The Journal of Obstetrics and Gynecology of India

, Volume 67, Issue 6, pp 405–408 | Cite as

Evaluation of Spot Urinary Albumin–Creatinine Ratio as Screening Tool in Prediction of Pre-eclampsia in Early Pregnancy

  • Vineet V. Mishra
  • Preeti A. Goyal
  • Roy Priyankur
  • S. Choudhary
  • Rohina S. Aggarwal
  • Khushali Gandhi
  • Bhumika Vyas
  • Shaheen Hokabaj
Original Article



The aim of this study was to establish whether a spot urinary albumin/creatinine ratio (ACR) measured between 20 and 28 weeks of gestation can predict subsequent pre-eclampsia in asymptomatic pregnant women.


Prospective observational study.


The patients included sixty-two women with singleton pregnancy, normal renal function and no evident proteinuria, attending antenatal clinics between 20 and 28 weeks of gestation in a tertiary care hospital.


The ACR was determined from midstream urine sample taken between 20 and 28 weeks of gestation. Estimation of albumin was done by immunoturbidimetric microalbumin method and creatinine by modified Jaffe’s method.


Incidence of pre-eclampsia in the study group was 12.90%. The cut-off value for ACR was taken as 35.5 mg/mol. The mean ACR in normotensive group was 19.26 ± 7.99, and in pre-eclampsia group it was 51.95 ± 18.78. For pre-eclampsia, screening in early pregnancy, spot ACR cut-off ≥35.5 mg/mol has sensitivity of 87.5%, specificity of 96.30%, PPV of 77.78% and NPV of 98.11%.


Spot urinary ACR values are higher in asymptomatic women in early pregnancy, who developed pre-eclampsia later on. When measured early in the second trimester, an ACR ≥ 35.5 mg/mmol predicted pre-eclampsia well before the onset of clinical manifestations with high sensitivity and specificity. It can be used as a good screening tool for predicting pre-eclampsia in early pregnancy.


Albumin Creatinine Pregnancy Pre-eclampsia 


Compliance with Ethical Standards

Conflict of interest

Vineet Mishra, Preeti Goyal, Priyankur Roy, Sumesh Choudhary, Rohina Aggarwal, Khushali Gandhi, Bhumika Vyas and Shaheen Hokabaj declare that they have no conflicts of interest.

Informed Consent

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


  1. 1.
    Kliman HJ. Uteroplacental blood flow the story of decidualization, menstruation and trophoblast invasion. Am J Pathol. 2011;157:1759–68.CrossRefGoogle Scholar
  2. 2.
    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.CrossRefGoogle Scholar
  3. 3.
    Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2012;116:402–14.CrossRefGoogle Scholar
  4. 4.
    North RA, Ferrier C, Gamble G, et al. Prevention of preeclampsia with heparin and antiplatelet drugs in women with renal disease. Aust N Z J Obstet Gynaecol. 2015;35:357–62.CrossRefGoogle Scholar
  5. 5.
    Mak A, Cheung MW, Cheak AA, et al. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression. Rheumatology. 2011;49:281–8.CrossRefGoogle Scholar
  6. 6.
    Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. Annu Rev Pathol. 2012;5:173–92.CrossRefGoogle Scholar
  7. 7.
    Yuyun MF, Khaw KT, Luben R, et al. Microalbuminuria independently predicts all-cause and cardiovascular mortality in a British population: the European prospective investigation into cancer in Norfolk (EPIC-Norfolk) population study. Int J Epidemiol. 2014;33:189–98.CrossRefGoogle Scholar
  8. 8.
    Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and non-cardiovascular mortality in general population. Circulation. 2012;106:1777–82.CrossRefGoogle Scholar
  9. 9.
    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;118:1126–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Risberg A, Larsson A, Olsson K, et al. Relationship between urinary albumin and albumin/creatinine ratio during normal pregnancy and preeclampsia. Scand J Clin Lab Invest. 2014;64:17–24.CrossRefGoogle Scholar
  11. 11.
    Fatema K, Khatun M, Akter S, et al. Role of urinary albumin in the prediction of preeclampsia. J Faridpur Med Coll. 2011;6(1):14–8.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Shaarawy M, Salem ME. The clinical value of microtransferrinuria and microalbuminuria in the prediction of preeclampsia. Clin Chem Lab Med. 2011;39:29–34.Google Scholar
  14. 14.
    Sanchez-Ramos L, Gillen G, Zamora J, et al. The protein-to-creatinine ratio for the prediction of significant proteinuria in patients at risk for preeclampsia: a meta-analysis. Ann Clin Lab Sci. 2013;43(2):211–20.PubMedGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2016

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyThe Institute of Kidney Diseases and Research Centre and Institute of Transplantation SciencesAhmedabadIndia

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