THE VALUE OF URINE SCREENING FOR GLUCOSE AT EACH PRENATAL VISIT

Objective: To determine whether chemical (dipstick) urinalysis for glu cose at each prenatal visit predicts gestational outcomes such as gest ational diabetes, abruptio placentae, preterm delivery, fetal heart ra te abnormality, cesarean delivery for dystocia, fetal macrosomia and s houlder dystocia. Methods: We retrospectively evaluated each of the 32 17 women who were delivered at St. Joseph's Hospital between July 1, 1 990, and September 1, 1993, and who had received all prenatal care at Marshfield Clinic. Study subjects had complete urinalyses at the first prenatal visit, blood glucose diabetes screening at 24-28 weeks, and dipstick urinalysis for glucose at each prenatal visit. Women were exc luded because of preexisting diabetes, multiple gestation, glucosuria at the first prenatal visit, or failure to complete the recommended bl ood screening at 24-28 weeks. The remaining 2965 women were grouped ac cording to whether their dipstick urine tests were positive for glucos e. Then the two groups were compared with regard to relevant pregnancy outcomes. Results: Women with glucosuria in the first two trimesters had a significantly higher incidence of gestational diabetes (12.8 ver sus 2.9%, P = .003). For women without evidence of gestational diabete s, there were no clinically important differences in the measured preg nancy outcomes between the two groups. Conclusion: Routine dipstick ur inalysis for glucose can identify gravidas at increased risk for gesta tional diabetes, possibly allowing certain women with gestational diab etes to be diagnosed earlier than 24-28 weeks. However, most glucosuri a testing is performed after a patient has completed routine blood scr eening for gestational diabetes. This third trimester testing is not p redictive of any clinically important pregnancy outcome.