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Medline ® Abstract for Reference 34

of 'Maternal adaptations to pregnancy: Renal and urinary tract physiology'

No need for glycosuria/proteinuria screen in pregnant women.
Alto WA
J Fam Pract. 2005;54(11):978.
OBJECTIVE: More than 22 million prenatal visits occur in the US each year. Each pregnant woman averages 7 visits. Most include urine testing for glucose and protein to screen for gestational diabetes and preeclampsia. Is there sufficient scientific evidence to support this routine practice?
METHODS: We searched Medline (1966-2004), the Cochrane review, AHRQ National Guideline Clearinghouse, the Institute for Clinical Systems Improvement, and Google, searching for studies on proteinuria or glycosuria in pregnancy. The reference list of each article reviewed was examined for additional studies, but none were identified. We found 6 studies investigating glycosuria as a predictor for gestational diabetes mellitus, or proteinuria as a predictor for preeclampsia (1 examined both). Because every study used different dipstick methods of determining results, or definitions of abnormal, each was evaluated separately.
RESULTS: Glycosuria is found at some point in about 50% of pregnant women; it is believed to be due to an increased glomerular filtration rate. The renal threshold for glucose is highly variable and may lead to a positive test result for glycosuria despite normal blood sugar. High intake of ascorbic acid or highurinary ketone levels may result in false-positive results. Four published studies assessed the value of glycosuria as a screen for gestational diabetes. All used urine dipsticks. Three of the 4 most likely overestimate the sensitivity of glycosuria for predicting gestational diabetes.
CONCLUSIONS: Routine dipstick screening for protein and glucose at each prenatal visit should be abandoned. Women who are known or perceived to be at high risk for gestational diabetes or preeclampsia should continue to be monitored closely at the discretion of their clinician.
Maine-Dartmouth Family Practice Residency, Fairfield, Maine, USA. waalto@dartmouth.edu