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

Abstract

To assess whether a spot urinary albumin:creatinine ratio (ACR) measured before 20weeks of gestation can predict subsequent development of preeclampsia. The ACR was determined from midstream urine sample taken between 17 and 20weeks 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.[Formula: see text]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. The median spot urinary albumin-to-creatinine ratio measured between 17 and 20weeks of gestation was 5.2mg/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 9.85mg/g of creatinine. The relative risk of developing preeclampsia in women with urinary albumin-to-creatinine ratio more than 9.85mg/g of creatinine was higher than in the women who had urinary albumin-to-creatinine ratio less than 9.85mg/g of creatinine. A spot urinary albumin-to-creatinine ratio of more than 9.8mg/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.