# Situation: A 30-year-old primigravida at 30 weeks' gestation attends a prenatal check-up at a lying-in clinic. Her pregnancy has been uncomplicated so far. She complains of heartburn after meals and low back pain at the end of the day. She takes the iron–folic acid tablet from the health center each morning. Her laboratory results at this visit are: Hemoglobin: 11.2 g/dL (112 g/L) White blood cells: 12,500/mm³ Serum creatinine: 1.0 mg/dL (88 µmol/L) Urine glucose: trace; fasting blood glucose normal Which result should the nurse report as abnormal for her stage of pregnancy?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629371  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 30-year-old primigravida at 30 weeks' gestation attends a prenatal check-up at a lying-in clinic. Her pregnancy has been uncomplicated so far. She complains of heartburn after meals and low back pain at the end of the day. She takes the iron–folic acid tablet from the health center each morning.

Her laboratory results at this visit are:
Hemoglobin: 11.2 g/dL (112 g/L)
White blood cells: 12,500/mm³
Serum creatinine: 1.0 mg/dL (88 µmol/L)
Urine glucose: trace; fasting blood glucose normal
Which result should the nurse report as abnormal for her stage of pregnancy?

## 보기

1. The hemoglobin level
2. The creatinine level **✔ 정답**
3. The trace urine glucose
4. The white blood cell count

**정답: 2**

## 해설

Glomerular filtration rises about 50% in pregnancy, so serum creatinine normally falls to about 0.4–0.8 mg/dL (35–70 µmol/L). A value of 1.0 mg/dL (88 µmol/L) would be normal in a nonpregnant woman but is above about 0.9 mg/dL (80 µmol/L) and needs evaluation in pregnancy. The other results are expected pregnancy changes.

## 심화 해설

Why creatinine is the abnormal finding

During pregnancy, the kidneys undergo marked hemodynamic adaptation. Renal plasma flow and glomerular filtration rate (GFR) rise substantially, beginning in the first trimester and peaking by the second trimester. Because more plasma is filtered per minute, waste products such as creatinine are cleared more rapidly from the blood. As a result, the serum creatinine concentration normally falls below the nonpregnant reference range.

In a healthy pregnant woman, serum creatinine is typically about 0.4–0.8 mg/dL (35–70 µmol/L). A value of 1.0 mg/dL (88 µmol/L) would be unremarkable in a nonpregnant adult, but in pregnancy it sits above the expected upper limit and should prompt further evaluation. The systematic review by Wiles et al. reinforces that pregnancy-specific reference ranges for serum creatinine are lower than nonpregnant values, and using standard laboratory cutoffs may miss early renal impairment in pregnant women [1].

Watch out! A creatinine value that appears “normal” on a routine lab report can still be abnormal in pregnancy because the expected baseline is lower. Always interpret renal function against gestational physiology, not the general adult range.

Why the other results are expected pregnancy changes

| Result | Pregnancy-related change | Clinical interpretation |
| --- | --- | --- |
| Hemoglobin 11.2 g/dL | Plasma volume expands more than red cell mass, causing hemodilution | Mild physiologic anemia of pregnancy; expected in the third trimester |
| White blood cells 12,500/mm³ | Leukocytosis occurs due to increased cortisol and bone marrow stimulation | Normal in pregnancy; counts up to about 15,000–16,000/mm³ can be seen |
| Urine glucose trace | GFR increases and tubular glucose reabsorption may not keep pace | Trace glycosuria is common even with normal fasting blood glucose |

Longitudinal data from healthy nulliparous women confirm that hemoglobin concentration is lower during pregnancy than after delivery, reflecting the dilutional effect of expanded plasma volume . The same study documents that routine biochemical parameters shift across gestation, supporting the principle that pregnancy-specific interpretation is essential for laboratory values .

Clinical application for nursing assessment

When reviewing prenatal laboratory results, the nurse should compare each value against gestational reference ranges, not general adult norms. A serum creatinine of 1.0 mg/dL in a woman at 30 weeks' gestation raises concern for reduced renal clearance and warrants further evaluation, including repeat testing, blood pressure assessment, and urine protein screening to rule out conditions such as preeclampsia or underlying renal disease. The heartburn and low back pain described are common discomforts of advancing pregnancy and do not explain the creatinine elevation.

Key point! In pregnancy, a serum creatinine above approximately 0.9 mg/dL (80 µmol/L) is considered abnormal and requires investigation, even though the same value would be normal outside of pregnancy.

References (research sources)

- [1]Serum Creatinine in Pregnancy: A Systematic Review.Meta-analysis/systematic reviewWiles K, Bramham K, Seed PT, Nelson-Piercy C, Lightstone L, Chappell LC (2019) · DOI: 10.1016/j.ekir.2018.10.015

## 임상 시나리오

Pregnancy-Specific Serum Creatinine InterpretationWhy a normal lab value can be abnormal in pregnancy
In pregnancy, glomerular filtration rate rises by about 50%, so serum creatinine normally falls to 0.4–0.8 mg/dL (35–70 µmol/L). A value of 1.0 mg/dL (88 µmol/L) is above the pregnancy-specific upper limit of about 0.9 mg/dL (80 µmol/L) and requires further evaluation.

Expected pregnancy changes include physiologic anemia from hemodilution, mild leukocytosis up to about 15,000–16,000/mm³, and trace glucosuria due to a lowered renal threshold for glucose despite normal fasting blood glucose.

CautionNever interpret renal function using the general adult reference range in pregnancy. A creatinine that appears normal on a routine lab report may still indicate early renal impairment because the expected gestational baseline is lower.

## 핵심 개념

- **Physiologic anemia of pregnancy** — Hemodilution from plasma volume expanding more than red cell mass, lowering hemoglobin concentration without true iron deficiency.
- **Pregnancy-specific creatinine reference** — Serum creatinine normally falls to about 0.4-0.8 mg/dL due to increased GFR, so values above 0.9 mg/dL warrant evaluation.
- **Glucosuria in pregnancy** — Trace urine glucose with normal fasting blood glucose occurs because the renal threshold for glucose decreases during pregnancy.
- **Leukocytosis of pregnancy** — Mild elevation of white blood cells is expected, with counts up to about 15,000-16,000/mm3 in the third trimester.

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