Skip to main content
Top
Published in: European Journal of Nutrition 1/2017

Open Access 01-02-2017 | Original Contribution

Urine color as an indicator of urine concentration in pregnant and lactating women

Authors: Amy L. McKenzie, Colleen X. Muñoz, Lindsay A. Ellis, Erica T. Perrier, Isabelle Guelinckx, Alexis Klein, Stavros A. Kavouras, Lawrence E. Armstrong

Published in: European Journal of Nutrition | Issue 1/2017

Login to get access

Abstract

Aim

Urine concentration measured via osmolality (U OSM) and specific gravity (U SG) reflects the adequacy of daily fluid intake, which has important relationships to health in pregnant (PREG) and lactating (LACT) women. Urine color (U COL) may be a practical, surrogate marker for whole-body hydration status.

Purpose

To determine whether U COL was a valid measure of urine concentration in PREG and LACT, and pair-matched non-pregnant, non-lactating control women (CON).

Methods

Eighteen PREG/LACT (age 31 ± 1 years, pre-pregnancy BMI 24.3 ± 5.9 kg m−2) and eighteen CON (age 29 ± 4 years, BMI 24.1 ± 3.7 kg m−2) collected 24-h and single-urine samples on specified daily voids at five time points (15 ± 2, 26 ± 1, and 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation; CON visits were separated by similar time intervals) for measurement of 24-h U OSM, U SG, and U COL and single-sample U OSM and U COL.

Results

Twenty-four-hour U COL was significantly correlated with 24-h U OSM (r = 0.6085–0.8390, P < 0.0001) and 24-h U SG (r = 0.6213–0.8985, P < 0.0001) in all groups. A 24-h U COL ≥ 4 (AUC = 0.6848–0.9513, P < 0.05) and single-sample U COL ≥ 4 (AUC = 0.9094–0.9216, P < 0.0001) indicated 24-h U OSM ≥ 500 mOsm kg−1 (representing inadequate fluid intake) in PREG, LACT, and CON.

Conclusions

Urine color was a valid marker of urine concentration in all groups. Thus, PREG, LACT, and CON can utilize U COL to monitor their daily fluid balance. Women who present with a U COL ≥ 4 likely have a U OSM ≥ 500 mOsm kg−1 and should increase fluid consumption to improve overall hydration status.
Literature
2.
go back to reference Häussinger D (1996) The role of cellular hydration in the regulation of cell function. Biochem J 313(Pt 3):697–710CrossRef Häussinger D (1996) The role of cellular hydration in the regulation of cell function. Biochem J 313(Pt 3):697–710CrossRef
3.
go back to reference Hytten FE, Paintin DB (1963) Increase in plasma volume during normal pregnancy. J Obstet Gynaecol 70:402–407CrossRef Hytten FE, Paintin DB (1963) Increase in plasma volume during normal pregnancy. J Obstet Gynaecol 70:402–407CrossRef
4.
go back to reference Goodlin RC, Anderson JC, Gallagher TF (1983) Relationship between amniotic fluid volume and maternal plasma volume expansion. Am J Obstet Gynecol 146:505–511CrossRef Goodlin RC, Anderson JC, Gallagher TF (1983) Relationship between amniotic fluid volume and maternal plasma volume expansion. Am J Obstet Gynecol 146:505–511CrossRef
5.
go back to reference Hytten FE, Thomson AM, Taggart N (1966) Total body water in normal pregnancy. J Obstet Gynaecol 73:553–561CrossRef Hytten FE, Thomson AM, Taggart N (1966) Total body water in normal pregnancy. J Obstet Gynaecol 73:553–561CrossRef
7.
go back to reference Neville MC, Keller R, Seacat J et al (1988) Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 48:1375–1386 Neville MC, Keller R, Seacat J et al (1988) Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 48:1375–1386
9.
go back to reference Institute of Medicine (US) Panel on Dietary Reference Intakes for Electrolytes, Water (2005) DRI, dietary Reference Intakes for water, potassium, sodium, chloride, and sulfate. Institute of Medicine of the National Academies,Washington, DC Institute of Medicine (US) Panel on Dietary Reference Intakes for Electrolytes, Water (2005) DRI, dietary Reference Intakes for water, potassium, sodium, chloride, and sulfate. Institute of Medicine of the National Academies,Washington, DC
12.
go back to reference Johnson EC, Muñoz CX, Le Bellego L et al (2015) Markers of the hydration process during fluid volume modification in women with habitual high or low daily fluid intakes. Eur J Appl Physiol 115:1067–1074. doi:10.1007/s00421-014-3088-2 CrossRef Johnson EC, Muñoz CX, Le Bellego L et al (2015) Markers of the hydration process during fluid volume modification in women with habitual high or low daily fluid intakes. Eur J Appl Physiol 115:1067–1074. doi:10.​1007/​s00421-014-3088-2 CrossRef
13.
go back to reference Armstrong LE, Pumerantz AC, Fiala KA et al (2010) Human hydration indices: acute and longitudinal reference values. Int J Sport Nutr Exerc Metab 20:145–153CrossRef Armstrong LE, Pumerantz AC, Fiala KA et al (2010) Human hydration indices: acute and longitudinal reference values. Int J Sport Nutr Exerc Metab 20:145–153CrossRef
15.
16.
go back to reference Hong PL, Leong M, Seltzer V (1988) Uroflowmetric observations in pregnancy. Neurourol Urodyn 7:61–70CrossRef Hong PL, Leong M, Seltzer V (1988) Uroflowmetric observations in pregnancy. Neurourol Urodyn 7:61–70CrossRef
17.
go back to reference Parboosingh J, Doig A (1973) Studies of nocturia in normal pregnancy. J Obstet Gynaecol 80:888–895CrossRef Parboosingh J, Doig A (1973) Studies of nocturia in normal pregnancy. J Obstet Gynaecol 80:888–895CrossRef
18.
go back to reference van Buul EJ, Steegers EA, Jongsma HW et al (1995) Haematological and biochemical profile of uncomplicated pregnancy in nulliparous women; a longitudinal study. Neth J Med 46:73–85CrossRef van Buul EJ, Steegers EA, Jongsma HW et al (1995) Haematological and biochemical profile of uncomplicated pregnancy in nulliparous women; a longitudinal study. Neth J Med 46:73–85CrossRef
19.
20.
go back to reference Stachenfeld NS, Silva C, Keefe DL et al (1999) Effects of oral contraceptives on body fluid regulation. J Appl Physiol 87:1016–1025 Stachenfeld NS, Silva C, Keefe DL et al (1999) Effects of oral contraceptives on body fluid regulation. J Appl Physiol 87:1016–1025
21.
go back to reference Armstrong LE, Maresh CM, Castellani JW et al (1994) Urinary indices of hydration status. Int J Sport Nutr 4:265–279CrossRef Armstrong LE, Maresh CM, Castellani JW et al (1994) Urinary indices of hydration status. Int J Sport Nutr 4:265–279CrossRef
22.
go back to reference Liu H, Wu T (2003) Estimating the area under a receiver operating characteristic (ROC) curve for repeated measures design. J Stat Softw 12:1–18 Liu H, Wu T (2003) Estimating the area under a receiver operating characteristic (ROC) curve for repeated measures design. J Stat Softw 12:1–18
29.
go back to reference Pitt M (1989) Fluid intake and urinary tract infection. Nurs Times 85:36–38 Pitt M (1989) Fluid intake and urinary tract infection. Nurs Times 85:36–38
32.
33.
go back to reference Sontrop JM, Dixon SN, Garg AX et al (2013) Association between water intake, chronic kidney disease, and cardiovascular disease: a cross-sectional analysis of NHANES data. Am J Nephrol 37:434–442. doi:10.1159/000350377 CrossRef Sontrop JM, Dixon SN, Garg AX et al (2013) Association between water intake, chronic kidney disease, and cardiovascular disease: a cross-sectional analysis of NHANES data. Am J Nephrol 37:434–442. doi:10.​1159/​000350377 CrossRef
36.
go back to reference Oppliger RA, Bartok C (2002) Hydration testing of athletes. Sports Med 32:959–971CrossRef Oppliger RA, Bartok C (2002) Hydration testing of athletes. Sports Med 32:959–971CrossRef
37.
go back to reference Armstrong LE, Soto JA, Hacker FT et al (1998) Urinary indices during dehydration, exercise, and rehydration. Int J Sport Nutr 8:345–355CrossRef Armstrong LE, Soto JA, Hacker FT et al (1998) Urinary indices during dehydration, exercise, and rehydration. Int J Sport Nutr 8:345–355CrossRef
38.
go back to reference Wakefield B, Mentes J, Diggelmann L, Culp K (2002) Monitoring hydration status in elderly veterans. West J Nurs Res 24:132–142CrossRef Wakefield B, Mentes J, Diggelmann L, Culp K (2002) Monitoring hydration status in elderly veterans. West J Nurs Res 24:132–142CrossRef
40.
go back to reference Kavouras SA, Johnson EC, Bougatsas D et al (2015) Validation of a urine color scale for assessment of urine osmolality in healthy children. Eur J Nutr. doi:10.1007/s00394-015-0905-2 Kavouras SA, Johnson EC, Bougatsas D et al (2015) Validation of a urine color scale for assessment of urine osmolality in healthy children. Eur J Nutr. doi:10.​1007/​s00394-015-0905-2
41.
go back to reference Drabkin DL (1927) The normal pigment of the urine I. The relationship of urinary pigment output to diet and metabolism. J Biol Chem 75:443–479 Drabkin DL (1927) The normal pigment of the urine I. The relationship of urinary pigment output to diet and metabolism. J Biol Chem 75:443–479
42.
go back to reference Drabkin DL (1927) the normal pigment of the urine Ii. The relationship of the basal metabolism to the output of the normal urinary pigment. J Biol Chem 75:481–487 Drabkin DL (1927) the normal pigment of the urine Ii. The relationship of the basal metabolism to the output of the normal urinary pigment. J Biol Chem 75:481–487
44.
go back to reference Hofmeyr GJ, Gülmezoglu AM, Novikova N (2002) Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume. Cochrane Database Syst Rev. doi:10.1002/14651858.CD000134 Hofmeyr GJ, Gülmezoglu AM, Novikova N (2002) Maternal hydration for increasing amniotic fluid volume in oligohydramnios and normal amniotic fluid volume. Cochrane Database Syst Rev. doi:10.​1002/​14651858.​CD000134
45.
go back to reference Battaglia F, Prystowsky H, Smisson C et al (1960) Fetal blood studies. XIII. The effect of the administration of fluids intravenously to mothers upon the concentrations of water and electrolytes in plasma of human fetuses. Pediatrics 25:2–10 Battaglia F, Prystowsky H, Smisson C et al (1960) Fetal blood studies. XIII. The effect of the administration of fluids intravenously to mothers upon the concentrations of water and electrolytes in plasma of human fetuses. Pediatrics 25:2–10
Metadata
Title
Urine color as an indicator of urine concentration in pregnant and lactating women
Authors
Amy L. McKenzie
Colleen X. Muñoz
Lindsay A. Ellis
Erica T. Perrier
Isabelle Guelinckx
Alexis Klein
Stavros A. Kavouras
Lawrence E. Armstrong
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nutrition / Issue 1/2017
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI
https://doi.org/10.1007/s00394-015-1085-9

Other articles of this Issue 1/2017

European Journal of Nutrition 1/2017 Go to the issue