Protein In Urine During Pregnancy: What It Means & How to Reduce?

If you ever wondered why your doctor advises a urine test every time you have a prenatal appointment, that is because, urine test gives an idea to a healthcare provider about some common pregnancy health issues and helps detect protein in your urine, preeclampsia, and urinary tract infection.

What is the protein in urine?

We all know the fact that our kidneys filter the blood. They have tiny blood vessels called glomeruli, which work to remove waste in urine and reabsorb the protein that is in the blood. But, if the kidneys do not work properly, the protein can leak into your urine. This high level of protein in urine is called proteinuria. 

Protein in your urine during pregnancy before 20 weeks is referred to as Chronic Proteinuria. And, it may be due to kidney problems or any other health conditions like heart disease and infections. Minor infections like Urinary Tract infection or kidney infection may also elevate the protein levels. However, after 20 weeks of your pregnancy, doctors take a greater interest in protein. As it is a possible indicator of a serious health condition called preeclampsia. Protein discharge in urine during pregnancy is a fundamental sign of preeclampsia. 

How much protein in your urine is normal?

While in normal non-pregnants the urine protein excretion is 150 mg/d, whereas, in normal pregnancy, it can increase up to 300 mg/d. This is due to an increase in blood volume and the glomerular filtration rate. But pregnancy proteinuria surpassing 500mg/d is key to diagnosing preeclampsia^[1] in hypertensive pregnancy.

What is preeclampsia?

Preeclampsia is a condition in early pregnancy marked by high blood pressure and protein in urine after 20 weeks of pregnancy^[2]. This condition may damage organs, especially kidneys and liver. In the United States, Preeclampsia happens in 1 in 25 pregnancies. 

Severe preeclampsia^[3] is a severe form of preeclampsia also called HELLP syndrome. The features of this condition include hemolysis (rupturing of red blood cells), low platelet count, and elevated liver enzymes. Hellp syndrome occurs in the third trimester of pregnancy or soon after delivery. Without proper treatment, both these conditions can be fatal to both mother and baby.

Postpartum preeclampsia^[4] is a rare condition where preeclampsia happens after delivery, which is diagnosed 48 hours after delivery but can also happen up to 6 weeks.

What are the symptoms of preeclampsia?

• Persistent headache
• Right upper abdominal pain
• Changes in vision like blurred vision, changes in eyesight, and seeing spots.
• Swelling of hands and face
• Nausea or vomiting
• Sudden weight gain
• Trouble breathing

Some may not show any symptoms of preeclampsia, which is why it’s important to get your urine tested during prenatal visits.

How to diagnose preeclampsia?

On physical examination, the doctor may find out if your blood pressure is 140/90 mm hg or higher. And further, the doctor might take your urine samples for urine protein dipstick test, blood samples for liver function to check elevated liver enzymes and low platelet count. Doctors may also do nonstress tests to check the amniotic fluid, baby’s development, fetal movements, and heart rate. And an ultrasound to check the fluid levels and fetus health.

Here are some Clinical findings^[5] in patients with severe preeclampsia.

• Oliguria (urine output less than 500cc/ 24 hours)
• Cerebral and visual disturbances 
• Pulmonary edema 
• Cyanosis 
• Impaired liver function.
• Thrombocytopenia (low platelet count)
• Fetal growth restriction and low birth weight

What are the risk factors associated with preeclampsia?

 Here are some maternal risk factors^[6] associated with preeclampsia.

• History of preeclampsia
• Previous pregnancy with preeclampsia and preterm delivery at <34 weeks pregnancy
• First pregnancy
• Multiple pregnancies
• Obesity 
• Emotional stress
• Pregnancy interval >10 years
• Assisted Reproductive technologies
• Family history of preeclampsia
• Age 40 years or older
• Multiple pregnancies
• Ethnicity – south Asian, nordic, black, or pacific island
• Use of cocaine and methamphetamine
• Existing high blood pressure

Other risk factors include

• Type 1 and 2 diabetes
• Chronic hypertension
• Chronic kidney disease like kidney infection, kidney dysfunction, and glomerular disease
• Heritable thrombophilias ( group of conditions where blood clots easily)
• Gestational trophoblastic disease
• Family history of early onset of cardiovascular disease
• Autoimmune disease like systemic lupus erythematosus and antiphospholipid syndrome.
• Infections of the urinary tract and kidney infection
• Rheumatoid arthritis
• Blood vessel problems
• Minor infection during pregnancy
• Sickle cell anemia 

How to reduce protein in urine during pregnancy

If you are wondering how to reduce protein in the urine and prevent preeclampsia, then here are some tips that work.

• Monitor your blood pressure at home regularly. Don’t miss your prenatal care visits and ultrasound exams. Any unusual changes in the body, report to the doctor immediately and discuss your health history to land an early diagnosis.
• A case study report^[7] suggests that a moderate protein-restricted and supplemented, plant-based diet might help control the protein in urine during pregnancy who are affected by focal segmental glomerulosclerosis.
• Foods that are rich in omega-three fatty acids like mackerel, sardines, cod liver oil, herring, anchovies, caviar, flax seeds, chia seeds, walnuts, and soybeans are good sources of omega-three fats. Low levels of Omega three fatty acids may increase the risk of preeclampsia.
• Foods like citrus fruits, berries, salmon, swiss chard, pumpkin seeds, beans and lentils, amaranth, pistachios, carrots, broccoli, celery, tomatoes, greek yogurt, herbs and spices, chia and flax seeds, spinach, beets, and beet greens are some of the best foods for high blood pressure. A proper diet with these foods can lower blood pressure. Foods rich in potassium and magnesium are great to combat high blood pressure.

A healthy diet

• Drink 6-8 glasses of water and urinate regularly to empty the bladder completely. A full bladder can lead to high blood pressure.
• Foods that prevent kidney disease are lean meat, dried beans, soybeans, fresh fruits like watermelons, apples, pears, bananas, oranges and fresh veggies like lettuce, tomatoes, green beans, potatoes and other foods like whole grains, rice, cottage cheese, tofu, and milk are great food choices for excess protein discharge in the urine and to maintain healthy kidneys. A low sodium diet is ideal for kidney disease and to improve kidney function.
• Avoid salty foods completely.
• Eat fiber-rich foods, probiotics, and foods that increase the gut microbiota, as early onset of preeclampsia^[8] is associated with poor gut health and gut microbes.

Although these above-mentioned foods are great, always discuss with your healthcare provider about the diet you should be consuming. Protein in the urine and high blood pressure may need enormous dietary changes.

What is the treatment for preeclampsia? 

Treatment starts at the prenatal period and close monitoring throughout pregnancy by a doctor is very essential to prevent preeclampsia from becoming a severe form.

Aspirin during the first trimester

Low dose aspirin in the first trimester in women at high risk may reduce the risk of preeclampsia by up to 50%^[9], moreover, it also improves the fetal and maternal outcomes associated with that.

Rest  

Considering the woman’s health, doctors would advise bed rest. Resting can bring down the high blood pressure and increases the blood flow to the placenta leading to a healthy baby. Physical activities should be strictly limited.

Delivery at 37 weeks of pregnancy

The only definite cure for preeclampsia is by delivering the baby and placenta, the rest of the management can stabilize the mother and allow the extension of pregnancy for the sake of the fetus. Any woman with gestational hypertension should have the delivery discussed with a healthcare provider. Delivering the baby can prevent the disease from progressing. At 37 weeks of pregnancy, your doctor may induce labor. Your doctor will consider both your and your baby’s health to decide the delivery. Delivering the baby and the placenta should mostly resolve this condition.

Medications like antihypertensives, anticonvulsants

Medications to treat high blood pressure like Antihypertensives and Anticonvulsants and magnesium sulfate to prevent seizures and improve uterine blood flow. Corticosteroids during pregnancy to help with the development of the baby’s lungs and platelet count. It can also prolong pregnancy and is a good choice for hellp syndrome.

Inducing labor 

If preeclampsia occurs closer to the end of the pregnancy, doctors may suggest delivering the baby as early as possible. The doctor might give medicine to start contractions and break the amniotic sac to induce labor. The symptoms of preeclampsia should resolve a few weeks after pregnancy.

Final words

Preeclampsia is among the serious complications of pregnancy. Due to an increase in maternal age, obesity, and comorbidities of women lead to an increase in the rates of preeclampsia. However, with the prevention, early diagnosis, screening, and treatment preeclampsia can be managed well without serious complications. Get your pregnancy medically reviewed by the doctor and go for further testing like ultrasounds to check fetal growth and urine analysis to detect proteinuria. 

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