Early Pregnancy Microalbuminuria as a Predictor of Pre-Eclampsia

Field: Medicine (Health Sciences)

Patients and methods: This study was done on 110 pregnant women attended the department of Obestatric and Gynecology, Sayed Galal University Hospital in the period from 4/2014 to 5/2015. From those 110 cases, 4 did not accept to be included in the study and another 6 cases were excluded due to history of significant liver disease, leaving one hundred cases to be included in the study. The laboratory investigations were done for all of the 100 cases in the department of Clinical Pathology, Sayed Galal University Hospital. Results: Although microalbuminuria were more frequently seen among high risk group, the difference was nonsignificant. The cause may be the limited number of cases in the two groups. The mean age of cases was slightly higher than controls, but with a non-significant difference. Taking into consideration that primigravida per se is a risk factor for preeclampsia, all of the 21 primigravida cases were considered as high risk. All of the low risk groups were in the full term, with three cases of the high risk group were preterm. The mean gestational age of the two groups showed non-significant difference. The mean blood pressure both at booking and at delivery showed non-significant differences between the cases and the control subjects. We found a mild rise of blood pressure by around 6-9 mm Hg. The difference between the blood pressure at booking and at delivery was highly significant, which means that this rise was seen in nearly all cases and controls. Slightly higher than one quarter of cases and control group delivered by CS, with the remaining delivered by normal vaginal delivery. There is no significant difference between the two groups as regards the mode of delivery. Birth weight was slightly lower in the cases group than in the control group, with a non-significant difference. The 24 h protein in urine was higher in the cases group than in the control group by around 35 mg. However, the difference between the two groups was non-significant. The non-significance here may be due to the high standard deviation in both groups. PIH was seen only in 7 subjects; 3 in the cases group and 4 in the control group, with a non-significant difference between the two groups. Preeclampsia was seen in 6 cases (12%) of the cases group, compared to 4 cases (8%) of the control groups. This difference was non-significant both because of the low difference between the two groups (only 2 cases) and the limited number of positive cases in both groups. No cases of eclampsia were diagnosed in our study patients or controls. Although age was directly related with the albuminuria, with maximum age among patients with macroalbuminuria and minimum age among patients with no albuminuria; the difference was non-significant. There was non-significant relation between parity and the albuminuria. The cause of this non significance is due to the limited number of micro and macro-albuminuria in our study groups. Blood pressure showed a steady increase between the normal and microalbuminuria and between micro and macroalbuminuria. However, the only significant difference was seen in the diastolic blood pressure at delivery. There was no significant relation between the gestational age and the occurrence of albuminuria. We found a non-significant relation between microalbuminuria and the mode of delivery. Although patients with albuminuria tended to give lower birth weighted babies, the difference was non-significant. There was non-significant relation between PIH and albuminuria. Among the 10 cases who developed preeclampsia, 5 had macroalbuminuria (41.7% of all macroalbuminuria cases), compared to 3 cased had microalbuminuria (14.3%) and only two cases having no albuminuria (3%). The difference was highly significant among the three groups. The most common risk in the high risk group was primigravia, seen in 42% of cases, followed by the maternal age>34 years, seen in 40% of cases (38% alone and 2% associated with twins). Previous history of preeclampsia was seen in 14% of cases and lastly twins were seen in 6% of cases. We found a non-significant relation between the occurrence of preeclampsia and the traditional risks for preeclampsia. The cause of this non significance may be due to the limited number of preeclampsia cases (only 6 cases in the high risk group). The predictive values of microalbuminuria in the pathogenesis of preeclampsia were as follows: sensitivity 80%, specificity 72.2%, positive likelihood ratio 288%, negative likelihood ratio 22.7%, positive predictive value 24.2%, negative predictive value 97%, Odd’s ratio 10.4 and lastly accuracy 76.1%. Conclusion: Microalbuminuria should be considered as an important risk factor for the development of preeclampsia, with high sensitivity and specificity values.