Evaluation of the value of calcium to creatinine ratio for predicting of pre-eclampsia

Introduction: Pre-eclampsia is one of the most serious complications in pregnancy and is one of the major causes of maternal death. Therefore, its prediction has special importance and many studies have been performed on different materials, which may be useful for its prediction. Objective: The purpose of the present study is to evaluate the calcium to creatinine ratio for the prediction of pre-eclampsia. Method: A prospective cohort study was performed on 150 pregnant women, who were aged from 15 to 35 years. A single urine sample was obtained at 20–24 weeks of gestation for measurement of urine calcium to creatinine ratio. The women were then monitored for delivery and this ratio was compared between the women with and without pre-eclampsia. Results: Mean urine calcium of pre-eclamptic women was significantly lower than normotensive women (179?±?35?mg/dl vs 272?±?59?mg/dl, P < 0.001). Mean calcium to creatinine ratio was significantly lower in pre-eclamptic women (0.07?±?0.007 vs 0.16?±?0.006, P < 0.001). The optimal cut off point for calcium to creatinine ratio was calculated to be 0.071 with a sensitivity of 77% and specificity of 78%. Conclusion: Urine calcium and calcium to creatinine ratio are lower in pre-eclamptic women and may be used as a screening test for the prediction of pre-eclampsia.     

Calcium metabolism in pre-eclampsia.

OBJECTIVES: To study calcium metabolism in pre-eclampsia and normotensive gravid women. METHOD: Ten milliliters of heparinized blood samples and 24-h urine samples were collected from 50 pre-eclamptic and 50 normotensive primigravidae. Blood samples were studied for calcium uptake, intracellular calcium level and calcium-dependent adenosine triphosphatase activity of red blood cell ghost. Urinary calcium excretion was estimated from the 24-h urine samples. These values were compared in the two groups. RESULTS: The mean gestational age at recruitment was similar in both the groups. The mean maternal age was 24.28 +/- 2.41 years in pre-eclamptic and 23.48 +/- 4.16 years in normotensive women. In pre-eclampsia 24-h urinary calcium excretion (71.20 +/- 22.95 mg/day) and calcium-dependent ATPase activity (10.78 +/- 2.40 nmol/Pi/mg protein/min) was significantly lower compared to normotensive primigravidae (calcium excretion = 189.24 +/- 57.06 mg/day; Ca2+-dependent ATPase = 12.64 +/- 2.42 nmolPi/mg /protein per min; P < 0.001). Intracellular calcium levels and calcium uptake at 10 min by red blood cells were significantly higher in pre-eclampsia (P < 0.05). Calcium uptake by red blood cells at 20 and 30 min was similar in both groups. CONCLUSION: Pre-eclampsia is associated with increased levels of intracellular calcium, decreased calcium-dependent ATPase activity of erythrocytes and hypocalciuria.     

Proteinuria in pre-eclampsia: how much matters?

OBJECTIVE: To determine, in women with proteinuric pre-eclampsia, whether a discriminant value of proteinuria at the time of diagnosis predicts the presence or absence of subsequent adverse maternal and fetal outcomes. DESIGN: Retrospective cohort study. SETTING: One teaching hospital and two primary referral hospitals in Sydney, Australia. SAMPLE: Three hundred and twenty-one pregnant women with proteinuric pre-eclampsia, managed according to a uniform management protocol. METHODS: All women with the diagnosis of proteinuric pre-eclampsia in the years 1998-2001 were studied. After exclusion of women with pre-eclampsia superimposed on pre-existing hypertension, a twin pair, unavailable spot urine results, 353 women were analysed using logistic regression to determine separately the predictors of any adverse maternal or fetal outcomes at the time of delivery. Receiver operating characteristic (ROC) curves, sensitivity and specificity were then calculated from the data. MAIN OUTCOME MEASURES: Adverse maternal outcomes: severe maternal hypertension (BP > or = 170/110 mmHg), renal insufficiency, liver disease, cerebral irritation, haematological disturbances. Adverse fetal outcomes: small for gestational age, perinatal mortality. RESULTS: There were 108 (34%) adverse maternal outcomes and 60 (19%) adverse fetal outcomes including two stillbirths. In multivariate analysis, an adverse maternal outcome was significantly associated with higher spot urine protein/creatinine ratio at diagnosis (P < 0.0001) with an odds ratio (OR) of 1.003 per mg/mmol (95% confidence interval [CI] 1.002-1.004) and with older maternal age (P= 0.014) with OR 1.06 per year (95% CI 1.01-1.11). An increased risk of adverse fetal outcome was associated with higher spot urine protein/creatinine (P= 0.013; OR 1.44 per log [mg/mmol], 95% CI 1.08-1.92), gestation at diagnosis <34 weeks (P < 0.0001; OR 3.60, 95% CI 1.90-6.82) and early pregnancy systolic blood pressure < or =115 mmHg (P= 0.0002; OR 3.41, 95% CI 1.77-6.57). The area under the receiver operating characteristic (ROC) curve was 0.67 for adverse maternal outcomes and 0.72 for adverse fetal outcomes. CONCLUSIONS: With increasing proteinuria, there is increased risk of adverse maternal and fetal outcomes. Although we did not identify a specific spot protein/creatinine ratio that could be used as a definitive screening value for adverse outcomes, it is possible to utilise data from this study to predict the likelihood of adverse maternal and fetal outcomes. A high spot urine protein/creatinine ratio in pre-eclamptic women of greater than 900 mg/mmol ( approximately 9 g/day), or greater than 500 mg/mmol (approximately 5 g/day) in women over 35 years, is associated with a greatly increased likelihood of adverse maternal outcomes.     

Outcome of infants delivered between 24 and 28 weeks' gestation in women with severe pre-eclampsia.

OBJECTIVE: To determine whether there are differences in neonatal outcome between infants born to mothers with severe pre-eclampsia and those born to normotensive mothers with preterm labor and intact membranes between 24 and 28 weeks' gestation. MATERIALS AND METHODS: Over a 4-year period between 1991 and 1995, neonates of women with severe pre-eclampsia delivering between 24 and 28 weeks were matched for maternal age, antenatally assigned gestational age and mode of delivery to normotensive women delivering during the same period. RESULTS: Fifty-eight women with severe pre-eclampsia were matched to 58 normotensive controls who delivered as a result of preterm labor. Antenatal steroids were used more often in pre-eclamptic women (75% vs. 47%, p < 0.01). The mean birth weight of pre-eclamptic neonates was significantly lower than that of controls, 767 g vs. 989 g, respectively. Other neonatal complications were similar for both groups. Neonates of pre-eclamptics required longer ventilator support (21 vs. 16 median days, p = 0.03). Neonatal survival was similar for both groups (72% and 79% for pre-eclamptics and normotensives, respectively). CONCLUSIONS: Neonates born to patients with severe pre-eclampsia have similar survival but a lower birth weight and require longer ventilator support than neonates born to women with preterm labor.     

Placental stem cell markers in pre-eclampsia

OBJECTIVE: To investigate the placental CD34, CD44, and leukemia inhibitory factor (LIF) levels in normotensive and pre-eclamptic women. METHOD: The study population consisted of 21 women with pre-eclampsia. Twenty normotensive pregnant women served as controls and were matched to pre-eclamptic patients by gestational age at delivery. Decidual samples obtained from the central part of the placenta were stored at -70 degrees C until analysis. CD44 and LIF were quantified in homogenates by enzyme-linked immunosorbent assay (ELISA), while CD34 was quantified by flow cytometry. RESULTS: The pre-eclamptic and normotensive groups were well matched. There were no significant differences in age, parity, weight, and gestational age at birth between the groups (P>0.05). The mean placental levels of CD34 (6.55+/-2.48 vs 3.16+/-1.23), CD44 (385.24+/-178.85 vs 157.75+/-31.73, and LIF (140+/-51.11 vs 96.25+/-31.62) were significantly higher in pre-eclamptic compared with normotensive women, respectively (P<0.05). CONCLUSION: Higher levels of CD34, CD44, and LIF were found in the placentas of pre-eclamptic compared with normotensive women.     

Insulin sensitivity in pre-eclampsia

Objective To investigate whether pre-eclampsia is associated with an exaggeration of the insulin resistance seen in normotensive pregnancy.
Design Minimal model analysis of a frequently sampled intravenous glucose tolerance test to assess insulin sensitivity.
Setting Royal Maternity Hospital, Belfast.
Participants Eleven women with pre-eclampsia and 11 matched normotensive pregnant women.
Results Insulin sensitivity (S_I) was increased in the group with pre-eclampsia compared with the normotensive women (mean [±SEM]: 2.6 [0.4] vs 1.6 [0.2] 10⁻⁴ min⁻¹ per mU/L;   P = 0.028  ). This was accompanied by a decrease in glucose effectiveness (S_G) (1*1 ±0.1 vs 1.7 ±0.1 10⁻² mid,   P = 0.006  ) in the pre-eclamptic women. In the normotensive group there was a significant inverse correlation between S, and mean arterial blood pressure ( Y =−0.65;   P = 0.03  ), but no such relation existed in the group with pre-eclampsia.
Conclusions As with other forms of secondary hypertension, and unlike essential hypertension, the pathophysiology of pre-eclampsia is not associated with insulin resistance.     

First trimester urinary placental growth factor and development of pre-eclampsia

Objective  To compare urinary placental growth factor (PlGF) concentration at 11⁺⁰ to 13⁺⁶ weeks of gestation in women who subsequently develop pre-eclampsia with normotensive controls.
Design  Nested case–control study within a prospective study for first trimester prediction of pre-eclampsia.
Setting  Routine antenatal visit in a teaching hospital.
Population  Fifty-two women who developed pre-eclampsia and 52 controls matched for gestational age and sample storage time.
Methods  Urinary PlGF concentration and PlGF to creatinine ratio were measured in women who developed pre-eclampsia and their matched controls. Comparisons between groups were performed using Student's t test.
Main outcome measures  Development of pre-eclampsia.
Results  In the pre-eclampsia group, the median urinary PlGF concentration (20.6 pg/ml, interquartile range [IQR] 9.1–32.0 pg/ml) and median urinary PlGF to creatinine ratio (1.6 pg/mg, IQR 1.2–2.5 pg/mg) were not significantly different from the control group (11.8 pg/ml, IQR 5.5–29.8 pg/ml, P = 0.1 and 1.7 pg/mg, IQR 1.2–2.3 pg/mg, P = 0.3, respectively). There were no significant differences between women with early-onset pre-eclampsia requiring delivery before 34 weeks ( n = 13) and those with late-onset pre-eclampsia ( n = 39) and between women with pre-eclampsia and fetal growth restriction (FGR) ( n = 25) and those with pre-eclampsia and no FGR ( n = 27) in either median PlGF concentration or median urinary PlGF to creatinine ratio.
Conclusions  The development of pre-eclampsia is not preceded by altered urinary PlGF concentration in the first trimester of pregnancy.     

Twenty-four-hour urine insulin as a measure of hyperinsulinaemia/insulin resistance before onset of pre-eclampsia and gestational hypertension

OBJECTIVE: To evaluate levels of 24-hour urine insulin excretion before the onset of pre-eclampsia and gestational hypertension. DESIGN: Nested case-control study within the Calcium for Preeclampsia Prevention (CPEP) study cohort. SETTING: Five university medical centres in the United States. SAMPLE: Cases had developed pre-eclampsia (n= 70) or gestational hypertension (n= 142) in the absence of gestational diabetes. Controls (n= 429) had remained normotensive without gestational diabetes. METHODS: Subjects were required to have had an adequate baseline 24-hour urine collection prior to CPEP enrolment at 13-21 weeks. Controls were matched to cases by enrolment site and specimen storage time, without regard to gestational age or CPEP treatment. Adjusted mean 24-hour urine insulin excretion was, however, calculated using analysis of covariance, with adjustment models for pre-eclampsia considering body mass index, race and smoking status; and for gestational hypertension, gestational age at specimen collection, height, body mass index and smoking. Urine insulin was measured by radio-immunoassay. MAIN OUTCOME MEASURES: Twenty-four-hour urine insulin excretion. RESULTS: Adjusted 24-hour urine insulin excretion at baseline (mean 17 weeks of gestation) was greater in women who developed pre-eclampsia than in normotensive controls (mean [SE]: 15.6 [1.5] vs 13.1 [1.2] x 10(3)microIU/24 hour, P= 0.06), but not in women who developed gestational hypertension (14.7 [0.9] vs 15.0 [0.6] x 10(3)microIU/24 hour, P= 0.79, in cases vs controls). Among women who developed pre-eclampsia, adjusted urine insulin excretion was greater than controls only in women with mild pre-eclampsia and not in severe pre-eclampsia (mild pre-eclampsia vs controls: 17.3 [2.0] vs 13.7 [1.6] x 10(3)microIU/24 hour, P= 0.04; severe pre-eclampsia vs controls: 12.3 [2.2] vs 11.5 [1.2], P= 0.69). CONCLUSION: The data suggest that early hyperinsulinaemia, a marker of insulin resistance, may predispose to mild pre-eclampsia.     

Tissue factor levels and high ratio of fibrinopeptide A:D-dimer as a measure of endothelial procoagulant disorder in pre-eclampsia.

To assess coagulation activation and endothelial cell injury in normotensive and pre-eclamptic pregnant women, a comparison was made of plasma levels of tissue factor, fibronectin, fibrinopeptide A and D-dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre-eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D-dimer were found in pre-eclamptic women. Moreover, the ratio fibrinopeptide A:D-dimer was much greater in the pre-eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre-eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsic coagulation pathway in pre-eclampsia. The increase of fibrinopeptide A:D-dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre-eclampsia.     

Lipoprotein(a) levels in women with pre-eclampsia and in normotensive pregnant women

AIM: To determine if plasma lipoprotein(a) levels are elevated in pre-eclampsia and if so, their association with the severity of the disease. METHODS: Ninety-one pre-eclamptic (48 mild, 43 severe) and 40 healthy normotensive pregnant women at more than 32 gestational weeks were recruited into study. Plasma levels of lipoprotein(a), lipids, total protein, albumin and fibrinogen were measured in all subjects. RESULTS: All groups were comparable with respect to maternal age, maternal weight, gravidity and parity. Platelet count, total serum protein and albumin levels were significantly decreased, whereas fibrinogen levels significantly increased in the pre-eclamptic group. There was no difference between the groups with respect to total cholesterol and low-density lipoprotein levels. In the pre-eclampsic group, triglyceride and very-low-density lipoprotein concentrations were significantly higher, whereas high-density lipoprotein levels were significantly lower. No difference in serum lipoprotein(a) levels was found between the three groups. CONCLUSIONS: No statistically significant difference existed between normotensive pregnant, and pre-eclamptic women, with regard to plasma lipoprotein(a) levels. It is improbable that high serum lipoprotein(a) levels are risk factors for the development of pre-eclampsia; however, elevated triglyceride-rich lipoproteins might cause endothelial damage leading to pre-eclampsia.     

A comparison of serum androgens in pre-eclamptic and normotensive pregnant women during the third trimester of pregnancy

Objective: To compare the serum androgens level during the third trimester of pregnancy between normotensive and pre-eclamptic women. Method: A case–control study was performed on 64 pregnant women with the gestational age of 28–34 weeks. 32 women were pre-eclamptic (case group), and 32 women were normotensive till term gestation (control group). The serum level of androgens including sex hormone binding globulin (SHBG), total and free testosterone, androstenedione (ADD), and dehydroepiandrosterone sulfate (DHEA-S), were compared between the two groups. Results: The women of the two groups had no statistically significant difference according to age, gestational age, BMI (body mass index), parity and fetal sex. Serum level of SHBG (90.86 ± 9.30 vs. 55.86 ± 8.02 nmol/l, p = 0.02), total testosterone (3.70 ± 0.57 vs. 2.06 ± 0.24 ng/ml, p = 0.01), free testosterone (1.28 ± 0. 17 vs. 0. 74 ± 0.07 pg/ml, p = 0.01), and ADD (2.47 ± 0.10 vs. 2.17 ± 0.10 ng/ml, p = 0.04), was higher in the pre-eclamptic women. However, there was no difference between the two groups for DHEA-S (0.75 ± 0.18 vs. 0.51 ± 0.08 μg/ml, p = 0.19). Conclusion: Serum androgen levels during third trimester of pregnancy are higher in pre-eclamptic women and this may propose an effect of androgens in the pathogenesis of pre-eclampsia.     

Increase in serum concentrations of inhibin in early onset pre-eclampsia with intrauterine growth restriction

AIM: Recently, it has been hypothesized that reduced placental blood flow in early pregnancy causes changes in endothelial function, leading to pre-eclampsia. To clarify this clinically, we assessed serum concentrations of inhibin and uric acid in pre-eclamptic women compared with those of normotensive pregnant women. METHODS: One hundred and forty normotensive pregnant women (at 20-41 weeks' gestation) and 50 women with pre-eclampsia (at 24-41 weeks' gestation) were the study subjects. Pre-eclamptic women were classified according to the new criteria for pregnancy-induced hypertension produced by the Japanese Society of Obstetrics and Gynecology (JSOG). Serum concentrations of uric acid and inhibin were measured enzymatically and by radioimmunoassay, respectively. RESULTS: Serum concentrations of inhibin and uric acid in the pre-eclamptic women were significantly higher than in gestational age-matched normotensive pregnant women. There were significant correlations among inhibin and uric acid, blood pressure and birth weight. According to JSOG criteria, of the 50 pre-eclamptic women, 18 were early onset (EO), including 16 cases complicated by intrauterine growth restriction (IUGR), and 32 cases were late onset, including 12 cases complicated by IUGR. In the patients with EO and IUGR, serum concentrations of inhibin, but not uric acid, were significantly elevated as compared with those of the other pre-eclamptic women. CONCLUSION: The results suggest that an increase in the serum concentration of inhibin seen in EO pre-eclampsia, together with IUGR, might be a cause of reduced placental blood flow.     

Urinary tissue kallikrein excretion in black African women with severe pre-eclampsia

BACKGROUND: A study of tissue kallikrein excretion in African women with severe pre-eclampsia. METHODS: Random untimed urine samples were collected from all women (n=198) recruited to this study; 66 women with severe pre-eclampsia, 66 normotensive pregnant women of similar length of gestation and 66 normotensive non-pregnant women. Urine specimens were analyzed for urinary tissue kallikrein using a selective, synthetic chromogenic tripeptide substrate (S2266) having the sequence H-D-Val-Leu-Arg-pNA. RESULTS: Urinary tissue kallikrein levels were decreased in women with severe pre-eclampsia compared with those of gestation matched normotensive pregnant women at 28 weeks of gestation (1.55+/-0.95 vs. 3.02+/-1.35 ng TK/microg protein; p<0.0001) and at near delivery date (1.21+/-0.53 vis. 3.11+/-1.2 ng TK/microg protein; p<0.0001). In the normotensive pregnant group, there was no significance difference in urinary tissue kallikrein excretion close at delivery date compared to 28 weeks of gestation (3.02+/-1.35 vs. 3.11+/-1.21 ngTK/microg protein; p=0.23). No statistical difference in urinary tissue kallikrein excretion was observed between normotensive pregnant and normotensive non pregnant women (3.02+/-1.35 vs. 2.97+/-1.12 ngTK/microg protein; p=0.16). Urinary tissue kallikrein excretion correlated positively with urinary creatinine levels at 28 weeks of gestation (r=0.69; p<0.0001) and close to delivery date (r=0.84; p<0.0001). There was no correlation between neonatal birthweight and urinary tissue kallikrein levels (r=-0.44; p=0.41). CONCLUSION: The decreased levels of urinary tissue kallikrein excretion in pre-eclamptic patients suggests an etiological role for this serine protease in hypertensive disorders of pregnancy.     

Periodontal disease as a risk factor for pre-eclampsia: a case control study

OBJECTIVE: To investigate the association between periodontal disease and pre-eclampsia, while controlling known risk factors for pre-eclampsia. METHODS: A matched case-control study was carried out on 41 pre-eclamptic women and 41 normotensive, healthy, pregnant, control women. The pre-eclamptic women and controls were individually matched for age, gravidity, parity, smoking and prenatal care. The number of teeth and the number of restorations and decay on all tooth surfaces, and clinical periodontal parameters, excluding third molars were determined within 48 h before delivery. The relation of independent variables to pre-eclampsia was assessed using conditional multiple logistic regression analysis on subject-based data. RESULTS: There were no statistically significant differences in mean percentages of sites with plaque between groups. The mean probing depth (PD) and mean clinical attachment level (CAL) for pre-eclamptic patients were significantly greater compared to those of normotensive patients (P < 0.01). The percentage of sites exhibiting bleeding on probing (BOP) (P < 0.05), the number of sites with PD >/= 4 mm and with CAL >/= 3 mm was significantly higher among pre-eclamptic patients than those with normotensive patients (P < 0.01). Conditional multiple logistic regression analysis indicated that periodontal disease and triglycerides level were significantly associated with pre-eclampsia. Other independent variables (maternal body weight and serum total cholesterol level) did not appear to be associated with pre-eclampsia. Conditional multiple logistic regression results showed that pre-eclamptic patients were 3.47 (95% CI = 1.07-11.95) times more likely to have periodontal disease than normotensive patients. CONCLUSION: The present study shows that maternal periodontal disease during pregnancy is associated with an increased risk for the development of pre-eclampsia. The higher incidence of periodontal disease parameters in pre-eclamptic group would suggest a possible role for periodontal disease in the development of pre-eclampsia. The nature both of periodontitis and pre-eclampsia is multifactorial, and caution should be exercised when implicating periodontal disease in causation of pre-eclampsia.     

Tissue factor levels and high ratio of fibrinopeptide A:D-dimer as a measure of endothelial procoagulant disorder in pre-eclampsia

To assess coagulation activation and endothelial cell injury in normotensive and pre-eclamptic pregnant women, a comparision was made of plama levels of tissue factor, fibronectin, fibrinopeptide A and D-dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre-eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D-dimer were found in pre-eclampsia women. Moreover, the ratio fibrinopeptide A:D-dimer was much greater in the pre-eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre-eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsir coagulation pathway in pre-eclampsia. The increase of fibrinopeptide A:D dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre-eclampsia.     

Urine albumin/creatinine ratio for the assessment of albuminuria in pregnancy hypertension

BACKGROUND: An accurate method to assess albuminuria in pregnancy is mandatory to diagnose pre-eclampsia. Twenty-four-hour urine collection is still the only universally accepted method. This is, however, a cumbersome and inconvenient method. Therefore, the present study aimed at assessing the accuracy of a spot urine albumin/creatinine ratio in pregnant women with hypertension. MATERIAL AND METHODS: In 54 pregnant women with blood pressure >or=140/90 mmHg, 24-h albumin excretion and subsequent albumin/creatinine ratio on morning spot urine were analyzed in the individual patients. Altogether 75 paired samples were included. Receiver operating characteristic curves, relating different albumin/creatinine ratio cut-off values to 24-h albumin excretion >300 mg were constructed. Correlations were assessed by Spearman rank correlation tests. RESULTS: The area under the receiver operating characteristic curve was 0.985. At the optimal cut-off albumin/creatinine ratio value of 27 mg/mmol the sensitivity, specificity, positive and negative predictive value for detecting albuminuria >300 mg/24 h were: 95, 100, 100 and 86% respectively. There was a close correlation between albumin/creatinine ratio and 24-h albumin excretion values (r=0.95; p<0.001). CONCLUSIONS: It is suggested that in most cases the more cumbersome 24-h urine collection can be replaced by the more convenient albumin/creatinine ratio on spot urine.     

Random urine protein to creatinine ratio as a diagnostic method of significant proteinuria in pre-eclampsia

BACKGROUND: Because of the importance of pre-eclampsia and proteinuria in pregnancy, a faster and simpler diagnostic method is needed. AIM: To compare random urine protein to creatinine ratio (p:c ratio) with 24-h urine protein excretion rate in pregnant women with a suspicion of pre-eclampsia. METHODS: The study was conducted on 100 pregnant women with gestational ages of >or=20 weeks; 50 patients were suspected of having pre-eclampsia and 50 were healthy pregnant women. A random urine sample for p:c ratio determination and a 24-h urine sample for protein measurement were obtained. RESULTS: All women suspected of having pre-eclampsia had significant proteinuria. The single-voided p:c ratio demonstrated a sensitivity of 94% with a specificity of 96% at the cut-off>or=0.2 mg/mg. There was strong correlation between the two methods in this group (r=0.70, P<0.001, R2=49%). Using the same cut-off in the pregnant women who were not thought to have pre-eclampsia, the sensitivity of the test (p:c ratio) was 29% and the specificity was 87%. Pearson's correlation coefficient was 26 (P<0.06). Negative predictive value and positive predictive value were 34 and 83%, respectively. CONCLUSION: There is a strong correlation between 24-h urine protein excretion and single-voided urine p:c ratio in women suspected of having pre-eclampsia. A single-voided p:c ratio of >or=0.2 mg/mg is highly predictive for significant proteinuria. However, this test was not found to be a reasonable alternative to 24-h urine collection; and it must be followed by 24-h urine collection in a clinically suspect patient with a p:c ratio of <0.2 mg/mg.     

A Prospective Study for the Prediction of Preeclampsia with Urinary Calcium Level

Objectives

To assess the efficacy of calciuria as a diagnostic test for the prediction of preeclampsia, and also to determine the changes in urinary excretion of calcium in preeclampsia and normotensive women.

Methods

A prospective study was conducted on 60 primi mothers in the age group of 20–30 years, and all were enrolled at 16 weeks of gestation with clinical follow up by 4 weeks and 24 h urinary calcium and creatinine estimation. Ten mothers developed preeclampsia (study groups) and fifty remained normotensive (control groups). By means of Receiver-operator curve, a cut-off level of urinary calcium in 24 h was chosen for predicting preeclampsia.

Results

Preeclamptic women excreted significantly less total urine calcium (87.0 ± 3.59 mg/24 h) than normotensive women (303.68 ± 17.699 mg/24 h) (p < 0.0001) at 40 weeks of gestation. Urinary calcium and calcium/creatinine (Ca:Cr) ratio decreases progressively from 28 weeks to 40 weeks in the study group when compared to normotensive group.

Conclusions

Preeclamptic women excrete less calcium than normotensive women. This parameter would predict preeclampsia earlier in pregnancy.     

Author Index to Volume 23

In pregnancy induced hypertension (PIH) hypocalciuria has been demonstrated from 24 hour urine collections. This method of detection of hypocalciuria is difficult and tedious in clinical practice. In this study, the calcium/creatinine ratio was analysed from a random single urine sample in 20 normotensive, 20 proteinuric PIH and 37 non-proteinuric PIH women. A significantly lower calcium/creatinine ratio was demonstrated in proteinuric PIH in contrast to normotensive and non-proteinuric PIH patients (p<0.001). The calcium/creatinine ratio correlated negatively (r–?0.33; p<0.01) with the albumin/creatinine ratio. There was no correlation between the calcium/creatinine ratio and platelet count, urate or birthweight centile.     

Selective deficit of angiogenic growth factors characterises pregnancies complicated by pre-eclampsia.

OBJECTIVE: To compare serum levels of angiogenic growth factors vascular endothelial growth factor (VEGF), placental growth factor (PlGF) and angiogenin in pre-eclamptic women and matched controls. DESIGN: Retrospective analysis of -70 degrees C stored serum of women who developed pre-eclampsia and matched controls. SETTING: Department of Gynaecology and Obstetrics, St Elisabeth Hospital, Cura?ao, Netherlands Antilles. SAMPLE: Thirty women with pre-eclampsia and 30 normotensive controls matched for age and gestation. RESULTS: VEGF and PIGF serum levels were significantly lower in pre-eclamptic pregnancies, compared with controls (VEGF 0.31 +/- 1.20 vs 18.30 +/- 24.97 pg/mL, P = 0.0004; PlGF 54.19 +/- 32.05 vs 497.95 +/- 340.51 pg/mL, P < 0.0001). Matched couple analysis showed VEGF serum concentrations to be lower in the majority of pre-eclamptic women and PlGF concentrations to be lower in all pre-eclamptic women. Angiogenin serum levels showed no statistical significant difference between pre-eclamptic pregnancies and controls (523.68 +/- 367.55 vs 670.41 +/- 251.54 ng/mL, P = 0.058), with matched couple analysis showing no clear pattern. CONCLUSIONS: Decreased serum levels of VEGF and PIGF characterise, and therefore seem to be of importance during (the development of), pre-eclampsia. This selective deficit of angiogenic growth factors might in part explain the shallow placentation found in this pregnancy complication.