Nutritional Intervention in Multiple Gestation Influences the Degree of Proteinuria [4C]

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Abstract

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

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