Preg Hypertens 1 Clinical significance of proteinuria determined with dipstick test , edema , and 2 weekly weight gain ≥ 500 g at antenatal visit 3 4

22 Objective: To determine how urine dipstick test, edema, and/or excessive weight gain 23 (EWG, defined as ≥ 500 g/week) at antenatal visits predict significant proteinuria 24 (defined as a protein-to-creatinine ratio [P/Cr, mg/mg] ≥ 0.27) and preeclampsia. 25 Methods: Data from 3279 antenatal visits between 30 and 36 weeks of gestation were 26 studied in 783 women with singleton pregnancies. In 24 preeclamptic pregnancies, data 27 from 89 antenatal visits at and before diagnosis of preeclampsia were used. Spot P/Cr 28 was determined in women with repeated positive dipstick test results in two successive 29 antenatal visits or in those with a positive dipstick test result test in the presence of 30 hypertension. 31 Results: Proteinuria on dipstick test, edema, and EWG appeared often in both women 32 with and without preeclampsia; 66.7% vs. 27.7%, 83.3% vs. 44.1%, and 91.7% vs. 33 81.6%, respectively. However, repeated positive dipstick test results in two successive 34 antenatal visits yielded sensitivity of 45.5%, specificity of 95.2%, and positive and 35 negative predictive values of 30.0% and 97.4%, respectively, for detection of significant 36 proteinuria and corresponding figures of 33.3%, 94.1%, 14.0%, and 98.0% for 37 prediction of preeclampsia. 38 Conclusion: Repeated positive dipstick test results in two successive antenatal visits 39 warrant a need for confirmation test of significant proteinuria. 40