Population-level data on antenatal screening for proteinuria; India, Mozambique, Nigeria, Pakistan

ABSTRACT

To estimate the prevalence and prognosis of proteinuria at enrolment in the 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia cluster randomized trials. We identified pregnant women eligible for inclusion in the trials in their communities in four countries (2013­2017). We included women who delivered by trial end and received an intervention antenatal care visit. The intervention was a community health worker providing supplementary hypertension-oriented care, including proteinuria assessment by visual assessment of urinary dipstick at the first visit and all subsequent visits when hypertension was detected. In a multilevel regression model, we compared baseline prevalence of proteinuria (≥1+ or ≥2+) across countries. We compared the incidence of subsequent complications by baseline proteinuria.Findings Baseline proteinuria was detected in less than 5% of eligible pregnancies in each country (India 234/6120; Mozambique 94/4234; Nigeria 286/7004; Pakistan 315/10 885), almost always with normotension (India 225/234; Mozambique 93/94; Nigeria 241/286; Pakistan 264/315). There was no consistent relationship between baseline proteinuria (either ≥1+ or ≥2+) and progression to hypertension, maternal mortality or morbidity, birth at <37 weeks, caesarean section delivery or perinatal mortality or morbidity. If proteinuria testing were restricted to women with hypertension, we projected annual cost savings of 153 223 981 United States dollars (US$) in India, US$ 9 055 286 in Mozambique, US$ 53 181 933 in Nigeria and US$ 38 828 746 in Pakistan. Our findings question the recommendations to routinely evaluate proteinuria at first assessment in pregnancy. Restricting proteinuria testing to pregnant women with hypertension has the potential to save resources.