Protein in the urine of pregnant women is a necessary norm. What is the danger of increased protein in the urine during pregnancy Increased protein in the urine in pregnant women

During pregnancy, a woman has to take many different tests, undergo examinations. The level of protein in the urine is fixed and measured every visit to a specialist, because the kidney filter does not always cope with its work, and protein in the urine of pregnant women can indicate this.

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When lactating calcium Dieting
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Determination of protein content is an important analysis for pregnant women. These indicators may indicate kidney disease, such pathology as preeclampsia.

In order to collect the required amount of material for analysis, you need to follow some rules. Not everyone knows how to do it right. You will have to prepare in advance not only according to the rules of hygiene, but it is also important to observe other points.

About a day before collecting the sample, the pregnant woman should protect herself from physical exertion. Exclude gymnastics, yoga, etc. You can not eat salty, spicy or meat food before collecting tests. This is necessary in order to obtain correct and correct information in the future when deciphering analyzes for the presence of protein in a pregnant woman.
Urine containers must be sterile; special containers can be purchased at a pharmacy.
Before collecting it is necessary to carry out the toilet of the genitals.
The collection of analyzes is carried out in the morning, immediately after waking up. Urine is more concentrated, the slightest deviations from the norm will be visible.
Urine should be medium, that is, the first few seconds you need to urinate into the toilet, then collect the required amount of material. Urine must be taken to the laboratory within the first 2 hours.
In order to correctly pass the analysis, it is undesirable to shake the sample, otherwise the decoding may be incorrect.

You can find out about the amount of protein content from the results of laboratory tests, but you can also determine the presence of protein by eye - if a persistent foam has formed during recruitment. It is recommended to retest in a week.

Delivery of analysis

Multiple urine collection will allow you to track the dynamics and determine the increased or normal protein content in a pregnant woman.

Deciphering the results of the analysis

The urine of a healthy person completely excludes the presence of protein. But during gestation, a certain amount of protein in pregnant women is considered the norm. With a content of more than 300 mg of a substance (per day), we can say that the body of girls undergoes various changes. More often this indicates the presence of pathology, they are associated with the work of the kidneys.

Under normal conditions, the daily norm should be about 0.08 grams (up to 0.2 grams during physical exertion or emotional overstrain). The norm is considered to be an indication not exceeding 0.14 g / l. In order to constantly monitor the female body for the presence of globulin, a pregnant woman should be observed by a gynecologist, urologist. BUT .

The more protein the body contains, the more dangerous it is for the unborn child. After detecting an increase in protein in the urine, the first thing a pregnant woman needs to do is examine herself for edema (face, legs, eyelids). Press on the inside of the lower leg, if the hole quickly straightens out, then there is no swelling, and vice versa.

You also need to measure blood pressure and, if the readings are more than 135 to 85, you need to contact a specialist. The absence of these symptoms suggests that this is not preeclampsia, and the woman has time to re-test.

Acceptable substance content

Treatment of a pregnant woman

If the results of the analysis show a substance content of more than 0.033 g / l, this means that the woman needs treatment. Such indicators indicate the presence of inflammatory processes in the kidneys. When diagnosing pyelonephritis, specialists prescribe anti-inflammatory drugs and diuretics to pregnant women.

In the laboratory

If a woman has an acute or chronic form of the disease, she is prescribed antibiotics. To eliminate kidney congestion, it is recommended to sleep on your back, move more and perform some gymnastic exercises that are allowed during pregnancy. The increased content of the substance at the same time quickly decreases.

If the decrease in protein in the urine has not occurred, then perhaps the reason is more serious, for example, preeclampsia. Treatment in pregnant women is much more difficult. Specialists ensure that the level of indicators stabilizes, and maintain its normal content until the moment of delivery. In such a situation, it is often possible to fully bear a child, but the threat of miscarriage will remain throughout the pregnancy.

To prevent the appearance of globulin in the tests, a woman must follow a diet that excludes or contains a small amount of salt, and fatty, smoked foods should also be avoided. You should give up coffee, strong tea, carbonated drinks. A good drink for prevention is lingonberry, cranberry juice and various herbal preparations.

Eat more fresh vegetables and herbs. Move more, walk in the fresh air. You also need to monitor your weight and blood pressure. All this will help control the increase in protein in the urine of a woman during pregnancy.

The main reasons for the increase in performance

An increase in the norm during pregnancy can speak not only about the presence of pathology. This may be the result of improper collection of urine, the cause may be normal physiology. For example, on the eve of the collection, a woman consumed a lot of products containing globulin (cottage cheese, eggs, milk, etc.).

Do not take dairy products before the test

Physical activity, experiences - all this can cause the formation of protein in the urine. In this case, the recollection will bring clarity. If, nevertheless, the analysis shows an increase in the norm, then the reasons may be in the pathology.

The main and most common cause is preeclampsia (late toxicosis in pregnant women). Another reason for the appearance of protein in the urine may not be as severe and dangerous as a problem with the kidneys.

An increase occurs in diabetes mellitus, if a woman has heart failure, hypertension, kidney infection. A small content of a substance with leukocytes and microbes may indicate pyelonephritis. In this case, women experience pain in the lumbar region, painful urination, fever or intoxication. The combination of globulin with red blood cells is a sign of glomerulonephritis (urine has a brick color).

Consequences of high content

The concentration of the substance primarily indicates the presence of inflammatory processes in the female body, or rather, the genitourinary system. This may be an acquired disease or an exacerbation of an existing pathology. Protein in the urine of a pregnant woman can mean that a woman is at risk of serious consequences, or simply talk about her overwork. How dangerous.

Consequences that pose a threat:

renal, heart failure in the expectant mother and baby;
pulmonary edema;
placental abruption;
premature termination of pregnancy;
delay in fetal development;
hypoxia;
fetal death;
intrauterine infection;
the birth of a child with conjunctivitis;
damage to the internal organs of the baby;
edema appears in women;
blood pressure rises.

It is important to undergo a scheduled examination on time and, at the slightest deviation from the norm, find out the main reason why a pregnant woman has protein in her urine, and also take the necessary measures to eliminate this pathology.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist

From the moment of registration to childbirth, a woman passes more than a dozen tests, each of which is designed to diagnose possible problems at the very beginning of their appearance. Protein in the urine during pregnancy is a symptom that requires immediate examination, as this violation can be a sign of dangerous pathologies.

Increased excretion of protein in the urine is called proteinuria. It usually occurs when the kidneys are unable to perform their functions. Minor proteinuria may also be physiological, that is, normal.

Protein in the urine during pregnancy - what does it mean

The main function of the kidneys is to cleanse the body of products formed during metabolism. The work of the kidneys is possible thanks to hundreds of thousands of nephrons, each of which contains a renal glomerulus - an accumulation of small capillaries. It is in the glomerulus that urine is filtered from the blood plasma. Water, excess electrolytes, products of nitrogen metabolism, and toxic substances easily pass through the glomerular membrane. All of them have a small molecular weight. If the kidneys are working well, blood proteins practically do not enter the urine, since their molecular size prevents them from leaking through the membrane.

What does protein in urine mean during pregnancy? It usually indicates pathologies in the process of filtering urine. If damage to the glomeruli is minimal, the protein with the smallest molecular size, albumin, is present in the urine. If the violations are significant, the protein becomes larger, as larger molecules begin to penetrate into the urine.

The reasons for the increase in protein are not limited to kidney disease. Slight proteinuria is a normal physiological phenomenon. Usually this is dead epithelium, which has already exhausted its resource. Also, protein can enter the urine after the kidneys, from the urinary organs. Normally - a little, and with infections, extensive inflammation of the bladder, ureters or urethra - in significant volumes.

When they say that a blood test showed the absence of protein in the urine, this does not mean that it is not there at all. In any case, there will be protein from the mucous membranes. It's just that there is so little protein in the urine that its content is either not detected by standard methods, or is determined in insignificant, so-called trace amounts. The wording in the analysis “traces of protein” and similar ones indicates that everything is normal, there are no violations.

When you pass urine for analysis, the laboratory first uses a qualitative method. It answers the question of whether a diagnostically significant amount of protein is present in the urine. If a lot of protein is found, a quantitative test is performed, which determines how many grams per 1 liter of urine.

Causes of protein in the urine in pregnant women

In the early stages of pregnancy, changes begin in the mechanisms of filtering and excretion of urine. In the 1st trimester, the volume of blood flowing through the glomeruli of the kidneys increases by 45%. The processes of reabsorption (returning the necessary substances into the blood) are slightly reduced, the volume of urine increases.

A sharp change in the mechanisms of urination does not always go smoothly:

When the filtration rate increases, the ability of the kidneys to reabsorb the right substances may not keep up with it, and glucose or protein appears in the urine. Its content is usually insignificant and fits into the norms.
After half of pregnancy, the uterus can compress the renal veins, resulting in orthostatic proteinuria. In this state, the protein is excreted in the urine with a long vertical position.
Due to hormonal changes that accompany pregnancy, 80% of expectant mothers have reduced ureteral tone. In this case, reflux may occur, which contribute to the penetration of toxins back into the kidneys, which cannot but affect their functions. If bacteria penetrate the same way, pyelonephritis develops.
At the end of pregnancy, the urethral sphincter weakens, which increases the risk of bladder infection. Protein in the urine may be one of the laboratory signs of cystitis.
Protein in the urine in late pregnancy is caused by preeclampsia, which is a multiple metabolic disorder. A sign of preeclampsia is always hypertension, depending on its form, edema or significant proteinuria (3-6 g of protein per day) joins it.

The physiological reasons for detecting protein in the urine during pregnancy are dehydration, eating with excess protein, prolonged or intense physical activity, hypothermia, acute stress, fever before taking the test.

The analysis may turn out to be false positive if the urine for it is collected incorrectly. Before collecting you need:

prepare a sterile container;
wash well;
place a cotton swab in the vagina;
ensure that only a medium portion of urine enters the container.

If you do not use a tampon, protein from vaginal discharge can enter the urine. Usually they are mixed with the last portion of urine that is not collected in a jar. During pregnancy, the discharge is more abundant and can enter the urine and in the middle of urination.

Signs and symptoms of the development of the problem

The most common pathological causes of protein in the urine are infection of the urinary organs, kidneys, nephropathy as one of the manifestations of preeclampsia.

Disease	Characteristic symptoms	Reflection of the disease in the analysis of urine
Preeclampsia	Rapid weight gain. Visible swelling of the legs, hands, face (may be absent). High blood pressure, thirst, nausea.	Severe proteinuria (>3 g/day), increased urine density. The rest of the parameters are usually normal. Daily protein is considered more informative during pregnancy (all urine per day is sent for analysis).
Cystitis	Frequent urination with a small volume of urine, burning or pain when passing urine.	Urine cloudy, sometimes with blood. The density is reduced, mucus and bacteria are detected. Protein and leukocytes in the urine during pregnancy complicated by cystitis are increased.
Pyelonephritis	Pain, heaviness in the lower back, nausea, fever, weakness, symptoms of cystitis.	Leukocytes are above the norm, bacteria are determined (> 100 thousand in 1 ml). Increased protein in the urine, but the level is lower than with preeclampsia: less than 1 g / l. In the biochemical analysis, phosphates, oxalates, urates are increased.

If the protein in the urine during pregnancy appeared for physiological reasons, this process is not accompanied by any special symptoms. Such a protein can only be detected by chance, having passed an analysis at this time. A single detection of a protein in the urine cannot be a sign of a disorder. If otherwise the urine values do not go beyond the normal range, it is advisable to retake the analysis the next day.

You can independently evaluate the protein in the urine using test strips: Bioscan, Uribel and similar ones. The minimum determined protein level in this way is 0.1 g / l. The price of the strips is low (from 120 rubles), one package is enough for the entire pregnancy. The tests are most sensitive to albumin and do not always reliably detect other proteins. Up to a quarter of such analyzes may not be true.

Home protein determination cannot completely replace the regular delivery of analysis to the laboratory. A urine test for protein during pregnancy is prescribed every month, and for longer periods even more often: from the 28th week - every 2 weeks, with an increased risk of complications - weekly.

Protein levels in urine during pregnancy

In women without pregnancy, a daily protein loss of up to 0.08 g is considered normal with low physical activity, up to 0.25 g after intense exercise (including long walking). During pregnancy, the indicators are slightly higher: the normal amount of protein is up to 0.33 g / day, short-term periods of its increase up to 0.5 g / day are possible.

In a serving of morning urine, protein should be<0,033 г/л., белок до этого уровня обозначается как следовые, несущественные количества.

A slight excess of the norm of protein, as a rule, indicates an infection in the genitourinary system. A very high protein is always a consequence of dysfunction of the renal glomeruli. During pregnancy, severe proteinuria often occurs with gestosis, less often it is caused by gromerulonephritis, diabetic nephropathy, neoplasms, kidney injuries, intoxication with drugs or salts of heavy metals, and congenital diseases.

What is the danger of protein in the urine for a pregnant woman and fetus

The threat to mother and baby is only pathological proteinuria, the cause of which was not eliminated in time by physiotherapeutic and medical methods. With timely detection and treatment of diseases, the risk is minimal.

What is the danger of high protein levels:

The most serious and difficult to treat cause of proteinuria is preeclampsia. Due to hypertension, there is a high risk of placental abruption, growth retardation of the child, stillbirth. Early delivery may be required. The last stage of preeclampsia is eclampsia. When it occurs, the death of the mother occurs in 5-9% of cases, the child - 13-19%. In 20% of surviving women, various abnormalities in the work of the kidneys are formed, in 18% - hypertension.
If during pregnancy the protein in the urine is high due to cystitis, there is a high risk of premature delivery, intrauterine infection, and leakage of fetal water. Urinary tract infection may be asymptomatic or asymptomatic. It can only be detected with regular tests. If left untreated, asymptomatic bacteriuria leads to anemia, placental insufficiency, and perinatal mortality. During pregnancy, an infection from the bladder quickly spreads to the kidneys, pyelonephritis begins.
When proteins in the urine during pregnancy are caused by pyelonephritis, the woman is at even greater risk than with cystitis. Possible renal failure, sepsis, hypertension. Increased risk of miscarriage, fetal hypoxia. In pregnancy complicated by pyelonephritis, the frequency of gestosis is much higher.

How to bring the tests back to normal

With cystitis, you should not try to remove the protein from the urine with decoctions of diuretic herbs or herbal preparations (Fitolizin, Canephron and the like). During pregnancy, cystitis needs to be cured as quickly as possible, until it gives complications. Only antibiotics can quickly eliminate a bacterial infection in the bladder. Among the many drugs, there are those that are allowed during pregnancy and do not interfere with the development of the baby.

Cranberry juice, warm sitz baths with chamomile, calendula or sage will be useful as additional measures. For the period of treatment, a woman is recommended to drink plenty of water and a diet that includes a lot of dairy products, vegetables, cereals. Spicy, overly salty, spicy foods, soda are excluded.

If a pregnant woman has pyelonephritis, she is always offered inpatient treatment. You shouldn't give up on it. Under the constant supervision of a doctor, it is easier to identify and eliminate complications at the initial stage, to choose the most effective and safe antibiotic or a combination of them. As a rule, vitamins and drugs that protect the kidneys are additionally prescribed.

With pyelonephritis, it is recommended to reduce salt intake, increase the volume of fluid. If pregnancy has led to swelling, it is possible to use mild diuretics. In the later stages, it is desirable for a woman to be in a knee-elbow position more often. It allows you to release the kidneys from the pressure of the uterus and reduce the protein in the urine.

Gestosis requires hospitalization. Mandatory daily monitoring of the condition of the fetus. A woman is prescribed rest, bed rest, a strict protein-vegetable low-salt diet. To improve the functions of organs, diuretics, antihypertensives, drugs to increase blood flow are used. To normalize the functions of the nervous system, sedatives are prescribed. If the mother's condition can be stabilized, the natural course of pregnancy becomes possible, without interfering with the further development of the child.

How to prevent an increase in protein in the urine

Prevention of diseases that cause protein during pregnancy begins even before conception. Identification and treatment of problems of the genitourinary system during planning significantly reduces the risk of preeclampsia, exacerbation of chronic inflammation.

Effective measures to prevent protein in the urine are:

Proper nutrition: the predominance of vegetables, herbs, protein foods.
Average level of physical activity: gymnastics for pregnant women, regular walks, swimming.
Exclusion of physical and psycho-emotional overload.
Extend sleep time up to 9 hours.
Exclusion of hypothermia.
High fluid intake during pregnancy: at least 2 liters.
Prompt emptying of the bladder.
Loose clothing that does not pinch the pelvis and abdomen.
Regular monitoring of pressure, leukocytes and protein in the urine.
Following the recommendations of the doctor, the use of prescribed antibacterial drugs.

Proteinuria- a laboratory symptom characterized by the appearance of protein in the urine. This phenomenon can be observed in a healthy woman, but most often it indicates dysfunction of the urinary system. Proteinuria is not an independent disease, but a symptom of some pathology - glomerulonephritis, arterial hypertension, etc.

According to the recommendations of experts, the expectant mother should control the amount of protein in the urine throughout the pregnancy. Timely detection of proteinuria helps to take measures aimed at preserving the life and health of the baby and woman.

Protein norm

The ideal indicator of a general urine test of a pregnant woman is the complete absence of protein. Such results indicate the good work of the filtration apparatus of the kidneys. The allowable rate of protein in the urine in pregnant women depends on the gestation period.

During the first trimester of pregnancy, there is a slight increase in the load on the urinary system, therefore, in the early stages, an increase in protein in the urine up to 0.002 g / l in a single sample is considered the norm. This is equivalent to proteinuria of not more than 0.066 grams per day.

At 18-22 weeks of gestation, an increase in circulating blood volume is observed, which further increases the load on the kidneys. That is why in the second trimester of the gestation period, daily proteinuria of up to 0.1 grams of protein per day is allowed.

In late pregnancy, the kidneys of the expectant mother experience the heaviest load for the entire period of gestation. After 30 weeks of the third trimester, proteinuria of 0.033 g / l in a single portion of urine is considered the norm. This value is equivalent to 0.2-0.3 grams of protein per day.

Table of norms of protein in the urine in women and men

The rate of protein in the urine

Children from 1 year to 18 years old

missing

Less than 0.1 g/l

Pregnancy

Less than 0.14 g/l

Proteinuria Tests

The easiest way to detect protein in the urine is a general analysis. To carry it out, the expectant mother must collect the average portion in a sterile dish and bring it to the laboratory.

Before collection, a pregnant woman should toilet the external genital organs with water and hygiene products. Then she needs to release the first portion of urine - this eliminates false results. After that, the expectant mother should substitute sterile dishes under the external opening of the urethra and collect about 50-100 milliliters of fluid. The last portion of urine should not be collected in a bowl.

In the absence of proteinuria in the general analysis of the expectant mother, no additional studies are required. If there are traces of protein in the urine (protein up to 0.033 g/l), it is recommended to repeat the test after three days. Before passing the second analysis, the expectant mother should reduce physical activity and reduce the amount of meat, fish, eggs, poultry and dairy products in the diet.

If the doctor found an increase in protein in the urine, the woman is recommended to undergo additional tests. They help determine the cause of proteinuria.

To determine the daily proteinuria of the expectant mother, a sterile container with a volume of more than 2 liters should be purchased. With each urination, a woman needs to collect all the excreted fluid for 24 hours. Between urine samplings, it is recommended to store the container in the refrigerator in a closed state.

A more accurate and complete analysis of the work of the kidneys is the Zimnitsky test. For its implementation, the expectant mother should find or buy 8 empty sterile jars. Every 3 hours, a pregnant woman needs to collect all the urine in a prepared container. Thus, in a day, the expectant mother will fill all 8 jars.

The Zimnitsky test helps to determine the daily protein in the urine of a pregnant woman. This analysis is necessary to differentiate the diagnosis.

Physiological causes

Increased protein in the urine may be due to physiological reasons. Mild proteinuria is characteristic of the following conditions:

Protein diet. Increased consumption of food of animal origin can cause mild proteinuria. This feature is associated with the non-assimilation of part of the proteins coming from outside. Proteinuria during pregnancy is typical after eating a large amount of meat, poultry, eggs, fish, seafood, milk and its derivatives.

Intense running, long walking, lifting sports equipment, and other strenuous activities can cause proteinuria. It occurs due to damage to muscle fibers, proteins from which enter the bloodstream and are excreted in the urine.

emotional stress. Nervous shock causes the release of adrenaline and norepinephrine - hormones of the adrenal glands. These substances contribute to the excretion of protein in the urine.

Fever. The presence of protein in the urine during pregnancy may be due to a strong increase in body temperature. Feverish conditions cause physiological proteinuria associated with the excretion of metabolic products.

Pathological causes

Among the pathological causes that cause the appearance of protein in the urine, the following pathologies are distinguished in pregnant women:

Gestational arterial hypertension. Previously, this disease was also called late gestosis of pregnant women. The presence of protein in the urine, an increase in blood pressure above 140/90 and edema are the triad of symptoms in this pathology. After newly diagnosed proteinuria later than 20 weeks of gestation, doctors must rule out gestational hypertension without fail.

Diabetes. The target of this disease are the small vessels of the kidneys. When they are damaged, the filtration capacity of the organ is disturbed, which causes the passage of protein into the urine.

Glomerulonephritis. The disease is characterized by an inflammatory process in the renal glomeruli - the main "filter" of the organ. Most often, glomerulonephritis occurs after suffering a sore throat and other diseases caused by streptococcus. The pathology is autoimmune in nature, both kidneys are usually affected. Proteinuria is associated with mechanical damage to the filtration apparatus of the organ.

Pyelonephritis. This pathology is a consequence of infection of the kidneys by various pathogens. Usually, with mild pyelonephritis, there is no damage to the glomerular apparatus of the organ, so proteinuria is not observed in women. However, in severe cases of the disease, an increase in the amount of protein in the urine is possible.

Urinary tract infections. Cystitis and urethritis can cause protein in the urine. Such proteinuria is not associated with kidney damage. The observation of protein in the urine is a consequence of inflammatory processes and exudation in the underlying organs.

Rare kidney pathologies. Amyloidosis, tuberculosis, polycystic disease, and other diseases can cause proteinuria. Its mechanism is associated with a malfunction of the filtration apparatus.

Heart failure. Reduced performance of the heart muscle leads to proteinuria. It is associated with the development of disorders in the synthesis and breakdown of amino acids, the passage of proteins through unchanged renal filters.

Signs of proteinuria

By itself, proteinuria does not give a clinical picture and characteristic signs in urine tests. To clarify the underlying disease, one should focus on a general urinalysis, additional research methods and subjective complaints of the expectant mother.

Late preeclampsia is characterized by an increase in blood pressure above 140 to 90, as well as the development of edema in atypical places - on the upper limbs, face, in body cavities. Severe hypertension () may be accompanied by pain in the head, the appearance of "flies" before the eyes, tinnitus, a decrease in platelets in the general blood test, convulsions, and heart rhythm disturbances.

Diabetes mellitus has characteristic changes in the general analysis of urine - the appearance of acetone and ketone. Blood testing for glucose is required to confirm the diagnosis. Its increase on an empty stomach above 5.6 mmol / l indicates the presence of diabetes. It is also possible to conduct a tolerance test - a blood test 1 and 2 hours after a glucose load.

Symptoms of diabetes mellitus are varied, they usually appear after a long course of the disease. The most common signs of pathology include frequent urination, especially at night, thirst, fungal skin lesions, dry mouth, and sudden weight loss for no apparent reason.

Attention! Proteinuria is a symptom of various diseases, therefore, when it is detected, a diagnosis of the underlying pathology should be made.

A distinctive feature of glomerulonephritis is the appearance of erythrocytes in the general analysis of urine. In severe cases, discharge from the urethra turns red. Also in the general analysis of urine, cylinders are observed, most often hyaline.

To clarify the diagnosis, a blood test for antibodies to streptococci is possible. Doctors may also recommend an ultrasound of the kidneys. The "gold standard" for diagnosing glomerulonephritis is an organ biopsy.

Symptoms of glomerulonephritis include general deterioration, headache, nausea. In the anamnesis, there is often a transfer of sore throats, colds and other infectious diseases. Also, with pathology, there are pains in the lumbar region, pallor, swelling, a slight increase in blood pressure, red urine.

Pyelonephritis and inflammatory diseases of the urinary tract are almost always accompanied by the appearance of leukocytes and bacteria in the general analysis of urine. In the blood, there is an increase in ESR, stab cells, urea and creatinine.

In acute pyelonephritis, fever, lower back pain, general weakness, dizziness are possible. Sometimes the disease proceeds in a latent form. and other pathologies of the urinary organs are accompanied by pain during a trip to the toilet, the appearance of blood in the urine, and the lack of a feeling of complete emptying.

The exclusion of the above diseases is a reason for suspicion of rare pathologies. For their diagnosis, it is necessary to conduct an ultrasound examination, magnetic resonance imaging.

Treatment

Treatment of proteinuria is based on the treatment of the underlying disease. Arterial hypertension in pregnancy includes taking antihypertensive drugs (methyldopa,). Also, expectant mothers may be recommended to take medicines that improve microcirculation in the placenta (Kurantil, B vitamins).

Treatment of gestational diabetes mellitus (new-onset diabetes during gestation) is limited to a carbohydrate-free diet. The expectant mother is forbidden to eat chocolate, flour products, sweet vegetables and fruits. Therapy for other forms of diabetes is based on diet, the use of sugar-lowering agents, or insulin injections.

Therapy of glomerulonephritis is to suppress inflammatory reactions. For this, the expectant mother is shown taking glucocorticoids (Dexamethasone, Prednisolone). Also, in the presence of this disease, it is forbidden to consume salt, a large amount of protein food.

Infectious pathologies of the kidneys and urinary tract are treated with antibacterial agents (). As an additional therapy, the use of diuretics (Canephron), vitamin therapy is indicated.

Complications

By itself, mild proteinuria does not cause complications for the mother and child. However, the underlying disease can contribute to severe disorders in the body of a woman. Gestational arterial hypertension is the cause of chronic fetal hypoxia - its oxygen starvation.

Fetal hypoxia can cause congenital pathologies of the central nervous system, intrauterine growth retardation and development. Sometimes lack of oxygen is the cause of premature birth and death of the baby. Severe arterial hypertension causes maternal complications - stroke, internal bleeding, heart attack, seizures.

Diabetes mellitus affects the vessels of the body, so it can cause fetal hypoxia. On the part of the expectant mother, the development of angiopathy of the capillaries of the retina, kidneys, brain, and heart is possible.

Infectious pathologies of the kidneys are a risk factor for intrauterine infection of the fetus. It can cause growth retardation, congenital pathologies and death. Pathologies of the urinary tract before childbirth at 37-39 weeks of gestation can provoke infection of the newborn.

Severe proteinuria (more than 5 grams per day) is a factor in the violation of the composition of blood plasma. This contributes to the development of massive edema, metabolic pathologies, muscle weakness, and delayed tissue regeneration.

Pregnancy and kidneys

Prevention

Prevention of proteinuria is the prevention of these diseases. The expectant mother should eat right, reducing the amount of table salt to 5 grams per day. Also, a pregnant woman is recommended to reduce fatty, fried, smoked, canned. She should exclude a large amount of fast carbohydrates, strong tea and coffee.

A pregnant woman should not expose herself to the risk of infection. To do this, she should not come into contact with sick people, visit places with large crowds of people during epidemics, and supercool. Also, the expectant mother should engage in light sports - yoga or gymnastics for pregnant women, swimming in the pool.

In the first trimester of pregnancy, a woman registers at the antenatal clinic, where one of the mandatory planned observations is the delivery of a urine test for the presence of protein. Normally, in a healthy person, urine does not contain protein, so if it is found in a pregnant woman, this means that there is a threat to the health of her and the child. To prevent the development of serious pathological conditions, it is necessary to detect and cure them in a timely manner. Therefore, the determination of protein in the urine is an important and targeted diagnostic method.

What does it mean?

During pregnancy, so-called gestosis, or toxicosis, often occurs. The origin of preeclampsia is due to the failure of the processes of restructuring the female body in new conditions of functioning due to intrauterine development of the fetus. Toxicosis can be detected already in early pregnancy - in about 30 percent of women. This rather dangerous condition has varying degrees of severity and represents a real threat of death for the mother and her unborn child.

Preeclampsia can begin to develop in any trimester of pregnancy, but in most cases it occurs after the twenty-eighth week of gestation. One of the markers for determining toxicosis in the early stages of its appearance is the presence of albumin in the urine. Albuminuria is a consequence of such manifestations as dehydration due to frequent vomiting, excessive salivation, as well as a shift in the metabolic reactions of the body.

These symptoms are common in many women. in the first twelve weeks of pregnancy, and by the fourteenth week their condition improves, the body begins to gradually adapt to a new state for it.

The negative manifestations of the body are based on the immune conflict of the female body and the fetus developing in it, as a result, immune inflammation of the kidneys and urinary tract occurs, the formation of edema with congestion in the tissues. With the development of the placenta, the content of specific metabolic products between the mother and fetus increases, which increase the permeability of capillaries, blood vessels, and even cell membranes. Against this background, the inflammatory process with edema is a natural phenomenon.

What is dangerous?

During pregnancy, as the fetus grows in utero, the overall load on the entire mother's body increases. First of all, changes are felt by the kidneys and urinary system, as they are in close proximity to the growing uterus. During pregnancy, the urinary tract is displaced and slightly compressed, congestion occurs in them, which leads to inflammatory processes. This cannot but affect the composition of urine - during the analysis in this situation, protein, a large number of leukocytes, and erythrocytes are detected.

Such an analysis reliably means that the woman's kidneys cannot cope with their functions, which is a real threat to the health and life of both the mother and the child.

Preeclampsia of any severity is the reason for a comprehensive examination and careful monitoring of a pregnant woman. It is extremely dangerous to leave such conditions without medical correction. With toxicosis, the following changes in the state may occur:

Violations of the functioning of the renal and urinary system in the form of pyelonephritis, glomerulonephritis, cystitis, as well as a more serious condition - acute renal failure, which is a threat to life;
Violations of the functions of the cardiovascular and respiratory systems in the form of shortness of breath, edema of the lung tissue, coronary insufficiency;

Spasm of the vascular and capillary network leads to tissue ischemia, the formation of blood clots - blood clots, which is dangerous for the development of ischemia, swelling of brain tissues up to falling into a coma. In addition, the fragility of blood vessels, as a rule, leads during the birth process to very heavy bleeding on the part of the woman in labor, requiring donor replenishment of blood loss;
Violation of the adrenal glands leads to a persistent increase in blood pressure, an extreme form of this condition can be a stroke;
Failure of the physiological work of the digestive tract is most often expressed in liver dysfunction, persistent vomiting, increased salivation. This leads to a violation of the water-salt balance and a decrease in the volume of circulating fluid in the body. In rare cases, liver dystrophy occurs - a process that is irreversible and leads to death.

Negative manifestations of preeclampsia are reflected not only in the maternal body - the fetus also suffers from it. The most common pathology is premature detachment of the child's place - the placenta, as a result of which the fetus cannot fully develop and dies. At later stages of pregnancy, placental abruption leads to the onset of early labor, and often the child is born unviable.

The risk of death of a child with toxicosis is more than 35 percent of the total number of cases. Surviving children subsequently often lag behind in development, are prone to colds, and are prone to problems with the respiratory and cardiac systems.

The consequences of gestosis can manifest themselves even after childbirth. If the body could not recover to the physiological norm within a period of up to two months, we can talk about irreversible chronic pathological processes that require constant monitoring and drug therapy.

At different times

It is customary to subdivide toxicosis of pregnant women according to the time of its development - in the first or second half of pregnancy. In the early stages of fetal development (up to the twentieth week), preeclampsia is so common that it is considered almost the norm for every woman. However, there can be no question of any norm here. A healthy body does not allow protein elements from the bloodstream to enter the urine through the filtering tubules of the kidneys.

As medical practice shows, every second woman who applied for registration in a antenatal clinic, when analyzing urine, has one or another amount of protein in it. And the morning portion of urine contains more protein than subsequent ones.

There is a certain standard for the protein content in the urine of a pregnant woman, which does not cause pathological changes for her body and the favorable development of the fetus. So, in the first trimester, the protein content is up to 0.033 g / l, the second trimester allows the content up to 0.4 g / l and in the third trimester the protein should not be more than 0.5 g / l.

At 35 or 36 weeks of gestation, the formation of the fetus has not yet been completed. However, the female body begins to experience increased overload and often does not cope with the functions assigned to it. Urinalysis indicates this by an increase in protein levels.

Doctors observe such pregnant women in a hospital for round-the-clock opportunity to provide the necessary assistance and save the life of the child.

At 37 or 38 weeks, the fetus is considered to be almost formed and ready for autonomous life. The presence of toxicosis in a woman at this time may be accompanied by edema, hypertension, nephropathy. Doctors call this condition pregnancy preeclampsia. At the same time, albumin in the urine is very different upwards from normal values. At that time increased risk of cerebral hemorrhage due to hypertension.

Preeclampsia is also dangerous because in a very short time the symptoms increase, blood pressure increases, and convulsions appear against the background of nephropathy, loss of consciousness up to coma. Thus, preeclampsia turns into a very dangerous condition - eclampsia, which can end very unfavorably for both the mother and the child.

Therefore, in late pregnancy - from 36 to 39-40 weeks, if there are signs of preeclampsia it is advisable to terminate the pregnancy through surgery, the so-called caesarean section, which is done to save the life of the mother and child. At such a late date, this will not affect the further development of the child. This measure is forced, but necessary.

Reasons for the appearance

To date, the pathological course of pregnancy has more than 30 different scientific justifications. The appearance of protein in the urine, as a harbinger of preeclampsia, is due to the initial level of poor health in women with obvious or hidden pathological changes, as well as the presence of bad habits and environmental factors: endocrine disorders, diseases of the genitourinary and cardiovascular system, a tendency to obesity, smoking, abuse of alcoholic or low-alcohol drinks, harmful working conditions, stressful situations.

Obstetricians and gynecologists refer to the risk group for toxicosis, during which the protein in the urine rises, the following category of women:

experiencing chronic nervous fatigue and stress;
the age of the pregnant woman is up to 18 years or more than 35 years;
previously occurring gestosis in re-pregnant women after a short period of time;
hereditary factor;

many abortive interventions in history;
the presence of chronic diseases or recent severe infections;
insufficient development of the genitourinary system (infantilism);
poor social conditions - lack of proper nutrition, excessive physical activity, polluted environment;
with multiple pregnancy;
in women with bad habits (smoking, alcoholism, drug addiction).

Quite often, toxicosis appears during the first pregnancy, but if it occurs at the appropriate reproductive age and under good conditions, preeclampsia may be insignificant and protein in the urine is corrected by diet and medication.

Symptoms

If a high level of protein was found in the urine of a pregnant woman, this means that the process of preeclampsia in her body is already in full swing. As a rule, a mild degree of preeclampsia is accompanied by the following symptoms:

dizziness and motion sickness when traveling by car;
increased separation of saliva (up to one and a half liters can be released per day);
aggravation of smell and change in taste preferences in food and drinks;
nausea and vomiting in the morning, after eating or even from its smell;
mood instability with sharp changes in excitation and inhibition;
excessive drowsiness or disruption of the process of falling asleep.

The average degree of toxicosis, in addition to the existing symptoms, manifests itself as follows:

increases the level of protein in the urine, as well as leukocytes, erythrocytes;
there are swelling of the upper and most often the lower extremities, later swelling can spread to the face, neck and body;
increased blood pressure;
vomiting becomes persistent several times a day, there is no appetite.

Severe preeclampsia is characterized by symptoms of preeclampsia or eclampsia, when the symptoms described above are joined by:

persistently rising blood pressure;
internal and external edema;
vomiting becomes indomitable, not bringing relief;
urine is difficult to pass, has a cloudy color due to the high concentration of protein and leukocytes;
the presence of convulsive syndrome, severe headache;
cardiac arrhythmia, cyanosis, shortness of breath;
often develops a coma with complete loss of consciousness.

If, in a state of preeclampsia, medical adjustment with drugs does not give any effect within 12 hours, the pregnancy is terminated by artificial labor.

Permissible rate

The results of clinical studies of the biochemical analysis of the urine of a pregnant woman for the content of protein in it differ from those of a woman in the absence of pregnancy. There are specially designed tables where, depending on the age of the woman and the presence or absence of pregnancy, protein indicators can be the maximum allowable. These tables are used not only by gynecologists and obstetricians, but also by any other specialists.

The fact is that protein in the urine of a healthy woman can be detected in some gynecological diseases, in the presence of chronic inflammatory processes that do not pose a threat to life, and also in violation of hygiene during urine collection for analysis.

In a healthy woman in the absence of pregnancy, the morning portion of urine allows the protein content in it to be from 0.033 g / l, and in the daily analysis - up to 0.066 g / l. In the presence of pregnancy, the content of albumin in the morning urine test is allowed - from 0.33 to 0.1 g / l, and in the daily analysis - from 0.2 to 0.3 g / l.

In late pregnancy with gestosis, the level of protein availability increases with each week of the impact of pregnancy on the body:

at the 27th week - 0.10 g / l;
at the 30th week - 0.15 g / l;
at the 34th week - 0.18 g / l;
at the 38th week - 0.20 g / l;
by the end of the 40th week - up to 0.23 g / l

As you can see, as the fetus grows, protein indicators can increase from the norm by 10 times or more.

Analyzes

When determining albumin in the urine, the correct collection of biological material is very important, since even the simplest violation of hygiene measures will result in traces of protein fractions, bacteria, and mucus. The study of urine is carried out from the morning portion or collected during the day. Morning urine collection involves the following measures:

after waking up, a woman conducts a thorough hygienic toilet of the external genitalia;
she collects the entire portion of morning urine in a clean and dry container;
then approximately 150-250 milliliters of urine should be taken from the total container into another clean and dry container;
transfer the collected material for analysis no later than 2 hours from the moment of its collection.

The collection of daily urine is carried out somewhat differently:

prepare a clean and dry container up to three liters;
at 9 o'clock in the morning, night urine should be sent to the toilet, it is not taken into account in this analysis;
all subsequent portions must be collected in one large three-liter container, which is stored in a cold place;
keep a record of the amount of liquid drunk during the day;
at 9 o'clock in the morning the next day we collect the final portion of urine;
count the recorded volume of fluid drunk per day, calculate the volume of urine received per day;
from the total volume of urine, take 150-200 milliliters for analysis into a clean, dry container;
send the material to the laboratory no later than 2 hours after collecting the final portion of urine.

If a pregnant woman has vaginal discharge, a swab or tissue should be used when collecting urine to isolate the area.

Treatment

In order to reduce the elevated level of albumin in the urine of a pregnant woman, a number of therapeutic measures are carried out in a hospital setting. The basic principles that doctors rely on to treat gestosis are as follows:

A woman is prescribed a bed or semi-bed rest necessary to treat her condition and maintain pregnancy. The period of such a protective regimen can take several months, up to the full term of the end of pregnancy. During this period, it is recommended to remove all psycho-emotional stimuli from the woman's environment, reduce wakefulness and increase sleep time. If the state of the nervous system and psyche requires it, the doctor prescribes sedatives;

Organization of proper and balanced nutrition plays an important role in the fight against proteinuria. It is necessary to remove spices, strong extractive broths, smoked meats and pickles, sugar from the diet. The amount of fluid consumed should be moderate to replace fluid losses and prevent dehydration. Food rich in fiber and vitamin and mineral components is recommended. Nutrition is best done lying down or half-sitting, several times a day in small portions. With severe toxicosis, warm or even chilled food is recommended, rather than hot. Dishes should not exude pungent odors;

Medicinal medicines are prescribed for symptomatic treatment in order to maintain the body of the mother and fetus in a normal physiological state, as well as to reduce the risk of developing hypoxia in a child. In order to get rid of edema, diuretics, as a rule, are not used, due to the fact that they can provoke a decrease in fluid in the bloodstream with the formation of blood clots, and in addition, disrupt placental circulation. Only with pulmonary edema and cardiac disorders, the use of diuretics is indicated, but in parallel with them, intravenous administration of physiological solutions is prescribed to replenish the volume of circulating fluid.

Most often, women are prescribed vitamin preparations, drugs that improve blood circulation and reduce vascular permeability, antihypertensive drugs, antiemetics;

With the development of preeclampsia and eclampsia, a set of emergency measures is used or urgent delivery is carried out in one way or another, the most favorable for the mother and child.

According to practicing obstetricians and gynecologists, the duration and intensity of therapeutic and protective measures is determined based on the general well-being of the pregnant woman and the fetus. Only in the initial stages of preeclampsia, they can be performed on an outpatient basis. All other cases require inpatient treatment without fail.

Early detection of pathological conditions and effective measures significantly reduce the risk of developing conditions that threaten the health and life of the mother and child.

Prevention

Great importance in the prevention of preeclampsia is given to preparing the body for the upcoming pregnancy. Even at the stage of planning the conception of a child, a woman is recommended to undergo a complete medical examination. If any pathology is found, it must be eliminated, since it is much easier and more expedient to do this at this stage than during a complicated pregnancy.

In addition, if a woman has addictions in the form of smoking or drinking alcoholic beverages, they must be eliminated at least six months before the start of pregnancy.

Testing during pregnancy is a necessary measure to reveal hidden serious diseases in expectant mothers. Some of them can be deadly for both the fetus and the woman. One of these pathologies is protein in the urine of pregnant women. We will discuss why it appears and how to treat it.

Protein in the urine of pregnant women - what does it mean

In medicine, the presence of protein in urine is called proteinuria. Urinalysis is one of the most important tests during pregnancy. This analysis must be taken weekly in order to be able to detect hidden diseases in a timely manner. But the results of the analysis are accurate only if the preparation for them has gone well.

If the expectant mother reveals the presence of protein in the urine, then she is re-sent to the test. This procedure allows the doctor to follow the process of increasing the protein, and to identify whether this was a one-time manifestation or there is a certain pathology in the pregnant woman's body.

How to properly collect urine

Experts advise before passing urine to abandon the use of salty and sour, as well as meat and spicy products.

The container where urine will be collected must be sterile, it is advisable to purchase a special container for this at the pharmacy, since it is much more convenient to use than improvised means. Before collecting urine, a pregnant woman should bathe with soap.

For analysis, you will need to collect average urine. To do this, empty the bladder for the first three seconds and stop, then substitute the container, continue emptying, stop again and remove the urine container. Then empty your bladder completely. After this procedure, it is advisable to immediately take the urine to the clinic so that the results of the analysis are most accurate.

The study of urine helps medical professionals evaluate the functioning of the kidneys of a pregnant woman, since during pregnancy these organs function in an enhanced mode. You can also find out in a timely manner about the presence of diabetes or other infectious diseases in the body of a future mother.

Norm

The rate of protein in the urine of expectant mothers is up to 0.002 g / l in a single portion of urine (in the last weeks of pregnancy up to 0.033 g / l). It is generally accepted that in this case there is no threat to the future mother and fetus. In the event that the kidneys begin to function improperly or an inflammatory process occurs in the female body, the amount of protein in the urine increases.

Causes of protein in the urine in pregnant women

If you are not sick with anything, then the protein in the urine will not be detected. Sometimes it may be present due to the load on the kidneys during the bearing of the baby.

Throughout pregnancy, the female body is under tremendous stress, as it has to protect not only the mother, but also the fetus. During this period, the urinary system functions with a vengeance, as the kidneys need to remove toxins from both the child and the mother.

Also, increased protein in the urine in pregnant women occurs in the following cases:

incorrect collection of urine;
the use before passing the analysis of a large amount of milk, cottage cheese;
excessive physical activity;
high blood pressure;
nervous tension;
taking certain medications;
diabetes;
heart failure;
diseases of the genitourinary system;
inflammatory diseases;
gestosis.

The presence of inflammatory diseases can be the result of an improper lifestyle of a pregnant woman. They can also appear due to chronic kidney disease if a woman had them before conception. Often, an increased amount of protein in urine is detected with cystitis.

In late pregnancy

In the last weeks of bearing a baby, pathology often occurs due to preeclampsia, which is formed due to improper functioning of the kidneys. In the future, it can cause a violation of placental function. The placenta will not only cease to protect the baby from infections and other negative influences, but will also cease to supply it with trace elements important for development. All this can lead to premature birth, problems in the development and growth of the fetus, and in some cases cause its death.

Also, the presence of preeclampsia may indicate high blood pressure, the formation of edema. In most cases, preeclampsia requires specific treatment in the inpatient department. If the disease manifested itself in the last weeks of pregnancy, then in this case, doctors recommend stimulating childbirth, since we are talking about saving the life of the baby and the woman.

Protein in the urine can only be a warning sign when several urine tests have been done and there is a regular increase in blood pressure. In all other cases, the expectant mother should not worry.

Treatment of protein in the urine in pregnant women

Therapeutic measures are based on the signs of the disease. If the indicators exceed the permissible norm due to inflammation in the body, then doctors begin treatment, trying to immediately eliminate the primary source of inflammation. For example, with pyelonephritis, a pregnant woman should take herbal anti-inflammatory drugs and diuretics. The use of antibiotics is permissible in the acute and chronic form of the disease.

To eliminate stagnation in the kidneys, it is advisable to sleep on your side, as well as get on all fours more often and move more. For example, walking in the fresh air helps improve mood and well-being, and also quickly reduces protein.

It is most difficult to treat a protein if it is caused by preeclampsia. Usually, doctors manage to stabilize the condition of the pregnant woman until the very birth. Sometimes they get it throughout the pregnancy and the baby is born at term. But at the same time, the threat of premature birth with gestosis remains high.

Often, doctors recommend women with preeclampsia to terminate the pregnancy. But if a woman decides to give birth, then most of the time she will have to spend in a hospital, constantly listening to the advice of doctors. Childbirth with gestosis, as a rule, occurs by caesarean section. Preeclampsia cannot be cured, but it is possible to reduce protein levels in urine if you follow a special diet.

Preventive measures for late preeclampsia include measuring blood pressure twice a day, as well as constantly listening to your well-being. At the slightest deterioration in health, you should immediately go to the hospital.

With a tendency to edema, you should limit the amount of salty and smoked food consumed, and also exclude salt from the diet. In this case, it is necessary to control your weight daily, with a rapid weight gain, contact your doctor, since such a symptom indicates progressive preeclampsia.

To reduce the load on the kidneys and facilitate their work, it is advisable to take herbal medicines: kanefron or phytolysin. Diuretic herbal teas, cranberry and lingonberry juice are also useful. But before using them, you need to consult a doctor.

Therapy for the elimination of protein in the urine of expectant mothers involves the rejection of strong black tea and coffee, chocolate, and fatty dairy products. At the same time, citrus fruits should also be abandoned for the duration of treatment.

Remember, timely treatment of protein in the urine of a future mother allows you to give birth to a strong and healthy baby. Stay healthy and have an easy delivery!