Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high-performance liquid chromatography
Article first published online: 12 APR 2011
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 118, Issue 9, pages 1126–1132, August 2011
How to Cite
Baweja, S., Kent, A., Masterson, R., Roberts, S. and McMahon, L. (2011), Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high-performance liquid chromatography. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 1126–1132. doi: 10.1111/j.1471-0528.2011.02960.x
- Issue published online: 12 JUL 2011
- Article first published online: 12 APR 2011
- Accepted 21 February 2011. Published Online 12 April 2011.
- High-performance liquid chromatography;
Please cite this paper as: Baweja S, Kent A, Masterson R, Roberts S, McMahon L. Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high-performance liquid chromatography. BJOG 2011;118:1126–1132.
Objective To establish whether a spot urinary albumin: creatinine ratio (ACR) measured before 20 weeks of gestation can predict subsequent pre-eclampsia when urinary albumin is measured by high-performance liquid chromatography (HPLC).
Design Prospective exploratory study.
Setting Antenatal clinic in a tertiary teaching hospital, Victoria, Australia.
Population A cohort of 265 women with a singleton pregnancy, normal renal function, and no evident proteinuria, attending antenatal clinics between 12 and 20 weeks of gestation.
Methods The ACR was determined from a mid-stream urine (MSU) sample taken between 17 and 20 weeks of gestation. Intact urinary albumin was determined by HPLC; creatinine was measured by modified Jaffe’s method.
Outcome measures Pre-eclampsia (primary); gestational hypertension, small for gestational age (SGA), gestational diabetes mellitus, gestational age at delivery, and prematurity (secondary).
Results The median ACR was 28 mg/mmol (IQR 16–46 mg/mmol). Women who subsequently developed pre-eclampsia had a significantly higher ACR (median 50 mg/mmol; IQR 33–90 mg/mmol) compared with women suffering from gestational hypertension (median 27 mg/mmol; IQR 8–35 mg/mmol), and compared with unaffected women (median 28 mg/mmol; IQR 16–46 mg/mmol). Mothers of SGA infants also had a significantly higher median ACR. By ROC analysis, the optimum ACR to predict pre-eclampsia was 35.5 mg/mmol: the relative risk of developing pre-eclampsia in women with a urinary ACR ≥ 35.5 mg/mmol was 7.8 times more than in those with a urinary ACR < 35.5 mg/mmol.
Conclusions When urinary albumin is measured by HPLC, spot urinary ACR values are higher in early uncomplicated pregnancy compared with previously reported conventional methods. When measured early in the second trimester, an ACR ≥ 35.5 mg/mmol predicted pre-eclampsia well before the onset of clinical manifestations.