Indicated vs. routine prenatal urine chemical reagent strip testing

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Diagnostics

Background:

• Prenatal care guidelines often include routine urine screening.
• The diagnostic yield and cost-effectiveness of routine vs. indicated testing are debated.
• Gestational diabetes mellitus (GDM), hypertension, and UTIs are common pregnancy complications.

Purpose of the Study:

• To compare the rates of diagnosing urinary tract infection (UTI), high blood pressure, and gestational diabetes mellitus (GDM) using routine versus clinically indicated prenatal urine testing.
• To evaluate the safety and efficacy of discontinuing routine urine screening.

Main Methods:

• Retrospective review of prenatal and delivery records for 2,981 subjects.
• Comparison of diagnoses between a period of routine urine screening (pre-August 2002) and a period of indicated urine screening (post-August 2002).
• Analysis included UTI, hypertension, and GDM diagnoses.

Main Results:

• Diagnosis rates for hypertension and UTI were similar between routine and indicated testing groups.
• The incidence of GDM significantly decreased from 9.3% to 4.2% after shifting to indicated screening, despite unchanged GDM screening protocols.
• No underdiagnosis of key conditions was observed with indicated testing.

Conclusions:

• Clinically indicated prenatal urine testing is adequate for diagnosing UTI, hypertension, and GDM.
• Discontinuing routine urine screening is safe and can be implemented with a protocol including initial urine cultures, timely GDM screening, indicated reagent strip testing, and routine blood pressure monitoring.
• Clear definition and consistent application of criteria for indicated urine testing are essential for successful implementation.