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ORIGINAL ARTICLE
Adv Biomed Res 2016,  5:186

Investigation of the relationship between idiopathic microscopic hematuria (in the first and second trimesters) and major adverse outcomes of pregnancy


1 Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran

Date of Submission14-Jul-2014
Date of Acceptance05-Jun-2016
Date of Web Publication28-Nov-2016

Correspondence Address:
Dr. Mahboobeh Esteki Bardeh
Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-9175.192736

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  Abstract 

Background: The aim of this study was to investigate the relationship between idiopathic microscopic hematuria (in the first and second trimesters) and major adverse outcomes of pregnancy.
Materials and Methods: Urinalysis was done for 700 pregnant women before 24 weeks of pregnancy. Those who had 3–5 red blood cells per milliliter in urinalysis were considered positive urinalysis. Then, all individuals were examined for blood pressure and other alarm signs of pregnancy complications in each visit. All mothers were followed for the incidence of preeclampsia, preterm delivery, and pregnancy outcome until the end of pregnancy.
Results: The results of this study showed that no significant difference in terms of incident of pregnancy complications between the pregnant women with and without hematuria and the only abortions and neonatal deaths differed between the two groups.
Conclusion: These results suggest that further studies are needed to determine whether idiopathic microscopic hematuria can be a predictive value for pregnancy complications or not.

Keywords: Idiopathic microscopic hematuria, low birth weight, preeclampsia, preterm labor


How to cite this article:
Shahraki AD, Bardeh ME, Najarzadegan MR. Investigation of the relationship between idiopathic microscopic hematuria (in the first and second trimesters) and major adverse outcomes of pregnancy. Adv Biomed Res 2016;5:186

How to cite this URL:
Shahraki AD, Bardeh ME, Najarzadegan MR. Investigation of the relationship between idiopathic microscopic hematuria (in the first and second trimesters) and major adverse outcomes of pregnancy. Adv Biomed Res [serial online] 2016 [cited 2017 Dec 11];5:186. Available from: http://www.advbiores.net/text.asp?2016/5/1/186/192736


  Introduction Top


Preterm labor, fetal growth restriction, low birth weight, and preeclampsia are considered as the most important and most common adverse pregnancy outcomes. Hypertensive disorders occur in the course of 5–10% of all pregnancies and can be allocated a major contribution to maternal morbidity and mortality.[1]

It is important that preeclampsia has prevented more than half of all deaths associated with pregnancy hypertension.[2]

Preeclampsia also caused fetal growth restriction with impaired uterine placental perfusion due to vascular spasm, and it is a major cause of increased rates of perinatal morbidity and mortality.[2]

Hence, it has been suggested to measure the various biological, biochemical, and biophysical markers that are involved in the pathophysiology of preeclampsia during early pregnancy to predict occurrence the disease.[3]

In a number of retrospective and prospective studies, it has been shown significant association between idiopathic hematuria and adverse pregnancy outcomes, particularly in preeclampsia.[4],[5] Significance of microscopic hematuria, especially during early pregnancy, is still unclear, and in some studies, association between the microscopic hematuria and pregnancy complications has been doubtful.

Incidence of microscopic hematuria during pregnancy has been reported 3–20%, and subsequently, its association with increased risk of preeclampsia has been reported from 2 to 8 times more than normal.[6]

Because of the preeclampsia is a major cause of maternal mortality, it is important prognostic factors. Urinalysis test is low cost and can be done in the first prenatal care visit, and it can estimate the risk of preeclampsia during pregnancy. Further, it can reduce heavy financial and emotional burden of preterm birth. The aim of this study was investigation of the relationship between idiopathic microscopic hematuria (in the first and second trimesters) and major adverse outcomes of pregnancy.


  Materials and Methods Top


This study is a prospective cohort study that was carried out on pregnant women referred to obstetric clinics of Alzahra Hospital and Shahid Beheshti Hospital in Isfahan, Iran. The study was conducted from January 2013 for 1 year and the samples were selected randomly.

The pregnant women who referred to gynecology clinic were examined by a gynecologist. Eligible women were informed about the study and informed consent was obtained from the participants.

Pregnant women referred to obstetrics and gynecology clinics were evaluated in terms of the prevalence of microscopic hematuria and urine analysis. All participants had informed consent. Then, those patients who had idiopathic microscopic hematuria were enrolled in the study.

Participants who have a history of chronic hypertension, preeclampsia, diabetes, collagen vascular diseases, and general diseases such as diabetes mellitus, hypertension, chronic heart, kidney, liver, and endocrinology disease that may be associated with an increased risk of high blood pressure or other complications of pregnancy were excluded from the study.

Notably urine sampling was performed before any vaginal pelvic examination, which might be associated with bladder irritation. In addition, participants who had an anterior placenta position were excluded from the study because of the potential impact on the bladder and hematuria.

Urinalysis was done two times for all participants before 24 weeks of pregnancy. Pregnant women who had 3–5 red blood cells per milliliter in urinalysis were considered as positive urinalysis.

The causes of microscopic hematuria were investigated, and after exclusion of urologic causes, infectious and other causes of hematuria based on history, physical examination, and routine laboratory tests, participants with idiopathic microscopic hematuria were enrolled in the study.

Then, all individuals were examined for blood pressure and other alarming signs of pregnancy complications in each visit. All mothers were followed for the incidence of preeclampsia, preterm delivery, and pregnancy outcome until the end of pregnancy.

Data were analyzed using the Statistical Package for the Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA). Chi-square test has been used for between-group differences, and Logistic regression to predict the effect of variables related to gestational diabetes. A P < 0.05 was considered statistically significant.


  Results Top


A total of 700 pregnant women were included in the study. Ninety participants (12.86%) had hematuria in urine analysis in the first and second trimesters and 610 participants (87.14%) had not. The mean age of participants was 28.42 years (5.65 standard deviation, range 17–36 years). The mean age of participants with hematuria was 28.25 ± 5.621 years and without hematuria was 28.59 ± 5.679 years, and difference between two groups was not significant (P = 0.791). It showed that two groups of patients were matched in terms of age.

The results of comparisons between the pregnancy outcomes participants with and without microscopic hematuria are shown in [Table 1].
Table 1: Comparison the pregnancy outcomes between participants with and without microscopic hematuria

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The results of correlation between microscopic hematuria and pregnancy outcome are shown in [Table 2].
Table 2: Correlation between microscopic hematuria and pregnancy outcome

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  Discussion Top


Dipstick hematuria is very common during pregnancy but rarely signifies a disorder likely to impact on the pregnancy outcome.

The present study was conducted to investigate the association between idiopathic microscopic hematuria with pregnancy complications. The results of this study showed that the incidence of hematuria in pregnant women was 12.86%. In the previous studies, the incidence of microscopic hematuria during pregnancy has been reported 3–20%,[6] and the results of the present study were consistent with the previous studies.

The results of this study showed no significant difference in terms of incident of pregnancy complications between the pregnant women with and without hematuria and the only abortions and neonatal deaths differed between the two groups.

In a retrospective cohort study that was conducted on 276/328 pregnant women to estimate the prevalence and associated risk of adverse pregnancy outcomes among pregnant women with microhematuria, 60% of the women had hematuria. Those with hematuria were at increased risk of developing preeclampsia (odds ratio [OR] =9.5) and premature labor (OR = 3.8). These associations persisted after controlling for age, race, and urinary tract infection (preeclampsia OR = 9.1; premature labor OR = 4.2). Infants of women with hematuria were at a nonsignificantly increased risk of low Apgar scores (OR = 2.8) and low birth weight (OR = 1.9). In that study, microscopic hematuria was independently associated with an increased risk of adverse maternal complications such as preeclampsia and premature labor.[6]

The results of a study by Stehman-Breen et al. on 4307 pregnant women with follow-up to at least 20 weeks' gestation showed that 132 (3%) of participants had idiopathic hematuria during pregnancy. Idiopathic hematuria was associated with an almost 2-fold increased odds for development of preeclampsia (adjusted OR = 1.89, 95% CI 1.12–3.18) but not with increased odds of gestational hypertension (OR = 0.78, 95% CI 0.46–1.32), and it was associated with greater risk of preeclampsia but not gestational hypertension.[7]

The cause of differences between the results of our study with above studies can be due to the lower sample size of our study. The sample size in this study was 700 and this is much less than the above-mentioned studies. However, our results are consistent with the results of other studies.

A cohort study by Brown et al. surveyed the prevalence of hematuria and the development of preeclampsia, gestational hypertension, and preterm labor in 902 pregnant women. The development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby was similar in women with and without dipstick hematuria.[8] These results suggest that further studies are needed to determine whether idiopathic microscopic hematuria can be a predictive value for pregnancy complications or not.

On the other hand, it is important to follow-up pregnant women with idiopathic microscopic hematuria during and after pregnancy.

Study of Brown et al. showed that microscopic hematuria persisted in half (15 women) after 3 months of postpartum follow-up. Postpartum follow-up is recommended to detect women who have persistent hematuria and presumed underlying mild glomerulonephritis.[8]

To the best of our knowledge, there was no study about hematuria and pregnancy in Iran.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cunningham L, Bloom H, Spon R. Williams Obstetrics. 23rd ed. Philadelphia: Lippincott Williams & Wilkins (LWW); 2010. p. 706-15.  Back to cited text no. 1
    
2.
Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of pregnancy-related deaths: Results of a state-wide review. Obstet Gynecol 2005;106:1228-34.  Back to cited text no. 2
    
3.
Radisic MV, Feldman D, Diaz C, Froment RO. Unexplained hematuria during pregnancy: Right-sided nutcracker phenomenon. Int Urol Nephrol 2007;39:709-11.  Back to cited text no. 3
    
4.
Chen Y, Liu F, Xing J, Liu R. Treatment of hematuria caused by renal arteriovenous malformation in pregnant patients. Int J Clin Exp Med 2015;8:3027-9.  Back to cited text no. 4
    
5.
Pillalamarri N, Shalom D, Sanidad S, Akerman M, Lind L, Winkler H. The prevalence of microscopic hematuria in a cohort of women with pelvic organ prolapse. Int Urogynecol J 2015;26:85-90.  Back to cited text no. 5
    
6.
Stehman-Breen C, Miller L, Fink J, Schwartz SM. Pre-eclampsia and premature labour among pregnant wowen with haematuria. Paediatr Perinat Epidemiol 2000;14:136-40.  Back to cited text no. 6
    
7.
Stehman-Breen CO, Levine RJ, Qian C, Morris CD, Catalano PM, Curet LB, et al. Increased risk of preeclampsia among nulliparous pregnant women with idiopathic hematuria. Am J Obstet Gynecol 2002;187:703-8.  Back to cited text no. 7
    
8.
Brown MA, Holt JL, Mangos GJ, Murray N, Curtis J, Homer C. Microscopic hematuria in pregnancy: Relevance to pregnancy outcome. Am J Kidney Dis 2005;45:667-73.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
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[Pubmed] | [DOI]



 

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