Obstetrics & Gynecology>>>>>Maternal-Fetal Physiology and Placentation
Question 11#

During a routine return OB visit, an 18-year-old G1P0 patient at 23 weeks’ gestational age undergoes a urinalysis. The dipstick done by the nurse indicates the presence of trace glucosuria. All other parameters of the urine test are normal.

Which of the following is the most likely etiology of the increased glucose detected in the urine?

A. The patient has gestational diabetes
B. The patient has a urinary tract infection
C. The patient’s urinalysis is consistent with normal pregnancy
D. The patient’s urine sample is contaminated
E. The patient has underlying renal disease

Correct Answer is C

Comment:

The finding of glucosuria is common during pregnancy, and usually is not indicative of a pathologic condition. During pregnancy, there is an increase in the glomerular filtration rate, and a decrease in tubular reabsorption of filtered glucose. In fact, one in six women will spill glucose into the urine during pregnancy. If the patient has risk factors for gestational diabetes, such as obesity, previous macrosomic baby, advanced maternal age, or family history of diabetes, the physician may want to screen for diabetes with a glucose challenge test. If the patient has a urinary tract infection, the dipstick will be more likely to show an increase in WBCs, and the presence of nitrites and blood. A contaminated urine sample would not be a cause of isolated glucosuria.