Microalbuminuria as an early predictor of preeclampsia in the pre-gestational diabetic population: A prospective cohort study

Monica Zen, Suja Padmanabhan, Ngai Wah Cheung, Adrienne Kirby, Shilpanjali Jesudason, Thushari I. Alahakoon, Vincent W. Lee

Research output: Contribution to journalArticle

Abstract

Objectives: To determine if microalbuminuria can be used as a predictive marker of preeclampsia and adverse pregnancy and neonatal outcomes in women with pre-existing diabetes and to compare the prognostic utility of urinary albumin to creatinine ratio (uACR) and urinary protein to creatinine ratio (uPCR). Study Design: Multicentre prospective cohort study. Antenatal Diabetes in Pregnancy clinics at three tertiary referral hospitals in Western Sydney, Australia. 158 women with pre-existing diabetes requiring insulin in pregnancy. A spot uPCR and uACR was performed in each trimester. Pregnancy and fetal outcomes were investigated using linear models and receiver-operating characteristic (ROC) curves. Main outcome measures: The primary outcome was preeclampsia (PE). Secondary outcomes investigated were other adverse pregnancy and neonatal outcomes. Results: Increased levels of both uPCR and uACR in trimester 3 were associated with the occurrence of PE (p = 0.007, 0.010 respectively). In the 113 patients with normal pregnancy uPCR (<30 mg/mmol) in trimester 1, microalbuminuria was found to be predictive of PE (p = 0.01) and need for operative delivery (p = 0.03). Conclusions: In women with pre-existing diabetes, uPCR and uACR appear to have similar ability to diagnose PE, but microalbuminuria demonstrates prognostic ability at a much earlier gestation, prior to the onset of other signs or symptoms of PE. We therefore suggest that assessing microalbuminuria rather than overt proteinuria in trimester 1 provides prognostic information in women with pre-existing diabetes requiring insulin and should be used routinely to evaluate risk of PE in this high-risk cohort of women.

LanguageEnglish
Pages182-188
Number of pages7
JournalPregnancy Hypertension
Volume15
DOIs
Publication statusPublished - 1 Jan 2019
Externally publishedYes

Keywords

  • Microalbuminuria
  • Pre-existing diabetes
  • Preeclampsia
  • Proteinuria

ASJC Scopus subject areas

  • Internal Medicine
  • Obstetrics and Gynaecology

Cite this

Zen, Monica ; Padmanabhan, Suja ; Cheung, Ngai Wah ; Kirby, Adrienne ; Jesudason, Shilpanjali ; Alahakoon, Thushari I. ; Lee, Vincent W. / Microalbuminuria as an early predictor of preeclampsia in the pre-gestational diabetic population : A prospective cohort study. In: Pregnancy Hypertension. 2019 ; Vol. 15. pp. 182-188.
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Microalbuminuria as an early predictor of preeclampsia in the pre-gestational diabetic population : A prospective cohort study. / Zen, Monica; Padmanabhan, Suja; Cheung, Ngai Wah; Kirby, Adrienne; Jesudason, Shilpanjali; Alahakoon, Thushari I.; Lee, Vincent W.

In: Pregnancy Hypertension, Vol. 15, 01.01.2019, p. 182-188.

Research output: Contribution to journalArticle

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AU - Lee, Vincent W.

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