Urinalysis is a part of the routine prenatal tests to diagnose any medical condition during pregnancy, including kidney infections, preeclampsia, and gestational diabetes. It also detects the increase of leukocytes in urine during pregnancy, which may indicate the presence of any infection or inflammation of the genitourinary or urinary tract. You may also need the urinary test to check the functioning of the maternal organs (1) (2). Read on to know the causes, risk factors, symptoms, diagnosis, treatment management, and preventive measures for leukocytes or white blood cells (WBCs) in urine when pregnant.
What Are Leukocytes In Urine?
Leukocytes or WBCs are a part of your immune system and include granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (T cells and B cells). Together, these WBCs help the body fight infections and other diseases. In general, measuring the leukocyte count is a part of a complete blood cell count (CBC) test (3). However, if urinary tract infections (UTIs) or inflammation are suspected, your health care provider may suggest a urine test to detect the presence of leukocytes (particularly neutrophils). Normally, urine is sterile, so the normal range of leukocytes in urine is low, i.e., up to 5 WBCs per high power field (WBC/HPF) (4). According to Dr. Alan Lindemann, obstetrician, who was also a former clinical associate professor at the University of North Dakota, Grand Forks, “Leukocytes are elevated in blood and urine during pregnancy, but the normal depends on where you start. If your non-pregnant WBC is 5000, then a WBC of 10,000 or 11,000 is probably normal for pregnancy, but if you start your pregnancy with a higher WBC, normal for you could rise to 15,000. “A urine WBC might not signify a bladder infection, but it could forecast trouble. An elevated WBC could represent a Group B strep infection, so a urine culture is needed because a Group B strep bladder infection can cause kidney infection and preterm labor or birth.”
Causes Of Leukocytes In Urine During Pregnancy
During pregnancy, elevated levels of leukocytes in urine may occur due to various infections, including
Symptoms Of White Blood Cells In Urine When Pregnant
The symptoms of WBCs or leukocytes in the urine samples of pregnant women may vary depending on the underlying cause. Some of these symptoms include (13) (14)
Dysuria (pain or burning while urinating) Frequent urination Urine urgency Suprapubic pain Foul-smelling urine Flank pain or renal angle (lower back) pain Rigor Fever (pyrexia) Nausea and vomiting
Diagnosis Of Leukocytes In Urine During Pregnancy
Dr. Lindemann observes, “There are two ways to check for leukocytes in urine during pregnancy: a clean catch urine sample or sterile catheterization. With more vaginal discharge in pregnancy, sterile catheterization is the most accurate test for leukocytes during pregnancy.” The following diagnostic methods can be used to detect leukocytes in urine (14):
Collection of the urine sample: Generally, a clean-catch urine sample is recommended. Your doctor may provide a clean-catch kit with a washing solution and sterile wipes, or you may be asked to collect a small sample of clean, midstream urine in a sterile plastic cup. Urine dipstick test: Your health care provider may test the sample right after the urine sample collection. Chemically prepared testing strips of leukocyte esterase with a color-sensitive pad are dipped into your urine sample to screen for indicators such as leukocytes.
Positive test: If the strip changes color within 30 seconds to two minutes (depending on the brand), it is taken as a positive test, suggesting infection or inflammation in the urinary tract. Negative test: If the strips show no color change, your urine sample may not have a significant amount of leukocytes. However, high protein and vitamin C levels in the urine or specimen contamination with vaginal secretions may interfere with the result. In such cases, your doctor may recommend a urine culture if you have other symptoms suggestive of UTI.
The urine sediment of a fresh urine sample is centrifuged at 1,500 to 3,000 rpm for five minutes and resuspended in the remaining liquid for analysis. A single drop is deposited on a clean glass slide, covered with a coverslip, and viewed under a microscope.
Treatment Of Elevated White Blood Cells In Urine During Pregnancy
The treatment options may vary depending on the cause and elevation level of leukocytes in the urine. Some common treatment methods to balance or decrease the levels of leukocytes in urine during pregnancy are
Complications Of Elevated White Blood Cells In Urine During Pregnancy
Treatment should be initiated soon after a high level of leukocytes is detected in urine samples to prevent adverse obstetrical outcomes. Some of the maternal complications include (10)
Preeclampsia Anemia Preterm delivery Maternal sepsis Chorioamnionitis (bacterial infection in the membranes surrounding the fetus)
It can also cause the following complications in the fetus (20):
Low birth weight Tachycardia Premature birth
Growth restriction Stillbirth Perinatal mortality Mental retardation Developmental delay
Prevention Of Elevated White Blood Cells In Urine During Pregnancy
Here are some tips that may help prevent elevated leukocytes in the urine (13) (18):
Do regular urine tests as suggested by your doctor to prevent recurrent infections Drink plenty of water Consume cranberry juice and supplements
Maintain good hygiene practices, such as wiping from front to back after a bowel movement Avoid synthetic and tight-fitting lingerie Avoid perfumed genital washing gels
