Protein in Urine During Pregnancy

Having protein in your urine (called proteinuria) while as a pregnant woman isn’t too unusual, but when the results start to be +1 or +2 your doctor will start to become more concerned, as you enter the third trimester.  Let this L&D RN tell you exactly why this happens, why they test your urine sample and why it’s a problem.

But, how do I know so much about protein in urine?

Hello! I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of labor and delivery nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ I have done a TON of urine tests on pregnant women in my time, so I’m a good resource on this one!

Why would you have protein in your urine while pregnant?

When you’re pregnant, your body has a much larger blood volume than normal. Your kidneys have to sort of “open up” a bit to let all that blood volume through.  A little isn’t a problem, but too much protein slipping through your kidneys may be a sign of preeclampsia.

Want to know more about your kidneys in pregnancy, this is a good concise paragraph.

If you have questions about your pregnancy and your care during it — your first step is this. It’s really going to help simplify pregnancy to make it easy to understand and participate in your care.

Trace protein in your urine during pregnancy

This isn’t unusual and isn’t a symptom of any problems.

Protein in your urine before 20 weeks or so (or, when you’re NOT pregnant) is usually indicative of a urinary tract infection (UTI) or some other issue, not preeclampsia. That is a pretty minor infection and not as problematic.

As you head into your third trimester (around 27 weeks) it begins to be more problematic.

How do they test for protein in your urine during pregnancy?

It can be done a few ways:

• Regular urine checks at your prenatal appointments (they check for a few other things as well — that’s why you have to pee in a cup at each appointment) — this is done quickly at the doctor’s office as a routine test.
• Another urine test that has to be sent to the lab called a protein creatinine clearance/ratio
• They can also send you home to collect your urine for 24 hours for a 24-hour protein test (you also have to keep it cold, so this is a pain).  BTW, if you’re wondering about testing that happens in your 3rd trimester, this free course explains a lot.
• Women often will say their urine looks “frothy” if they are losing protein, so something else to keep an eye on.

Around your 20th week of pregnancy, your healthcare provider will start to be more alert to your blood pressure, and any protein in your urine.

While the 24-hour urine protein test has been the “gold standard” for a number of years, they seem to be finding that the protein creatinine ratio test is just about as good and MUCH more convenient (and fast) vs a 24-hour urine.

With the 24-hour urine collection you most often have to stay at home most of the day as you have to collect all your urine and keep it cold (usually either in your fridge or on ice at home).  That makes it hard to leave much longer than an hour, and most women prefer not going into work when they’re collecting their urine all day long.

**In the Call the Midwife book, they put women’s urine on the heater to see if the protein would congeal — a pretty cool old school method, like cooking eggs!

What does it mean if I have protein in levels in my urine?

I want to be clear that it’s not the actual PROTEIN that’s a problem.  It’s what’s happening in your kidneys as a result of possible preeclampsia that’s the problem. If we let it continue long term you could get serious kidney damage or chronic kidney disease. They can check your kidney function by running a BUN or a serum creatinine (those are blood tests).

Preeclampsia (or hellp syndrome) makes your blood vessels leak even more than usual.  That’s why you would get swelling (again, SOME swelling isn’t unusual — it’s an excessive amount) and also your kidneys leak fluid and don’t filter your urine as well as it did before you became pregnant/had preeclampsia. About 15% of women in the united states get PIH or preeclampisa (also called HELLP syndrome). But, most pregnant women do NOT have this issue — and have a totally normal pregnancy.

Signs of Preeclampsia include:

• Headaches
• Swelling (although most often it’s nothing — sudden facial swelling is a bigger “sign”)
• Vision issues (where things go fuzzy)
• Right sided pain pain below your braline.

I know it’s annoying to be weighed in during pregnancy, but sudden weight gain can be a sign of preeclampisa due to the swelling in your body, so those weigh-ins are important.

What does HELLP Syndrome stand for?

• Hemolysis
• Elevated Liver enzymes — showing changes in liver function
• Low Platelet count

They will take other lab tests to check for these things, usually called a PIH Panel. These can be ordered from your regular antenatal appointments, or sometimes they send you to the hospital for monitoring.

How to reduce protein in urine during pregnancy?

There really isn’t a way to get rid of protein in your urine durig pregnancy, as it is caused by something entirely not your fault.  Preeclampsia starts the minute your fetus implants in the womb, and while you don’t see symptoms until later in your pregnancy, it is due to something that science isn’t quite sure of yet (that post I linked to has a TON of information on preeclampsia, I highly recommend it).

AND, just because you have preeclampsia during this pregnancy, doesn’t mean you’ll have it next pregnancy. The best thing you can do is try to live as healthy a lifestyle as you can (but to be aware that sometimes that doesn’t help much either).

Higher risk factors or for preeclampsia include:

• Obesity
• Multiple gestations (twins or more)
• Being over 35 at the time of conception (advanced maternal age)
• Previous issues with high blood pressure (hypertension)
• Previous kidney disease
• Gestational or other types of diabetes

You’ll notice it doesn’t really matter if it’s your third or your first pregnancy (beyond the fact that you get older the more babies you have). Protein in your urine can show up at any time.

So, by losing weight, lowering your risk of diabetes, and watching other health conditions — you can help prevent it — but not all women with preeclampsia have any of those high risk factors — we just know that they’re more likely to have it with those.

+1 Protein in Urine During Pregnancy

This is when your healthcare provider may start to get concerned — that is too much protein in you urine.  They may double check your blood pressure, or refer you for more labs.  They may also watch you until your next appointment if you don’t have other signs and symptoms of preeclampsia.

This is NOT a definitive test for preeclampsia, there are other factors they consider.

On the scale of the amount of protein it goes:

• Trace (being just a tiny bit — and each # increases)
• +1
• +2
• +3
• +4 (this one would cause your doctor to be very concerned and you would likely head to the hospital for more testing — it shows high levels of protein)

These numbers are associated with a quick urine dipstick — the other tests (the ratio and the 24-hour urine have different numbers)

Keep in mind there are a lot of other reasons they test your urine, including gestational diabetes (but that’s a different test on the urine dipstick). They also test for white blood cells — which could show a kidney infection. Or red blood cells which could show kidney stones or an infection.

What is a high level of protein in your urine?

4+ protein in the urine is as high as a urine dipstick testing goes — they see that in a lot of severe cases of preeclampsia.  They have more definitive numbers in the 24-hour urine or the ratio test I mentioned above, and as a pregnant woman, you may end up taking that as well.

Treatment for protein in the urine/Preeclampsia Treatments

Hopefully, I’ve made it clear that it’s not the PROTEIN we’re treating, but preeclampsia. You can learn more about preeclampsia here.

Preeclampsia is a serious condition, so it’s an a big reason reason why prenatal checks are so important.

Keep in mind that high blood pressure ALONE would be just be more of a chronic hypertension (it also could just be around during pregnancy — which is called gestational hypertension) — so that would be treated DIFFERENT than preeclampsia. The protein creatinine ratio is really important in determining that.

If you are diagnosed with preeclampsia you may be induced early and have an early delivery — but all of that will be decided under a team of healthcare professionals, who most often consult a perinatologist (a high risk pregnancy doctor).

FAQ’s about Protein in Urine

Does protein in urine always mean preeclampsia?

Not always, but it is probably the most-often test used for diagnosis.

Is Protien in urine dangerous?

Nope, it’s what is CAUSING the protein in the urine that is dangerous (preeclampsia).

What is the first sign of preeclampsia?

Since doctors check your urine at checkups.  Often trace protein in the urine is the first sign.  But, severe headaches are often the first sign as well.

Keep in mind, it’s not unusual to have headaches during pregnancy — but a preeclampsia headache sticks around, even with Tylenol or water.

Tests need to be done with accurate results to give you a diagnosis of preeclampsia.

How does preeclampsia affect baby?

It can restrict blood flow to the baby (even if you have higher blood pressure, less is getting through the placenta) but mostly the problem is due to MOM’S health so that she doesn’t seize, etc.

Ultimately, if there is so much pulsating blood flow (shown by the high blood pressure) you could be at risk for a placental abruption where the placenta starts to peel from the uterine wall — a serious complication. Also, because your heart is working so hard with all of this it can cause heart disease, or pulmonary edema.

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If you have more questions about preeclampsia, don’t miss my whole other post about preeclampsia that will give more info on the treatments and more symptoms to keep an eye out for.

But, it’s important to understand the whole thing — bump to bassinet, so come join me in The Online Prenatal Class for Couples where we simplify things and easily get you prepared!

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.