Research-backed

Protein In Urine (Proteinuria) During Pregnancy: Causes And Treatment

Image: Shutterstock

IN THIS ARTICLE

During pregnancy, urine analysis gives the doctor an idea about the functioning of the vital maternal organs. This is a routine test that helps the doctor determine several things, right from finding out if you are pregnant to any disorders you might encounter during pregnancy.

One of the things that doctor checks for is the presence of excess protein in urine during pregnancy. Read this MomJunction post to find out more about it, what causes it, and how it affects your pregnancy.

Is It Normal To Excrete Protein In Urine During Pregnancy?

Usually, our urine contains a definite amount of protein. The standard excretion level is usually 300mg/d in normal pregnancy (which is higher than the usual level of 150mg/d in non-pregnant women). This happens due to an increase in blood volume, and as the burden on the kidneys doubles during pregnancy, adding stress on the kidneys.

However, if the levels exceed this value, it could be a sign of a disorder (1).

What Might Cause Protein In Urine When You Are Pregnant?

Low levels of protein in the urine are either normal or indicate a minor infection. But high levels indicate problems that are detailed below.

  1. Preeclampsia: This condition is characterized by high blood pressure (140-160 mmHg- 90-110mmHg), protein in the urine (more than 300mg/d in a 24-hour sample) and fluid retention, which might occur after the 20th week of pregnancy. The other symptoms include headaches, vomiting, blurred vision, and abdominal pain.

When untreated, it could lead to eclampsia (preeclampsia with seizures), kidney disorder, and low birth weight babies (2). On early diagnosis and treatment, you may give birth to a healthy baby.

  1. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count): It usually occurs in women with preeclampsia or eclampsia, but sometimes develops in the absence of these conditions. It shows similar symptoms, along with protein in the urine. If not treated on time, it might result in serious complications, including low birth weight, stillbirth, and preterm labor (2).
  1. Urinary tract infection (UTI) or kidney infection: If you have the urge to urinate frequently and experience discomfort while urinating, you may have a UTI. This could lead to the appearance of protein in the urine. If this condition is not treated on time, it might lead to a kidney infection that is associated with fever, nausea, vomiting, and back pain. Though UTI will not affect the baby, kidney infections could cause low birth weight babies and preterm labor (3).
  1. Other factors: Some conditions such as emotional stress, dehydration, arthritis, exposure to high temperatures, diabetes, strenuous exercise, and medications might increase the chances of protein in the urine. Also, certain medical conditions, including diabetes, heart disease, rheumatoid arthritis, sickle cell anemia, lupus, and chronic kidney illnesses, could also increase the risk.

What Are The Symptoms Of Protein In Urine During Pregnancy?

In general, proteinuria is mainly detected from the routine urine examinations performed during pregnancy.

A few symptoms that may be experienced with high protein in urine include (4):

  • Swelling in the hands, and ankles
  • Facial swelling
  • Foamy urine

Most importantly, you should be aware of proteinuria in the later part of pregnancy, which could develop from preeclampsia. The symptoms associated with it include (5):

  • Blurry or flashy vision
  • Swelling of the hands, ankles, and face
  • Pain underneath the ribs
  • A severe headache and vomiting
  • Feeling unwell
  • Heartburn

The above symptoms would prompt you to consult a doctor, who would then instruct for a urine test.

How Is Urine Tested For Protein?

During the regular prenatal checkup, your doctor will ask you for a urine sample. Two types of tests on the sample can help detect proteinuria.

  1. The dipstick test: A chemically treated strip with patches is inserted into the urine sample. It changes color, revealing the presence of protein in the urine. The level of protein in urine can range from ‘+’ to ‘++++’, with +1 (plus one) being low and +4 (plus four) high (6).
  1. 24-hour urine protein test: It checks the amount of protein spilled into the urine and helps detect specific conditions. Urine samples are collected over a 24-hour period in separate containers and taken for analysis. The first urine (that is, in the morning) is not taken into consideration. If the protein levels are higher than 300mg/d in 24 hours, it signals kidney dysfunction (7).

Treatment Of Proteinuria During Pregnancy

Proteinuria is not a disease, but an indication of something abnormal in the body. However, special care has to be taken, and you should not neglect the problem.

Simple dietary and lifestyle changes might help manage the trace levels of protein in the urine. But to control high protein levels in the urine, treating the root cause is vital.

  • If the underlying cause is diabetes, you require medication, dietary changes, and exercise to control it.
  • If it is hypertension, get treatment for managing the condition.
  • If preeclampsia is the cause, the treatment depends on the stage of pregnancy.
  • If it is UTI or kidney infection, antibiotics that are safe to use during pregnancy might help.

If the fetus is mature enough, then planned delivery can help in preventing further damage to the kidneys and controlling the underlying problem such as diabetes or preeclampsia (8).

Measures To Prevent Further Impact of Protein In Urine

You may take the following measures to control the further impact (9):

  1. Cut down salt intake: Craving sour and salty foods is very common during pregnancy. But increased salt intake will result in higher protein levels in the urine. So, stay off salty foods, reduce the amount of added salt to your diet, and avoid outside food.
  1. Lower sugar intake: Cakes, desserts, sweets, and ice creams must be removed from your diet. It might significantly reduce the burden on your kidneys and protect them from infections.
  1. Manage your weight: Excess weight gain will increase the risk of gestational diabetes or preeclampsia, which again causes protein discharge in urine. Do not try to reduce weight during pregnancy as it might lead to complications, but make sure you are following a healthy diet and moderate exercise regimen that might help in managing preeclampsia and gestational diabetes.
  1. Rest well: Take out some time for yourself from the everyday routine to beat away the stress. It also recharges your body and might help in reducing stress and anxiety.
  1. Practice good hygiene: Wipe yourself dry with a clean towel after the shower. Also, wipe front to back after urination. This could help maintain gut health and prevent any infections.

Next, we answer some frequently raised queries from our readers.

Frequently Asked Questions

1. Is albuminuria similar to proteinuria?

Albuminuria is a condition where there is too much albumin protein in the urine. The average amount of albumin is usually less than 20 m/day (10). Albumin protein is usually found in the blood, and healthy kidneys will not filter it into the urine. But a damaged kidney will let some of it flow into the urine. High glucose levels and high blood pressure levels might be the cause of albumin levels in urine.

2. What do leukocytes in urine indicate during pregnancy?

Leukocytes are white blood cells released in response to foreign particles, such as bacteria. Their presence in the urine signals an infection. A high number of these cells in the urine indicates a kidney or bladder or a UTI infection (11). The urine dipstick also shows positive for leukocytes in the case of proteinuria (3).

3. Why are ketones produced in urine during pregnancy?

The body breaks down fat into ketones found in the urine, to produce energy during emergencies, such as glucose deficiency or starvation. Trace levels of ketones will not pose a risk, but high levels would indicate gestational diabetes and pose a threat to the fetus (12).

If you are pregnant and feel that your urine is frothy, then report it to the doctor. During pregnancy, ensure that urine test is done regularly, to ensure that it does not contain protein. If you have high blood pressure and/ or diabetes, then it is important to check for protein in the urine to see the impact of the disease on the kidneys.

Have you dealt with proteinuria during pregnancy? Do share your experiences or tips on how to manage it in the comment section below.

References:

1. Indu Saxena ET AL.; Detection of Proteinuria in Pregnancy: Comparison of Qualitative Tests for Proteins and Dipsticks with Urinary Protein Creatinine Index; J Clin Diagn Res (2013)
2. How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome; NIH (2017)
3. KY Loh and N Sivalingam; Urinary Tract Infections In Pregnancy; Malaysian Family Physician
4. Kidneys and Kidney Disease; University of Maryland School of Medicine (2018)
5. Preeclampsia; Beaumont (2018)
6.  Urinalysis; WebPath Guide – University of Utah
7. 24-Hour Urine Collection; University of Rochester Medical Center
8. Lowe SA et al.; The Management of Hypertensive Disorders of Pregnancy; The Society of Obstetric Medicine of Australia and New Zealand (2014)
9. Proteinuria; Kidney & Urology Foundation of America (2018)
10.  Albuminuria: Albumin in the Urine; NIH (2016)
11. John E. Delzell, And Michael L. Lefevre; Urinary Tract Infections During Pregnancy; American Family Physician
12. Helen L Robinson, et al.; Prevalence of maternal urinary ketones in pregnancy in overweight and obese women; The Royal Society of Medicine Journals