Indicated vs. routine prenatal urine chemical reagent strip testing.

Objective: To determine if urinary tract infection, high blood pressure and gestational diabetes mellitus (GDM) are underdiagnosed when prenatal urine testing is done on a clinically indicated vs. routine basis.

Study Design: Prenatal and delivery records of 2,981 subjects were reviewed in a predominantly Hispanic and medically underserved population. Patients prior to August 2002 received routine urine screening. After August 2002, women were tested only if preestablished criteria were present.

Results: The number of patients diagnosed with high blood pressure and urinary tract infection was equivalent in the 2 groups. Despite unchanged screening for GDM between groups, the incidence of GDM declined from 9.3% to 4.2%.

Conclusion: GDM, high blood pressure and urinary tract infection will not be underdiagnosed if prenatal urine testing is done on an indicated basis. It is safe to discontinue routine urine screening when a regimen of initial urine cultures, GDM screening at 24-28 weeks, indicated urine chemical reagent strip testing and routine blood pressure determination is used. Criteria for indicated urine testing should be clearly defined and consistently followed by all staff.