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

Abstract

The aim of this study was to establish whether a spot urinary albumin/creatinine ratio (ACR) measured between 20 and 28weeks 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 28weeks of gestation in a tertiary care hospital. The ACR was determined from midstream urine sample taken between 20 and 28weeks 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 35.5mg/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 ≥35.5mg/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≥35.5mg/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.