--
Anna Meenan, MD, FAAFP
Routine dipstix for protein and glucose at each antenatal visit is not
needed
To identify the scientific evidence to support routine urine screening
for gestational diabetes and preeclampsia, researchers in Maine, USA
searched Medline (1966-2004), the Cochrane review, AHRQ National
Guideline Clearinghouse, the Institute for Clinical Systems Improvement,
and Google, for studies on proteinuria or glycosuria in pregnancy. They
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.
They found "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 high urinary 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 four most likely overestimate the sensitivity
of glycosuria for predicting gestational diabetes."
The researchers concluded "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"
The Journal of Family Practice November 2005. Vol. 54, No. 11©2005
Dowden Health Media
No need for routine glycosuria/proteinuria screen in pregnant women.
William A. Alto, MD, MPH. Correspondence to William A. Alto
waalto@dartmouth.edu
Category W. Pregnancy, Childbirth, Family Planning, U. Urinary System,
T. Endocrine/Metabolic/Nutritional. Keywords: antenatal, screening,
glycosuria, proteinuria, preeclampsia, diabetes, literature review.
Synopsis edited by Dr Jim Vause, Blenheim, New Zealand. Posted on
Global Family Doctor 15 November 2005
