Abstract
Aims and Objectives
To determine utilization of spot urinary albumin/creatinine ratio (UACR) to predict subsequent development of preeclampsia, measured between 17 and 24 weeks of gestational age in asymptomatic antenatal woman and determine their maternal and neonatal outcomes.
Introduction
In preeclampsia the basic pathology is generalized endothelial dysfunction. It causes glomerular endotheliosis which leads to proteinuria, decreased glomerular filtration rate and renal blood flow. Thus microalbuminuria is an early marker which can measured to predict preeclampsia.
Materials and Methods
It is a prospective observational study, carried out for one year in a cohort of asymptomatic antenatal women at 17–24 weeks of gestational age, attending hospital for routine antenatal check-up with a singleton pregnancy and no associated complications. Urine albumin and creatinine ratio (UACR) is measured at first visit, and women were followed till delivery and the maternal and foetal outcomes were recorded.
Results
Out of 81 pregnant women enrolled in the study, 58% belonged to 18–25 years, 54.3% belonged to lower middle class. There was a significant difference in mean UACR among women who developed preeclampsia (PE) and gestational diabetes mellitus (GDM) with p value < 0.05. In the study there was significant association between severe PE, PE and GDM with UACR at 22 as cut-off, with p value < 0.05. In the study among those with UACR > 22, 2.5% had IUFD, 12.5% had LBW, and 7.5% were admitted to NICU.
Conclusion
With the measurement of spot UACR in mid-trimester we can predict the development of preeclampsia before the onset of clinical manifestations. UACR > = 171 mg/g predicted preeclampsia well before the onset of clinical manifestations with high sensitivity of 83.3% and specificity of 98.6%.
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References
Martin JN Jr, My O, Keiser SD, et al. Standardized Mississippi protocol treatment of 190 patients with HELLP syndrome: slowing disease progression and preventing new major maternal morbidity. Hypertens Pregnancy. 2012;31(1):79–90. https://doi.org/10.3109/10641955.2010.525277. (Epub 2011 Jan 10. PMID: 21219123).
Roberts JM, Hubel CA. The two stage model of preeclampsia: variations on the theme. Placenta. 2009;30(Suppl. A):S32–7. https://doi.org/10.1016/j.placenta.2008.11.009.
Macdonald-Wallis C, Silberwood RJ, de Stavola BL, et al. Antenatal blood pressure for prediction of preeclampsia, preterm birth, and small for gestational age babies: development and validation in two general population cohorts. BMJ. 2015;351: h5948.
Ohkuchi A, Hirashima C, Takahashi K, et al. Prediction and prevention of hypertensive disorders of pregnancy. Hypertens Res. 2017;40:5–14. https://doi.org/10.1038/hr.2016.107.
Arias F, Daftary SN, Bhide AG, et al. Hypertensive Disorders in Pregnancy. In: Arias F, Bhide AG, Arulkumaran S, Damania K, Daftary SN, editors., et al., Practical guide to high risk pregnancy and delivery. A South Asian perspective. New Delhi: Elsevier India; 2015. p. 185–230.
Huang Q, Gao Y, Yu Y, et al. Urinary spot albumin:creatinine ratio for documenting proteinuria in women with preeclampsia. Rev Obstet Gynecol. 2012;5(1):9–15.
Mishra VV, Goyal PA, Priyankur R, et al. Evaluation of spot urinary albumin-creatinine ratio as screening tool in prediction of pre-eclampsia in early pregnancy. J Obstet Gynaecol India. 2017;67(6):405–8.
Kozer E, Costei AM, Boskovic R, et al. Effects of aspirin consumption during pregnancy on pregnancy outcomes: meta-analysis. Birth Defects Res Part B Dev Reprod Toxicol. 2013;68:70–84. https://doi.org/10.1002/bdrb.10002.
Gupta N, Gupta T, Asthana D. Prediction of preeclampsia in early pregnancy by estimating the spot urinary albumin/creatinine ratio. J Obstet Gynecol India. 2017;67(4):258–62. https://doi.org/10.1007/s13224-016-0958-z. (Epub 2016 Dec 19. PMID: 28706364; PMCID: PMC5491411).
Baweja S, Kent A, Masterson R, et al. Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high-performance liquid chromatography. BJOG. 2011;118(9):1126–32. https://doi.org/10.1111/j.1471-0528.2011.02960.x. (Epub 2011 Apr 12).
Nisell H, Trygg M, Back R. Urine albumin/creatinine ratio for the assessment of albuminuria in pregnancy hypertension. Acta Obstet Gynecol. 2012;85:1327–30. https://doi.org/10.1080/00016340600808747.
Sibai BM, Caritis S, Hauth J, et al. Risks of preeclampsia and adverse neonatal outcomes amongwomen with pregestational diabetes mellitus. Am J Obstet Gynaecol. 2000;182:364–9.
Rodriguez MH, Masaki DI, Mestman J, et al. Calcium/creatinine ratio and microalbuminuria in the prediction of preeclampsia. Am J Obstet Gynecol. 1988;159(6):1452–5.
Shaarawy M, Salem ME. The clinical value of microtransferrinuria and microalbuminuria in the prediction of preeclampsia. Clin Chem Lab Med. 2001;39(1):29–34. https://doi.org/10.1515/CCLM.2001.008. (PMID: 11256797).
Chawla R, Malik S. Microalbuminuria detected at Mid Term as a marker for adverse pregnancy outcome. Int J Health Sci Res. 2018;8(2):41–52.
Bomback AS, Rekhtman Y, Whaley-Connell AT, et al. Gestational diabetes mellitus alone in the absence of subsequent diabetes is associated with microalbuminuria: results from the kidney early evaluation program (KEEP). Diabetes Care. 2010;33(12):2586–91. https://doi.org/10.2337/dc10-1095. (Epub 2010 Aug 31. PMID: 20807871; PMCID: PMC2992195).
Bar J, Hod M, Erman A, et al. Microalbuminuria as an early predictor of hypertensive complications in pregnant women at high risk. Am J Kidney Dis. 1996;28:220–5.
Massé J, Forest JC, Moutquin JM. Microalbumin as a marker of premature delivery. Obstet Gynecol. 1996;87:661–3.
Ekbom P, Damm P, Feldt-Rasmussen B, et al. Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care. 2001;24:1739–44.
Singh H, Samal S, Mahapatro A, et al. Comparison of obstetric outcome in pregnant women with and without microalbuminuria. J Nat Sci Biol Med. 2015;6(1):120–4. https://doi.org/10.4103/0976-9668.149106.
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Akkenapally Prasanna Latha is an Associate Professor; V. Haripriya is an Associate Professor; P. Ramya Raj is a Resident.
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Latha, A.P., Haripriya, V. & Ramya Raj, P. Mid-Trimester Spot Urinary Albumin/Creatinine Ratio as a Screening Tool in Prediction of Pre-eclampsia. J Obstet Gynecol India 73 (Suppl 2), 234–239 (2023). https://doi.org/10.1007/s13224-023-01862-9
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DOI: https://doi.org/10.1007/s13224-023-01862-9