence, referred to as gestational proteinuria.
- HELLP syndrome(hemolysis, elevated liver enzymes, and low platelet count), a severe form of preeclampsia, may also lead to a high protein in the urine of a pregnant woman 5.
What Are The Risk Factors For High Protein In Urine During Pregnancy?
- Multiparity (a woman who has given birth more than once)
- History (personal or family) of preeclampsia with previous pregnancies
- Age over 35 years
- Obesity (BMI over 30)
- Health conditions, such as chronic high blood pressure or diabetes (type 1 or type 2)
What Are The Symptoms Of Protein In Urine?
You may not notice any symptoms of a mild increase in urinary protein levels. However, high protein levels in urine during pregnancy could cause the following symptoms (8).
- Frothy, foamy, or bubbly urine
- Swelling (edema) in your hands, feet, belly, or face
- Frequent urination
- Feeling nauseous and an urge to vomit
- Muscle cramps at night
Additionally, since proteinuria is strongly associated with preeclampsia during later stages of pregnancy, you should also look for symptoms of preeclampsia. These symptoms may include (9):
- High blood pressure during pregnancy(≥ 140/90 mg/Hg)
- Lower back pain
- Vision changes, including light sensitivity and blurry vision
- Shortness of breath
- Facial edema
- Swelling of hands
If you notice any of these symptoms, you should immediately contact your healthcare provider.
How Can Protein In Urine Be Tested During Pregnancy?
- 24-hour urine collection (24-hour urine protein test):It is a common test for determining urinary protein excretion during pregnancy. However, this test may yield erroneous results during pregnancy due to factors such as insufficient collection, ureters physiological dilatation, and incomplete bladder emptying.
- Urine dipsticks: It is a low-cost test for proteinuria based on its pH. However, this test may yield erroneous results for predicting substantial proteinuria in pregnancy. Also, because it can only detect albumin levels, it may produce false-negative results when proteinuria includes additional proteins such as transferrin, immunoglobulins, and low-molecular-mass proteins.
- Acetic acid/ Sulfosalicylic acid: It is a test that employs a heat coagulation test to determine proteinuria in pregnancy. This test has an advantage over the urine dipstick test for detecting other proteins.
- Urine protein to creatinine ratio: This test employs spot urine analysis for protein/creatinine ratio. It is a more reliable, accurate, and simple way of quantifying proteinuria than collecting urine for 24 hours.
- Albumin to creatinine ratio: It is a method of detecting urinary albumin to creatinine ratio (UACR) as an alternative to urine protein to creatinine ratio that accurately predicts severe proteinuria.
How Is High Protein In Urine Treated?
Proteinuria is not a disorder but a condition caused due to various factors and medical conditions in pregnant women. However, you should be attentive to your protein urine levels and should not neglect them.
If you have a mild increase in the levels of protein in the urine, simple dietary and lifestyle modification can be useful. Proteinuria during underlying conditions, such as hypertension and infection, will require the treatment of the condition through medications to cure proteinuria eventually (8) (11). The doctor may also suggest lifestyle changes, such as including exercises and avoiding certain foods to bring down protein levels in the urine.
How To Prevent High Protein In Urine During Pregnancy?
- Monitor your blood glucose levels on a regular basis
- Adhere to a healthy eating plan
- Do pregnancy-friendly physical activities
- Limit the intake of salt and protein in your diet
- Maintain a healthy weight, especially during pregnancy, as excess weight gain is a risk factor for gestational diabetes or preeclampsia
- Take adequate rest
- Drink plenty of water and fluids
- Maintain good hygiene
- High protein or proteinuria in pregnancy often occurs due to changes in the body during pregnancy.
- Preeclampsia and diabetes can cause proteinuria along with other serious complications.
- Diagnosing and treating the underlying cause can bring down the protein levels.
- Good prenatal care and a healthy lifestyle may help prevent this condition during pregnancy.
Frequently Asked Questions
- Can high protein in urine affect my baby?
While protein in urine does not have any direct adverse effect on your baby, it is a probable sign of many serious pregnancy-related complications, such as preeclampsia, which may negatively affect your fetus (9).
- Can you have high protein in urine without preeclampsia?
Yes. Proteinuria may occur without preeclampsia due to other conditions such as kidney problems and UTI infections (2).
- Can drinking less water treat the cause of protein in urine?
Urine contains some amount of protein, but when the protein levels increase, it leads to proteinuria. Most cases usually occur due to physiological changes in pregnancy, but some may occur due to underlying problems, including serious ailments such as preeclampsia, kidney problems, and diabetes. High protein in urine does not cause any issues to the fetus, but the conditions that cause high protein can have complications. Therefore, timely treatment of the causative conditions is essential since it also brings down the protein levels in the urine. A healthy lifestyle and prenatal care are some ways to prevent high protein in urine during pregnancy.
- Getting a Pregnancy Urinalysis: About Prenatal Urine Tests.
- Osman O and Maynard S; (2019); Proteinuria in pregnancy-Review.
- Michele Mussap and Antonio Noto; (2020); Renal disorders in pregnancy.
- Indu Saxena et al; (2013); Detection of Proteinuria in Pregnancy: Comparison of Qualitative Tests for Proteins and Dipsticks with Urinary Protein Creatinine Index.
- How do health care providers diagnose preeclampsia eclampsia and HELLP syndrome?
- Lulzime Dhora and Mirela Lika; (2015); Risk factors for proteinuria in pregnancy.
- G.O. Ibeh et al.; (2006); Protein levels in Urine of Pregnant women in Rivers State Nigeria.
- Protein in Urine (Proteinuria) Causes Symptoms & Treatments.
- Michal Fishel Bartal et al.; (2020); Proteinuria during pregnancy: definition pathophysiology methodology and clinical significance.
- K.Y. Loh and N. Sivalingam; (2007); Urinary Tract Infections In Pregnancy.