Microalbuminuria in early pregnancy as a Predictor of Preeclampsia

Abstract

Background: Hypertensive disorders of pregnancy have been a challenge to the obstetricians and researchers since many centuries. Prediction of preeclampsia (PE) in the early pregnancy is of utmost help in preventing the disorder and minimizing its severity. Objective: To evaluate the predictive accuracy of microalbuminuria in early pregnancy for the development of preeclampsia. Methods: A prospective cohort study was carried out in the Obstetrics and Gynaecology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, over a period of one year. 133 pregnant women at 10 – 14 weeks of gestation were included in the study. The group of women with microalbumin excretion 20 – 300 mg/L in a spot sample of urine was designated as ‘exposed’ group and those with albumin excretion < 20 mg/L as ‘unexposed’ group. The outcome variable was development of either Preeclampsia or Eclampsia or Gestational Hypertension. Result: Among 133 study subjects, 13 developed adverse outcomes (PE/GHTN). The pregnant women were predominantly in their 2nd decades of life (20 – 30 years old) with mean ages of the adverse and normal outcome groups being 25.6 and 24.9 years respectively (p = 0.614). No significant association was found between adverse outcome and parity (p = 0.729). The past history of preeclampsia tends to be significantly associated with PE or GHTN (p = 0.048). Nearly half (46.2%) of those who developed preeclampsia/GHTN had microalbuminuria in early pregnancy compared to 23.3% of those who did not have microalbuminuria. The risk having preeclampsia/GHTN in the ‘exposed’ group is 2.5 (95% CI = 1.0 – 6.9) times higher than that in the ‘unexposed’ group (p = 0.037). The sensitivity of microalbuminuria was inappreciably low (46.2%). However, its specificity is optimum (76.7%). The positive and negative predictive values of the test were 17.6% and 92.9% respectively with high yield of false positive and low yield of false negative results. The overall predictive accuracy of the test was found to be 73.7%. Conclusion: The study concluded that presence of microalbuminuria in pregnant women in their 1st trimester significantly predicts PE/GHTN.