title: Maternal proteinuria in twin compared with singleton pregnancies.
abstract: OBJECTIVE
  To compare 24-hour urinary protein excretion in twin and singleton pregnancies not complicated by hypertension.
  
  
  METHODS
  We prospectively evaluated mean 24-hour urinary protein excretion in twin and singleton pregnancies between 24 0/7 weeks and 36 0/7 weeks of gestation. Women with urinary tract infections, chronic hypertension, pregestational diabetes, and renal or autoimmune diseases were excluded. Collection adequacy was assessed by urinary creatinine excretion adjusted for maternal weight.
  
  
  RESULTS
  Adequate samples were obtained from 50 twin and 49 singleton pregnancies at a mean gestational age of 30 weeks. At collection, the two groups were similar with regard to maternal age, gestational age, body mass index, and blood pressure. Mean urinary protein excretion was higher in twin compared with singleton pregnancies (269.3±124.1 mg compared with 204.3±92.5 mg, P=.004). Proteinuria (300 mg/day protein or greater) occurred in 38.0% (n=19) of twin and 8.2% (n=4) of singleton pregnancies (P<.001). After adjusting for confounding variables, the difference in mean total protein excretion remained significant (P=.004) and twins were more likely to have proteinuria compared with singleton pregnancies (adjusted odds ratio 9.1, 95% confidence interval 2.1-38.5). Nineteen participants developed a hypertensive disorder at a mean of 7.7 weeks after the urine collection (range 2.6-14.5 weeks). After excluding these women, proteinuria was present in 43% of twin and 7% of singleton pregnancies (P<.001).
  
  
  CONCLUSIONS
  Mean 24-hour urinary protein excretion in twin pregnancies is greater than in singletons. These data suggest a reevaluation of the diagnostic criteria for preeclampsia in twin pregnancies.
  
  
  METHODS
  II.
authors.affiliation: Departments of Obstetrics and Gynecology, Medicine, and Pathology, Stanford University School of Medicine, Stanford, and the Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Osmundson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lafayette
authors.forename: Raffick A
authors.initials: RA
authors.lastname: Bowen
authors.forename: Valerie C
authors.initials: VC
authors.lastname: Roque
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Garabedian
authors.forename: Natali
authors.initials: N
authors.lastname: Aziz
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000652:urine; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000097:blood / Q000652:urine*; D011446:Prospective Studies; D011507:Proteinuria / Q000097:blood / Q000652:urine*
chemical_list: D003404:Creatinine