Pregnant women with twins consume high amounts of protein, up to 175 grams daily. Proteinuria increases as a woman's protein intake increases. Providers may not be aware that diet can influence proteinuria and they might falsely think proteinuria is a sign of preeclampsia. We questioned how much more proteinuria our multiples patients had after eating a higher protein diet.
We identified a group of ten pregnant women with twins without increased risk for proteinuria. After obtaining baseline 24 hour collections of urinary protein and urinary spot protein:creatinine ratios (PR:CR), they were asked to follow a balanced high protein diet. After informed consent, we prospectively followed them after the higher protein intervention through delivery obtaining successive urinary collections in second and early third trimesters. A dietitian reviewed their dietary intake logs. For each patient, we analyzed any differences in proteinuria as the pregnancy progressed and examined perinatal outcomes.
Patients often increased their protein intake throughout pregnancy confirmed by 24 hour collections (P<.01). Urinary PR:CR was less precise in both trimesters but was statistically higher after the intervention (P=.03 and P<.01, respectively). One patient was labeled as a preeclamptic at delivery based upon one BP elevation and her proteinuria.
Proteinuria increases significantly in the last two trimesters related to our dietary recommendations in multiples. A larger study would be needed to identify if patients are being falsely labeled as preeclamptics. Providers need to be educated about diet related proteinuria.
Mednax, Obstetrix of WA, Eastside Maternal Fetal Medicine, Kirkland and Bellevue, WA
Financial Disclosure: The author did not report any potential conflicts of interest.