title: Microalbuminuria is a predictor of adverse pregnancy outcomes including preeclampsia.
abstract: OBJECTIVE
  Abnormal urinary protein loss is a marker associated with a diverse range of renal diseases including preeclampsia. Current measures of urine protein used in the diagnostic criteria for the diagnosis of preeclampsia includes urine protein:creatinine ratio and 24-h urine protein. However very little is known about the value of urine albumin:creatinine ratio (uACR) in pregnancy. In this study we examined the prognostic value of microalbuminuria detected antepartum to predict adverse pregnancy outcomes.
  
  
  METHODS
  This is a single-centre retrospective analysis of 84 pregnant women over the age of 16 attending a tertiary 'high-risk' pregnancy outpatient clinic between July 2010 and June 2013. Utilising medical records, antepartum peak uACR level and pregnancy maternal and fetal outcomes were recorded.
  
  
  RESULTS
  The primary outcome was a composite of poor maternal and fetal outcomes including preeclampsia, maternal death, eclampsia, stillbirth, neonatal death, IUGR, premature delivery and placental abruption. As the antepartum peak uACR level (in mg/mmol) increased from normoalbuminuria (uACR<3.5) to microalbuminuria (uACR 3.5-35) to macroalbuminuria (>35), the percentage of women with the primary composite outcome increased in a stepwise fashion (13.8% to 24.1% to 62.1% respectively, p<0.001). After adjusting for covariates including history of hypertension, chronic kidney disease and aspirin therapy during pregnancy, micro- and macroalbuminuria remained significant predictors of the primary outcome.
  
  
  CONCLUSIONS
  We have shown that antepartum peak uACR is a useful simple marker to help predict adverse maternal and fetal outcomes. Further studies are required to utilise uACR as a prognostic tool in pregnancy before it can be applied in clinical practice.
authors.affiliation: Westmead Hospital, Sydney, NSW, Australia. Electronic address: mjayaballa@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Jayaballa
authors.affiliation: Sydney Medical School, University of Sydney, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Sood
authors.affiliation: Westmead Hospital, Sydney, NSW, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Alahakoon
authors.affiliation: Westmead Hospital, Sydney, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Padmanabhan
authors.affiliation: Westmead Hospital, Sydney, NSW, Australia.
authors.forename: N W
authors.initials: NW
authors.lastname: Cheung
authors.affiliation: Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Lee
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000378:metabolism*; D015992:Body Mass Index; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000652:urine*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D003404:Creatinine
keywords: Albumin:creatinine ratio; Microalbuminuria; Preeclampsia; Pregnancy; Proteinuria