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- Title
Urinary protein-to-creatinine ratio in pregnant women after dipstick testing: prospective observational study.
- Authors
Baba, Yosuke; Yamada, Takahiro; Obata-Yasuoka, Mana; Yasuda, Shun; Ohno, Yasumasa; Kawabata, Kosuke; Minakawa, Shiori; Hirai, Chihiro; Kusaka, Hideto; Murabayashi, Nao; Inde, Yusuke; Nagura, Michikazu; Hamada, Hiromi; Itakura, Atsuo; Ohkuchi, Akihide; Maeda, Makoto; Sagawa, Norimasa; Nakai, Akihito; Kataoka, Soromon; Fujimori, Keiya
- Abstract
<bold>Background: </bold>The dipstick test is widely used as a primary screening test for detection of significant proteinuria in pregnancy (SPIP). However, it often shows a false positive test result. This study was performed to determine which pregnant women should be recommended to undergo determination of urinary protein-to-creatinine ratio (mg/mg, P/Cr test) after dipstick test for confirmation of SPIP.<bold>Methods: </bold>This was a multicenter, prospective, and observational study of 2212 urine specimens from 1033 pregnant women who underwent simultaneous dipstick and P/Cr tests in the same spot urine samples at least once. SPIP was defined as P/Cr > 0.27. Preeclampsia was diagnosed in women with both hypertension and SPIP.<bold>Results: </bold>Preeclampsia, hypertension alone, and SPIP alone developed in 202 (20 %), 73 (7.1 %), and 120 (12 %) women, respectively. Creatinine concentration [Cr] varied greatly, ranging from 8.1 to 831 mg/dL in the 2212 urine samples. Rate of positive dipstick test results increased with increasing [Cr], while SPIP prevalence rate was lower in urine samples with higher [Cr], yielding higher false positive rates in samples with higher [Cr]. Postpartum urine samples had significantly lower [Cr] compared to those obtained antepartum (60 [8.7-297] vs. 100 [10-401] mg/dL, respectively). At the first P/Cr test among women with similar dipstick test results, the risk of having SPIP was consistently and significantly higher for hypertensive women than for normotensive women at any dipstick test result: 18 % (14/77) vs. 3.2 % (8/251), 47 % (26/55) vs. 8.7 % (37/425), 91 % (82/90) vs. 59 % (44/75) for negative/equivocal, 1+, and ≥ 2+ test results, respectively. The risk of SPIP was 16 % (9/55) for normotensive women when two successive antenatal urine samples showed a dipstick test result of 1 + .<bold>Conclusions: </bold>For prediction of SPIP, the dipstick test was more likely to show a false positive result in concentrated urine samples with higher [Cr]. Hypertensive women with ≥ 1+ as well as normotensive women with ≥ 2+ on dipstick test should be advised to undergo the P/Cr test.
- Subjects
HYPERTENSION in pregnancy; PREECLAMPSIA diagnosis; PREGNANCY complications; PROTEINURIA diagnosis; BLOOD pressure; COMPARATIVE studies; CREATININE; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; URINALYSIS; EVALUATION research; ODDS ratio; DIAGNOSIS
- Publication
BMC Pregnancy & Childbirth, 2015, Vol 15, Issue 1, p331
- ISSN
1471-2393
- Publication type
journal article
- DOI
10.1186/s12884-015-0776-9