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VOLUME 14 , ISSUE 6 ( November-December, 2022 ) > List of Articles

Original Article

Spot Urinary Albumin–Creatinine Ratio in Prediction of Pre-eclampsia: A Prospective Study

Anitha A Manjappa, Thuthi Mohan

Keywords : Pre-eclampsia, Prediction, Pregnant women, Prospective study, Spot urine albumin–creatinine ratio

Citation Information : Manjappa AA, Mohan T. Spot Urinary Albumin–Creatinine Ratio in Prediction of Pre-eclampsia: A Prospective Study. J South Asian Feder Obs Gynae 2022; 14 (6):676-680.

DOI: 10.5005/jp-journals-10006-2157

License: CC BY-NC 4.0

Published Online: 31-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Pre-eclampsia is a multisystem disorder with two-stage disease pathology where abnormal placentation precedes the endothelial dysfunction which ultimately leads to the systemic inflammatory response. Endothelial dysfunction is one of the hallmark pathologies of pre-eclampsia, microalbuminuria is the measure of the same and could be used as a marker for predicting pre-eclampsia in early gestation. This study has been carried out to predict pre-eclampsia among low-risk pregnant women with the use of spot urine albumin–creatinine ratio (ACR) and to derive at a definite cut-off value of spot urine ACR. Materials and methods: This prospective study was done in ESIC Medical College & PGIMSR, Chennai, Tamil Nadu, India, for a period of 12 months. Low-risk singleton pregnant women between 16 and 20 weeks of gestational age who satisfied the inclusion criteria were considered. Participants who tested negative for urine albumin by urine dipstick method were subjected to a spot urine ACR test. Urine albumin was measured by the immunoturbidimetric method and urine creatinine by Jaffe's kinetic method. Urine albumin is expressed as mg/dL, urine creatinine as gm/dL, and ACR as mg/gm. All the participants were followed up to delivery. The primary outcome measure was pre-eclampsia, secondary outcome measures were gestational hypertension (GHTN), gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), and a cut-off value of urine spot ACR in the prediction of pre-eclampsia was calculated by receiver operative curve (ROC) analysis. Results: Among 164 participants, the proportion of pregnant women affected with pre-eclampsia was 3.04%. The optimum value of ACR in predicting pre-eclampsia obtained was 25.89 mg/gm by applying the ROC curve. It also derived 80% sensitivity and 87% specificity with a positive predictive value (PPV) of 16% and a negative predictive value (NPV) of 99%. Conclusion: The ACR test is widely available with easy interpretation and also convenient for pregnant women. Spot urine ACR value of more than 25.89 mg/gm in asymptomatic pregnant women when measured between 16 and 20 weeks of gestation can predict the development of pre-eclampsia with the sensitivity and specificity of 80 and 87%, respectively. The higher NPV value of 99% of spot urine ACR ratio may help in accurately diagnosing true negatives. However, additional prospective studies with higher sample size and cost–benefit analysis of the test are recommended to confirm these findings before routinely using urine spot ACR as a predictive marker.

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  1. Konar H, Chakraborty AB. Maternal mortality: A FOGSI study (based on institutional data. J Obstet Gynecol India 2013;63(2):88–95. DOI: 10.1007/s13224-012-0258-1.
  2. American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia. ACOG Practice Bulletin Nnumber 222. Obstet Gynecol 2020;135(6):e237–e260. DOI: 10.1097/AOG. 0000000000003891.
  3. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol 2012;36(1):56–59. DOI: 10.1053/j.semperi. 2011.09.011.
  4. Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet 2019;145(Suppl. 1):1–33. DOI: 10.1002/ijgo.12802.
  5. National Health Portal of India. Preeclampsia. Available at: https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/preeclampsia Accessed on: 11 August 2022.
  6. Mutter WP, Karumanchi SA. Molecular mechanisms of preeclampsia. Microvasc Res 2008;75(1):1–8. DOI: 10.1016/j.mvr.2007.04.009.
  7. Redman CW, Sargent IL. Placental stress and pre-eclampsia: A revised view. Placenta 2009;30(Suppl. A):S38–S42. DOI: 10.1016/j.placenta.2008.11.021.
  8. Staff AC, Braekke K, Johnsen GM, et al. Circulating concentrations of soluble endoglin (CD105) in fetal and maternal serum and in amniotic fluid in preeclampsia. Am J Obstet Gynecol 2007;197(2):176.e1–176.e6. DOI: 10.1016/j.ajog.2007.03.036.
  9. Cunningham FG, Leveno KJ, Bloom SL, et al. Hypertensive disorders. William's Obstetrics, 25th edition. New Delhi: McGraw-Hill, 2018, pp. 710–754.
  10. Brown MA, Mageec LA, Kennyd LC, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis and management recommendations for international practice. Pregnancy Hypertension 2018;13:291–310. DOI: 10.1016/j.preghy.2018.05.004.
  11. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017;377(7):613–622. DOI: 10.1056/NEJMoa1704559.
  12. 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 2010;116(2 Pt. 1):402–414. DOI: 10.1097/AOG.0b013e3181e9322a.
  13. Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2018; 10(10):CD001059. DOI: 10.1002/14651858.CD001059.
  14. Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. Annu Rev Pathol 2010;5:173–192. DOI: 10.1146/annurev-pathol- 121808-102149.
  15. Khan F, Belch JJ, MacLeod M, et al. Changes in endothelial function precede the clinical disease in women in whom preeclampsia develops. Hypertension 2005;46(5):1123–1128. DOI: 10.1161/01.HYP. 0000186328.90667.95.
  16. 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):1126–1132. DOI: 10.1111/j.1471-0528.2011.02960.x.
  17. 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 2004;33(1):189–198. DOI: 10.1093/ije/dyh008.
  18. Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002;106:1777–1782. DOI: 10.1161/01.cir. 0000031732.78052.81.
  19. Lindheimer MD, Kanter D. Interpreting abnormal proteinuria in pregnancy: The need for a more pathophysiological approach. Obstet Gynecol 2010;115(2 Pt. 1):365–375. DOI: 10.1097/AOG. 0b013e3181cb9644.
  20. Côté AM, Firoz T, Mattman A, et al. The 24-hour urine collection: Gold standard or historical practice? Am J Obstet Gynecol 2008;199(6):625.e1–e6. DOI: 10.1016/j.ajog.2008.06.009.
  21. Cote AM, Brown MA, Lam E, et al. Diagnostic accuracy of urinary spot protein: Creatinine ratio for proteinuria in hypertensive pregnant women – systematic review. BMJ 2008;336:1003–1006. DOI: 10.1136/bmj.39532.543947.BE.
  22. Cade TJ, Gilbert SA, Polyakov A, et al. The accuracy of spot urinary protein-to-creatinine ratio in confirming proteinuria in pre-eclampsia. Aust N Z J Obstet Gynaecol 2012;52(2):179–182. DOI: 10.1111/j.1479-828X.2011.01409.x.
  23. Morris RK, Riley RD, Doug M, et al. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: Systematic review and meta-analysis. BMJ 2012;345:e4342. DOI: 10.1136/bmj.e4342. DOI: 10.1136/bmj.e4342.
  24. National Institute for Health and Care Excellence. Hypertension in pregnancy: Diagnosis and management. NICE guideline. Available at: www.nice.org.uk/guidance/ng133 Accessed on: 11 August 2022.
  25. 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 Gynecol India 2017;67(6):405–408. DOI: 10.1007/s13224-016-0950-7.
  26. Chan P, Brown M, Simpson JM, et al. Proteinuria in pre-eclampsia: How much matters? BJOG 2005;112(3):280–285. DOI: 10.1111/j.1471-0528.2004.00395.x.
  27. Mateus J, Newman R, Sibai BM, et al. Massive urinary protein excretion associated with greater neonatal risk in preeclampsia. AJP Rep 2017;7(1):e49–e58. DOI: 10.1055/s-0037-1601866.
  28. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1–S22. DOI:10.1067/mob.2000.107928.
  29. Kuo VS, Koumantakis G, Gallery ED. Proteinuria and its assessment in normal and hypertensive pregnancy. Am J Obstet Gynecol 1992;167:723–728. DOI: 10.1016/S0002-9378(11)91578-6.
  30. Phelan LK, Brown MA, Davis GK, et al. A prospective study of the impact of automated dipstick urinalysis on the diagnosis of preeclampsia. Hypertens Pregnancy 2004;23(2):135–142. DOI: 10.1081/PRG-120028289.
  31. 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):258–262. DOI: 10.1007/s13224-016-0958-z.
  32. Agarwal S, Devi P, Gupta R, et al. Evaluation of spot urinary albumin–creatinine ratio as a screening tool in prediction of preeclampsia. New Indian J OBGYN 2022;8(2):269–272. DOI: 10.21276/obgyn.2022.8.2.21.
  33. Upadhyay A, Dayal M. Screening for preeclampsia by urine albumin to creatinine ratio. New Indian J OBGYN 2018;4(2):117–120. DOI: 10.21276/obgyn.2018.4.2.5.
  34. Fatema K, Khatun M, Akter S, et al. Role of urinary albumin in the prediction of preeclampsia. J Faridpur Med Coll 2011;6(1):14–18. DOI: 10.3329/fmcj.v6i1.7404.
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