Q & A: Protein in Urine

Q: We are approx. 9 weeks into our second pregnancy. We had our first
midwife appt. for this new pregnancy last week. When we used the urine test strip, I had protein in my urine. My midwife wasn't concerned and thought it was maybe that I'm not getting enough calories. Do you have any more information on what could cause protein in the urine so early in the pregnancy? My blood pressure is very low, I walk, am slim, drink lots of water, etc. Thanks for any advice you have!!!

A: Protein in the urine is common during pregnancy, and the causes range from benign to life-threatening. According to Anne Frye, one of the best authors on midwifery, protein in the urine can be caused by: dehydration, contamination from blood, contamination from vaginal secretions, contamination from semen, a urinary tract injection, a normal sign of normal kidney strain during pregnancy, strenuous exercise (including labor!) and, of course, the big bad ugly: pre-eclampsia/toxemia. I'll talk about pre-eclampsia later this week - that doesn't appear until at least 28 weeks (except in extraordinary circumstances). But since you are far from 28 weeks, that wouldn't be you.

Although Anne doesn't mention it, I have also seen protein spilled in people who have a history of eating disorders, which makes sense, because their kidneys and liver are more likely to have been stressed in the past. But unless you have a history of eating disorders or other liver/kidney problems, then that wouldn't be you either.

Urinary tract infections (UTI's) will have other signs - pain on urination, low back pain, etc., along with the presense of other things on the urine "dipstick."

Most midwives (as do doctors) check urine with a dipstick as a routine part of each prenatal. If they find something concerning, they will then proceed to have the pregnant woman do a "clean catch," which involves an acrobatic series of events with wipes and sterile cups and starting peeing before catching, and doing the hokie-pokie as you turn yourself around. If you had a large amount of protein in your urine, your midwife would probably proceed with a clean catch. But if it was just a small amount, they likely wouldn't worry about it. If it wasn't a clean catch, which it probably wasn't, then the likely suspects are the blood (even trace amounts that you can't see), vaginal washdown, or residual semen, which are all normal. Almost all women have a small amount of protein show on their dipstick at some point during pregnancy - some women have a low level show throughout the whole pregnancy!

As with any issue, if you feel concerned about the protein in your urine, talk with your midwife. If you still feel concerned, it's ok to ask to do a clean catch. Then you'll know if the protein is really in your urine, or from another source.