When pregnant, you will have your urine checked at routine appointments. One of the reasons urine is analyzed is to detect protein. While it is normal to have a small amount, a large amount of protein in the urine (proteinuria ) during pregnancy is serious.
Proteinuria during pregnancy may signal preeclampsia, a condition that causes high blood pressure during and right after pregnancy. It may also mean you have kidney disease that needs to be treated. Large amounts of protein in the urine may indicate that your kidneys are not functioning normally. Poor Follicular Development
Other possible causes of proteinuria during pregnancy are dehydration, inflammation, infection, kidney stones, stress, low blood pressure, or intense exercise.
This article discusses proteinuria during pregnancy, how to treat it, and if you can prevent it.
It is normal to have some protein in your urine, especially when pregnant. For people who are not pregnant, an average urine protein level is under 150 milligrams per day (mg/d). For pregnant people, the upper limit is 300 mg/d. Most healthcare providers consider a urine protein level over 500 mg/d serious and a sign of preeclampsia.
The symptoms of high protein in your urine depend on the underlying cause. A common cause of proteinuria during pregnancy is preeclampsia, which usually develops after 20 weeks' gestation. Preeclampsia affects about 3% to 7% of pregnancies in the United States.
Symptoms of preeclampsia may include:
When left untreated, preeclampsia can lead to life-threatening complications, including seizures, stroke, and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. HELLP syndrome is a medical emergency and needs to be treated immediately.
Proteinuria during pregnancy may also be caused by kidney disease. Symptoms of kidney disease may include:
A dipstick test (urinalysis) checks the protein level in your urine. This is a quick test that can be completed in an outpatient facility. Your provider will give you a cup in which you will provide a small urine sample. They will then dip a test strip into the urine. This test strip contains chemical patches that change color when protein and other substances are detected.
If the dipstick test reveals a high protein level, your provider will likely recommend a 24-hour urine protein test to confirm the high result. If the result is high, your provider will work with you to determine the cause. If preeclampsia is a concern, your provider will perform a physical exam and order additional lab tests to look for other signs, including:
A healthcare provider may recommend an ultrasound or a nonstress test to check on the health of your baby.
Preeclampsia usually resolves on its own after your baby is born and the placenta is delivered. Sometimes, preeclampsia continues for days to weeks after delivery.
To reduce the risk of complications from preeclampsia, your healthcare provider may recommend inducing labor. This is usually only an option once you reach 37 weeks' gestation. Your provider may recommend induction if you develop any of the following serious preeclampsia symptoms:
If your preeclampsia symptoms are mild and your baby is not in distress, your healthcare provider may recommend closely monitoring you as you continue your pregnancy. Close monitoring may include frequent medical appointments and checking your blood pressure at home.
Your provider may also recommend close monitoring in the hospital if your symptoms are worsening but still manageable. In the hospital, your medical team can monitor your blood pressure 24 hours daily. The team can also administer medications, including steroids, to help a baby’s lungs develop quicker.
Once your kidneys are damaged or under stress, they cannot keep proteins from entering the urine. Drinking more water will not help reduce protein in the urine. The only way to treat proteinuria is to treat the underlying cause.
If you are at risk for preeclampsia, pregnancy can also be a time of stress or fear about the future. It may be helpful to remember that for most people with preeclampsia, the condition resolves on its own after childbirth.
Although preeclampsia cannot be prevented, it may be possible to lower your risk. Your healthcare provider may recommend taking baby aspirin or a calcium supplement daily to reduce your risk. However, never start a new medication or supplement without talking with your healthcare provider.
If you develop preeclampsia, monitor your symptoms from home and alert your provider to any changes in your health. Your provider will likely ask you to check your blood pressure daily and count the number of times you feel your baby move (kick count).
People with kidney disease can have a healthy pregnancy and baby. However, complications are possible, so it is best to make a plan with your healthcare provider before becoming pregnant.
To manage chronic kidney disease during pregnancy, your healthcare provider may recommend medications, changes to your diet, and blood pressure monitoring. Daily exercise and avoiding tobacco may improve your blood pressure readings.
If you have been diagnosed with proteinuria, it means that there are unusually high protein levels in your urine. It is normal to have slightly higher levels during pregnancy. However, very high levels could mean that you have preeclampsia or kidney disease.
Symptoms of preeclampsia include high blood pressure, swelling in the hands and face, and sudden weight gain. If the condition is not treated, it can lead to dangerous complications like seizures, stroke, or HELLP syndrome. Pregnancy with kidney disease can be managed with medication, dietary changes, and other treatments. Talk with your healthcare provider about the right plan for you.
Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: Pathophysiology, challenges, and perspectives [published correction appears in Circ Res. 2020 Jan 3;126(1):e8]. Circ Res. 2019;124(7):1094-1112. doi:10.1161/CIRCRESAHA.118.313276
Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies [published correction appears in Nat Rev Nephrol. 2019 Jun;15(6):386]. Nat Rev Nephrol. 2019;15(5):275-289. doi:10.1038/s41581-019-0119-6
Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol. 2022;226(2S):S819-S834. doi:10.1016/j.ajog.2020.08.108
Saxena I, Kapoor S, Gupta RC. Detection of proteinuria in pregnancy: comparison of qualitative tests for proteins and dipsticks with urinary protein creatinine index. J Clin Diagn Res. 2013;7(9):1846-1848. doi:10.7860/JCDR/2013/6656.3330
American College of Obstetricians and Gynecologists. Preeclampsia and high blood pressure during pregnancy.
American College of Obstetricians and Gynecologists. Usefulness of urine protein dipstick testing as part of routine prenatal care.
National Kidney Foundation. Pregnancy and kidney disease.
By Carrie Madormo, RN, MPH Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.
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