Urine dipstick and protein:creatinine ratio in pregnancy
What each dipstick pad means in pregnancy, why a 1+ protein needs a spot protein:creatinine ratio, the 30 mg/mmol and ACR 8 mg/mmol thresholds (SOMANZ 2023, ISSHP, NICE), PCR accuracy against 24-hour collection, booking proteinuria, nephrotic-range results and worked examples.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The urine dipstick is a cheap screen at antenatal visits in women with hypertension or other risk factors. It measures concentration, so it misleads in dilute or concentrated urine.
- Any dipstick of 1+ or more in a hypertensive pregnant woman needs quantifying with a spot urine protein:creatinine ratio (PCR).
- PCR 30 mg/mmol or more (or ACR 8 mg/mmol or more) is significant proteinuria (SOMANZ 2023, ISSHP 2021). NICE NG133 uses the same 30 and 8 mg/mmol thresholds.
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Sources
- SOMANZ Hypertension in Pregnancy Guideline 2023AU/NZSociety of Obstetric Medicine of Australia and New Zealand (NHMRC approved), 2023 (current; no later version found, November 2026)
- The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis and management recommendations for international practiceMagee LA et al. Pregnancy Hypertens 2022;27:148-69, 2021 (no later ISSHP classification found, November 2026)
- Hypertension in pregnancy: diagnosis and management (NG133)National Institute for Health and Care Excellence, 2019, updated 2023
- Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic reviewCote AM, Brown MA, Lam E, et al. BMJ 2008;336:1003-6, 2008
- Australian Pregnancy Care Guidelines (asymptomatic bacteriuria, proteinuria testing)AU/NZLiving Evidence for Australian Pregnancy and Postnatal Care, funded by the Australian Government Department of Health, Living guideline, 2024 onwards
- Serum creatinine in pregnancy: a systematic reviewWiles K, Bramham K, Seed PT, et al. Kidney Int Rep 2019;4(3):408-19, 2019
- RCPA Manual (urine protein, urine albumin:creatinine ratio)AU/NZRoyal College of Pathologists of Australasia
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback