Twenty-four-hour urinary protein excretion in uncomplicated singleton pregnancy

Yuguo Deng; Qiulu Wu; Xiaoyu Tan; Wei Ye; Guilian Liao; Jinying Yang

doi:10.1016/j.ajog.2023.12.009

Twenty-four-hour urinary protein excretion in uncomplicated singleton pregnancy

Am J Obstet Gynecol. 2023 Dec 13:S0002-9378(23)02129-4. doi: 10.1016/j.ajog.2023.12.009. Online ahead of print.

Authors

Yuguo Deng¹, Qiulu Wu¹, Xiaoyu Tan¹, Wei Ye¹, Guilian Liao¹, Jinying Yang²

Affiliations

¹ Department of Obstetrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China; Longgang Maternity and Child Clinical Institute, Shantou University Medical College, Shenzhen, China.
² Department of Obstetrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China; Longgang Maternity and Child Clinical Institute, Shantou University Medical College, Shenzhen, China. Electronic address: yangjinying1981@126.com.

PMID: 38101528
DOI: 10.1016/j.ajog.2023.12.009

Abstract

Background: Twenty-four-hour urinary total protein excretion is an essential parameter used for evaluation of renal function and early detection of gestational complications. However, data on reference ranges of 24-hour urinary total protein excretion in normal pregnancy are scarce.

Objective: This study aimed to determine reference ranges for 24-hour urinary total protein excretion in a population with uncomplicated singleton pregnancies using a standard method for urinary total protein. In addition, the values of 24-hour urinary total protein were stratified by maternal age and prepregnancy body mass index.

Study design: This study was based on a prospective cohort study in Shenzhen, China. The pregnant women were enrolled at their first prenatal clinical visit. All the participants were instructed to collect 24-hour urine samples during the following successive gestational periods: 6⁺⁰ to 13⁺⁶, 14⁺⁰ to 27⁺⁶, and 28⁺⁰ to 41⁺⁶ weeks. Total urinary protein excretion was analyzed by a colorimetric method. Ultimately, the study encompassed a total of 4844 pregnant women with uncomplicated pregnancies. The nonparametric percentile method was used to determine reference ranges for 24-hour urinary total protein excretion during different trimesters in women with uncomplicated pregnancies (excluding those with previous kidney disorders, gestational or chronic hypertension, preeclampsia, and pregestational diabetes mellitus, among others).

Results: The 24-hour urinary total protein levels expressed as medians and percentiles (5th, 95th) for each trimester were as follows: 72.0 (28.4, 165.0), 88.0 (34.0, 185.0), and 108.0 (37.5, 258.0) mg in the first, second, and third trimesters, respectively. A significant increase in 24-hour urinary total protein excretion was observed throughout pregnancy (all P values <.001). Moreover, 24-hour urinary total protein levels were higher in the older (≥35 years) than in the younger (<35 years) group from mid-gestation. Specifically, the median (interquartile range) 24-hour urinary total protein levels by age were 72.2 (50.6-100.0) vs 70.5 (50.5-100.0) mg, 85.8 (62.0-117.0) vs 96.0 (68.0-127.8) mg, and 106.6 (76.0-146.2) vs 114.7 (81.5-153.6) mg in the first, second, and third trimesters, respectively. In addition, 24-hour proteinuria was significantly increased in higher-weight (overweight or obese) subgroups compared with lower-weight (underweight or normal-weight) subgroups (all P values <.05).

Conclusion: Our study provides reference values for 24-hour urinary total protein excretion with apparently uncomplicated pregnancies. Understanding these changes in low-risk pregnancies is essential for optimizing maternal management.

Keywords: 24-hour urinary total protein excretion; reference ranges; uncomplicated pregnant women.