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Prediction of Preeclampsia in Early Pregnancy by Estimating the Spot Urinary Albumin/Creatinine Ratio

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Abstract

Objective

To assess whether a spot urinary albumin:creatinine ratio (ACR) measured before 20 weeks of gestation can predict subsequent development of preeclampsia.

Methods

The ACR was determined from midstream urine sample taken between 17 and 20 weeks of gestation. Urine albumin was measured by immunoturbidimetric method using commercially available kit (Beckman Coulter) through Beckman AU 480 fully automated biochemistry analyzer. Urine creatinine was measured by modified kinetic Jaffe reaction without deproteinization.

$$\begin{aligned} & {\text{Urine}}\,{\text{Albumin}}\,\left( {\text{mg/dl}} \right) \\ & {\text{Urine}}\,{\text{Creatinine}}\,\left( {\text{g/dl}} \right){\text{ = UACR}}\,{\text{in}}\,{\text{mg/g}} \\ \end{aligned}$$

Participants were then followed until delivery. Primary outcome measure was preeclampsia, secondary outcome measures were gestational hypertension, gestational diabetes mellitus, IUGR, and normal range estimate of urinary albumin-to-creatinine ratio was established.

Result

The median spot urinary albumin-to-creatinine ratio measured between 17 and 20 weeks of gestation was 5.2 mg/g of creatinine (2.5–9.6). Women who subsequently developed preeclampsia had higher spot urinary albumin-to-creatinine ratio (median 30.795 [9.7–92.8]) in comparison with women who developed gestational hypertension (median 5.2 [0.7–7.2]) and unaffected women (median 5.2 [2.5–9.6]). The urinary albumin-to-creatinine ratio of the mother who developed IUGR was significantly higher. By ROC analysis, the optimum ACR to predict preeclampsia was 9.85 mg/g of creatinine. The relative risk of developing preeclampsia in women with urinary albumin-to-creatinine ratio more than 9.85 mg/g of creatinine was higher than in the women who had urinary albumin-to-creatinine ratio less than 9.85 mg/g of creatinine.

Conclusion

A spot urinary albumin-to-creatinine ratio of more than 9.8 mg/g of creatinine can predict the development of preeclampsia in later pregnancy with the sensitivity and specificity of 67 and 76%, respectively. However, additional studies and cost–benefit analysis are required to confirm these finding before recommending this test for screening purposes.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, ESI PGIMSR, Basaidarapur, New Delhi, India

    Nupur Gupta, Taru Gupta & Deepti Asthana

Authors
  1. Nupur Gupta
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  2. Taru Gupta
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  3. Deepti Asthana
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Corresponding author

Correspondence to Nupur Gupta.

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Conflict of interest

Dr. Nupur gupta, Dr. Taru Gupta and Dr. Deepti Asthana declare that they have no conflict of interest.

Ethical Standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Animal Rights

This article does not contain any studies with animal subjects.

Additional information

Dr. Nupur Gupta is an Assistant Professor at ESI PGIMSR New Delhi, Dr. Taru Gupta is a Professor at ESI PGIMSR New Delhi, Dr. Deepti Asthana is a Senior Resident at ESI PGIMSR New Delhi.

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Gupta, N., Gupta, T. & Asthana, D. Prediction of Preeclampsia in Early Pregnancy by Estimating the Spot Urinary Albumin/Creatinine Ratio. J Obstet Gynecol India 67, 258–262 (2017). https://doi.org/10.1007/s13224-016-0958-z

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  • DOI: https://doi.org/10.1007/s13224-016-0958-z

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