Urine in pregnancy, everything you need to know

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Philippe Gloaguen
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Contents

  • 1 What is the use of the urine test in pregnancy  
  • 2 How often to undergo urinalysis during pregnancy 
  • 3 How urine is collected 
  • 4 How do you read the urine test report during pregnancy 
  • 5 Substances found in the urine during pregnancy (chemical examination)
  • 6 Microscopic examination of urine in pregnancy 
  • 7 Urine culture: what it is and why it is done 
  • 8 Use of antibiotics in pregnancy 

During pregnancy it is one of the fixed appointments, one that you cannot really give up. We are not talking about the hairdresser or even the beautician, although both are not negligible. Let's talk about urinalysis. It is a very simple test that is repeated several times over the course of months and which gives important information on the state of health not only of the urinary tract, but also of other organs. Monitoring urine during pregnancy is therefore essential and now let's see in detail why.



What is the use of the urine test in pregnancy  

It may seem strange, but peeing is also an indicator of well-being, especially during pregnancy. In addition to its components, even its appearance can in fact tell us a lot about how we are and if there are any problems that we apparently do not see. Therefore, regularly undergoing this examination is very important. 

The presence in the urine of some substances (such as glucose or proteins) becomes the indicator of something that is not working as it should and that must be investigated in more detail. Recall that some ailments do not always give symptoms. Just to give an example, staying on the subject of the urinary tract, cystitis in pregnancy is sometimes asymptomatic. Without routine urinalysis, therefore, it may not be diagnosed, leading to more complex problems in the long run. 


How often to undergo urinalysis during pregnancy 

It is one of the exams that are done most regularly, practically every month. The recommendations of the Ministry of Health say that the complete urinalysis, together with the urine culture (we will see what it is later on), must be done: 


  • within the first trimester of pregnancy;
  • in the second quarter between weeks 24 + 0 and 27 + 6;
  • in the third quarter between weeks 33 + 0 and 37 + 6. 

In these three gestational periods, the examination is entirely paid by the National Health System (therefore it is free). However, gynecologists are more likely to prescribe it every month, due to its relevance in terms of health. 

How urine is collected 

The urine to be analyzed must be early in the morning because the concentration of the various substances contained is greater. Unlike most blood tests, you don't need to fast. Always wash your hands well before starting. Use a sterile container. You can buy it in pharmacies, parapharmacies or health centers, although it is often also found in supermarkets. 

The first jet of pee should not be collected because it stagnated in the urethra and was more in contact with the outside. Also be careful not to touch the edge of the container and the genitals with your hands. The sample must be delivered to the analysis laboratory as soon as possible, preferably within one hour of collection. 

How do you read the urine test report during pregnancy 

The urinalysis is basically divided into two parts: 


  • Physical and chemical analysis.
  • Sediment analysis. 

Physical analysis indicates the main characteristics of the urine. Based on them and any modifications, the doctor can understand if in fact there is some small or big problem. We list a few to give you an idea of ​​what we are talking about. 

  • Color. The normal one is straw-yellow. Urine color can be influenced by various factors, such as nutrition or certain medications. That is, it could happen that after taking a pregnancy supplement or eating carrots, pee turns orange. In some cases, however, the color is the indicator of a possible problem: for example, blue / green urine can be caused by a bacterial infection. Dark yellow urine indicates a strong concentration or presence of bilirubin, while pink ones are associated with the intake of anticoagulants. 
  • Odor. This feature can also depend on various elements, including foods and drugs. For example, if you smell sweet / fruity, ketones may be present, for example due to vomiting. An ammonia smell, on the other hand, can also mean that a long time has passed between collection and analysis and the bacteria are alkalizing the urine. The smell of beer, on the other hand, is often a sign of urinary tract infections. 
  • Appearance. Normally the urine must be clear, transparent. If, on the other hand, their appearance is cloudy, there may be an infection in progress or the amount of water taken by the expectant mother is scarce. In fact, especially if you are in the first period and suffer from nausea or vomiting, drinking becomes difficult, considering among other things that the quantity should be at least one and a half liters per day. 
  • Specific weight. Its value indicates the ability of the kidneys to concentrate and excrete urine. It therefore gives information on renal function. The higher the specific gravity, the more concentrated the urine. Normal specific gravity values ​​range from 1,015 to 1,030. The increase or decrease may depend on various factors, from the amount of fluids taken, from medications, from certain diseases, to stress. 
  • pH. The correct pH level is between 5 and 7 and indicates the person's acid-base state. A pH greater than 7 is often found when there is a urinary tract infection (very frequent during pregnancy) or other types of problems. Low values, on the other hand, could be linked to disorders such as dehydration, fever, diarrhea. In addition to drugs, some foods also influence the pH trend. Fruits and vegetables, for example, tend to increase it, while high-protein diets make urine more acidic and therefore lower the pH. 

Substances found in the urine during pregnancy (chemical examination)

In addition to the characteristics we have just listed, the chemical-physical analysis also gives information on the presence of some substances in the urine. In most cases they shouldn't be there, so they're a sign that something is wrong. Let's see some examples. 



  • Glucose. It is usually absent or is present in very small quantities. If, on the other hand, the value rises, it means that there is an important circulation of sugars in the blood which are therefore partially eliminated by urinating. Excess glucose is one of the symptoms of gestational diabetes. If it is found in the urine it is likely that other tests, such as the glucose load curve, will be needed.
  • Chetonic bodies. Ketones are substances that develop when the body runs out of sugar and starts burning fat. It is the mechanism of acetone in children, which occurs for example when they have a very high fever or vomit or even after a very intense effort. The presence of ketone bodies in the urine of a pregnant woman could be explained by pregnancy vomiting.
  • Nitrites. Under normal conditions, there should be no nitrites in the urine. If, on the other hand, they are highlighted by the urine test, it means that there is probably a urinary tract infection of bacterial origin. The hypothesis is more plausible if there is a pH above 7 and a cloudy appearance of the urine. Among the most common pathogens (also in pregnancy) are Escherichia coli and Klebsiella. 
  • Proteins. During pregnancy they are a very important indicator, when they are found in the urine. If the upside is mild and there are no other symptoms, the situation is of no particular concern. The problem is if other disorders, such as high blood pressure and edema (swelling caused by fluid accumulation) also appear at the same time. These are all alarm bells of preeclampsia, which absolutely must not be taken lightly due to the serious consequences it can have on the baby and mother. In case of protein in the urine, the pregnant woman will be closely monitored to monitor the progress of the pregnancy. 
  • Hemoglobin. It is a red-colored protein found in red blood cells. Its function is to transport oxygen to all the tissues of the body. Finding it in the urine therefore means the presence of blood, which should not happen. Among the causes are cystitis, cervical polyps, gravel (it is a kind of "sand" inside the kidneys that can cause small blood loss in the ureter), kidney stones. 
  • Bilirubin. It is produced by the destruction of red blood cells and is the main pigment in bile. Its presence in the urine may suggest liver problems, but regardless of pregnancy.  

Microscopic examination of urine in pregnancy 

In addition to being analyzed from the point of view of appearance and chemical composition, the other parameter that is checked is the sediment, that is, what settles on the bottom of the test tube after the centrifugation process and is viewed under the microscope. It is therefore possible to find: 


  • Leukocytes. They are white blood cells and, especially if other parameters are positive, they indicate that there is an infection in progress. 
  • Erythrocytes. Another way to define red blood cells. Small traces of blood in the urine are of no concern, but they need to be monitored. When there is hemoglobin in the physico-chemical examination, it is likely that there are erythrocytes in the microscopic examination.
  • Cells of the lower or upper pathways. If they are few, they are not of particular concern because they derive from the normal turnover of the superficial layer of urinary tract cells.
  • Crystals. They are formed, for example, if you drink little or because of your diet. A diet rich in cheese or meat is a predisposing factor. 
  • Bacteria. If there are no other signs of infection (for example, changes in pH or appearance, presence of white blood cells, etc.), it could simply be due to the low amount of water normally consumed. It is therefore advisable to drink more and repeat the exam. Different speech if instead there are other elements that suggest an infectious state. In this case a urine culture is required.
  • Fungi. They are mushrooms. If there are also white blood cells, an upper or lower urinary tract infection is likely. 
  • Cylinders. Normally there are none in the urine. Their presence therefore indicates a problem, such as acute or chronic kidney disease. 

Urine culture: what it is and why it is done 

Urine culture is a urine test that is performed in the same way as the "simple" one we have talked about so far. Its purpose is to detect any bacteria that indicate a urinary tract infection. It is also a "second level" exam. If the normal one gives the suspicion of an infection, a urine culture is done to understand the responsible person. 

The urine culture is associated with the so-called antibiogram. It is a laboratory test that puts the microorganism found in the urine in contact with an antibiotic. The aim is to figure out which drug is most effective for that specific bacterium. Not all antibiotics are in fact indicated for the treatment of infections. Often what is suitable for treating a urinary problem is not good for the respiratory tract. Moreover, using drugs improperly favors antibiotic resistance, the phenomenon that makes diseases resistant to certain drugs because the pathogen has "got used" to their mechanism of action. It is therefore important to choose the right product. 

Use of antibiotics in pregnancy 

The urinalysis is positive, the urine culture has identified the culprit bacterium, the gynecologist prescribes the antibiotic and you worry. Don't panic, moms! It is a well-considered choice for you and your baby's health. There are antibiotics that are compatible with pregnancy and you shouldn't be afraid of harming your little one. They have been specially designed. So be calm. It is much more important to heal. The risk of some diseases is much higher than that of antibiotics. In any case, never do it your own way: drugs are only taken under medical supervision. 

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