A cohort study on use of the spot urine calcium-creatinine ratio for prediction of antepartum preeclampsia among high-risk pregnant women in Delta State, Nigeria
Spot urine calcium-creatinine ratio in pregnant women
Keywords:
Preeclampsia, Urine calcium-creatinine ratio, Screening High-risk women, Significant proteinuriaAbstract
Background/Aim: Preeclampsia is a multisystemic disorder, which significantly contributes to maternal and fetal morbidity and mortality, especially in developing countries where it accounts for about one-third of maternal mortality cases. Predicting its occurrence will reveal a sizeable population of pregnant women who will undoubtedly benefit from prevention. The ideal screening marker for the disease is still being investigated. The urine calcium-creatinine ratio (CCR) is an inexpensive, simple, and easily assayed biomarker. This study determined the accuracy of the spot urinary calcium-creatinine ratio in predicting the occurrence of preeclampsia.
Methods: This was a prospective cohort study conducted in Delta State, which involved four healthcare facilities in Nigeria. A total of 138 pregnant women between 8 and 18 weeks gestation were recruited. Urine samples were obtained at 18 weeks to assay their CCR, and patients were followed up weekly for blood pressure measurement and dipstick urinalysis until delivery.
Results: The mean spot urine CCR in this study was 0.225 (0.101). It was significantly lower in women who developed preeclampsia compared to normotensive women (P < 0.001). Multiple logistics regression analysis showed that the association between urine CCR and occurrence of preeclampsia was statistically significant. At a receiver operating characteristic cutoff of ≤ 0.1065, CCR had a sensitivity of 75%, specificity of 91.3%, positive predictive value (PPV) of 35.3%, and negative predictive value (NPV) of 98.3%. The low PPV of 35.3% can be explained by the low prevalence of preeclampsia (5.78%) in the study population.
Conclusion: In conclusion, the poor PPV of the urine CCR was due to the low prevalence of preeclampsia in the study. However, in considering all women at risk, urine CCR may be a good prognostic marker when the illness prevalence is substantial.
Downloads
References
Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Publ Gr. 2014;10(8):466–80. Available from: doi: 10.1038/nrneph.2014.102 DOI: https://doi.org/10.1038/nrneph.2014.102
Aronow WS. Hypertensive disorders in pregnancy. Ann Transl Med. 2017;5(11):12–4. Available from: doi: 10.21037/atm.2017.03.104 DOI: https://doi.org/10.21037/atm.2017.03.104
Milne F, Redman C, Walker J, Al E. The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre- eclampsia in the community. BMJ. 2005;330(7491):576–80. doi: 10.1136/bmj.330.7491.576 DOI: https://doi.org/10.1136/bmj.330.7491.576
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Look PFA Van. WHO analysis of causes of maternal death : a systematic review. Lancet. 2006;367(6):68397–9. doi: 10.1016/S0140-6736 DOI: https://doi.org/10.1016/S0140-6736(06)68397-9
Dadelszen P Von, Magee LA. Pre-eclampsia : An Update. Curr Hypertens Rep. 2014;16:454. doi: 10.1007/s11906-014-0454-8 DOI: https://doi.org/10.1007/s11906-014-0454-8
Osungbade KO, Ige OK. Public Health Perspectives of Preeclampsia in Developing Countries : Implication for Health System Strengthening. J Pregnancy. 2011;2011(481095):1–6. doi: 10.1155/2011/481095 DOI: https://doi.org/10.1155/2011/481095
Ashimi A, Omole-Ohonsi A. Pre-eclampsia: a study of risk factors. Niger Med Pract. 2008;53(6):99–102. doi: 10.4314/nmp.v53i6.28935 DOI: https://doi.org/10.4314/nmp.v53i6.28935
Olopade FE, Lawoyin TO. Maternal mortality in a Nigerian Maternity Hospital. African J Biomed Res. 2008;11(3):267–273. DOI: https://doi.org/10.4314/ajbr.v11i3.50726
Population Council Nigeria, “Administering Magnesium Sulfate to Treat Severe Pre-eclampsia and Eclampsia. Popul Counc Niger. 2009; Available from: http://www.popcouncil.org/projects/134
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130–7. doi: 10.1053/j.semperi.2009.02.010 DOI: https://doi.org/10.1053/j.semperi.2009.02.010
Carol L, Stephanie AC, Amy Woodruff. Hypertension and Pregnancy. Texas Hear Inst J. 2017;44(5):350–1. Available from: doi: 10.14503/THIJ-17-6359 DOI: https://doi.org/10.14503/THIJ-17-6359
Staff AC, Benton SJ, Von Dadelszen P, Roberts JM, Taylor RN, Powers RW, et al. Redefining preeclampsia using placenta-derived biomarkers. Vol. 61, Hypertension. 2013. p. 932–42. doi: 10.1161/HYPERTENSIONAHA.111.00250 DOI: https://doi.org/10.1161/HYPERTENSIONAHA.111.00250
Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, JP Vogel C. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121(1):14–24. Available from: doi: 10.1111/1471-0528.12629 DOI: https://doi.org/10.1111/1471-0528.12629
Lisonkova S, Sabr Y, Mayer C, Young C, Skoll A, Joseph K. Maternal Morbidity Associated With Early-Onset and Late-Onset Preeclampsia. Am J Ob- stet Gynecol. 2014;124(4):771–81. doi: 10.1097/AOG.0000000000000472 DOI: https://doi.org/10.1097/AOG.0000000000000472
Steegers EAP, Dadelszen P Von, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376:631–44. doi: 10.1016/S0140-6736(10)60279-6 DOI: https://doi.org/10.1016/S0140-6736(10)60279-6
Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, Groot CJM De, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016;387(10022):999–1011. doi: 10.1016/S0140-6736(15)00070-7 DOI: https://doi.org/10.1016/S0140-6736(15)00070-7
Mustafa R, Ahmed S, Gupta A, Venuto RC. A Comprehensive Review of Hypertension in Pregnancy. J Pregnancy. 2012;2012:19. doi: 10.1155/2012/105918 DOI: https://doi.org/10.1155/2012/105918
Inversetti A, Smid M, Candiani M, Ferrari M, Galbiati S. Predictive biomarkers of pre-eclampsia and effectiveness of preventative interventions for the disease. Expert Opin Biol Ther. 2014;14(8):1–13. doi: 10.1517/14712598.2014.912271 DOI: https://doi.org/10.1517/14712598.2014.912271
Acharya A, Brima W, Burugu S, Rege T. Prediction of Preeclampsia-Bench to Bedside. Curr Hypertens Rep. 2014;16:491. doi: 10.1007/s11906-014-0491-3 DOI: https://doi.org/10.1007/s11906-014-0491-3
Prasad I, Bandana K, Narayan RA, Pritam P. Evaluation of Urinary Calcium Creatinine Ratio in Pre eclampsia. Natl J Lab Med. 2016;5(2):1–5. doi: NJLM/2016/17110:2102
Austdal M, Tangerås L, Skråstad R, Salvesen K, Austgulen R, Iversen A, et al. First Trimester Urine and Serum Metabolomics for Prediction of Preeclampsia and Gestational Hypertension : A Prospective Screening Study. Int J Mol Sci. 2015;16(9):21520–38. doi: 10.3390/ijms160921520 DOI: https://doi.org/10.3390/ijms160921520
Shilpa M, Shaikh MK., Ratna T, Darshana J. Calcium / Creatinine Ratio in Spot Urine Sample for Early Detection of Preeclampsia. J Evol Med Dent Sci. 2014;3(04):966–71. doi: 10.14260/jemds/2014/1933
Frans J M Huikeshoven, M.J. Zuijderhoudt F. Hypocalciuria in hypertensive disorder in pregnancy and how to measure it. Eur J Obstet Gynecol Reprod Biol. 1990;36(1–2):81–5. doi: 10.1016/0028-2243(90)90053-4 DOI: https://doi.org/10.1016/0028-2243(90)90053-4
Kessler JB, Costa CA, Barros E, Medicina F De, Alegre P. Calciuria and preeclampsia. Brazilian J Med Biol Res. 1998;31(4):519–22. doi: 10.1590/S0100-879X1998000400007 DOI: https://doi.org/10.1590/S0100-879X1998000400007
Golmohammad lou, A. Amirabi, M. Yazdian NP, Department. Evaluation of Serum Calcium, Magnesium, Copper, and Zinc Levels in Women with Pre-eclampsia. Iran J Med Sci. 2008;33(4):4–7.
Mandira D, Sudhir A, Mamtaz S. Urinary calcium levels in pre-eclampsia. J Obs Gynecol India. 2008;58(4):308–13.
David A, Padmaja P. Calcium-to-Creatinine Ratio in a Spot Sample of Urine , for Early Prediction of Hypertensive Disorders of Pregnancy : A Prospective Study. J Obstet Gynecol India. 2015;66:94–7. Available from: doi: 10.1007/s13224-015-0797-3 DOI: https://doi.org/10.1007/s13224-015-0797-3
Szmidt-Adjide V, David S, Bredet-Bangou J, Janky E. Calciuria and preeclampsia : A case-control study. Eur J Obstet Gynecol Reprod Biol. 2006;125(1):193–8. DOI: https://doi.org/10.1016/j.ejogrb.2005.06.029
Williis MR. The urinary calcium/creatinine ratio measure of urinary calcium excretion. JClin Pathol. 1969;22(3):287–90. DOI: https://doi.org/10.1136/jcp.22.3.287
Phuapradit W, Manusook S, Lolekha P. Urinary Calcium-Creatinine Ratio in the Prediction of Preeclampsia. Aust NZ J Obs Gynaecol. 1993;33(3):280–1. doi: 10.1111/j.1479-828X.1993.tb02086.x DOI: https://doi.org/10.1111/j.1479-828X.1993.tb02086.x
Saudan PJ, Shaw L, Brown MA. Urinary Calcium/Creatinine Ratio as a Predictor of Preeclampsia. Am J Hypertens. 1998;7061(98):839–43. doi: 10.1016/S0895-7061(98)00054-5 DOI: https://doi.org/10.1016/S0895-7061(98)00054-5
Kazerooni T, Hamze-Nejadi S. Calcium to creatinine ratio in a spot sample of urine for early prediction of pre-eclampsia. Int J Gynecol Obstet. 2003;80:279–83. DOI: https://doi.org/10.1016/S0020-7292(02)00382-X
Sheela C, Beena S, Mhaskar A. Calcium-Creatinine Ratio and Microalbuminuria in Prediction of Preeclampsia. J Obstet Gynecol India. 2011;(1–2):72–6. Available from: Accessed 24th November 2018 DOI: https://doi.org/10.1007/s13224-011-0005-z
Vahdat M, Kashanian M, Sariri E, Mehdinia M. Evaluation of the value of calcium to creatinine ratio for predicting of pre-eclampsia. J Matern Neonatal Med. 2012;25(9):2793–4. doi: 10.3109/14767058.2012.712561 DOI: https://doi.org/10.3109/14767058.2012.712561
Rashmi S, Bhushan I. Study Of Urinary Calcium / Creatinine Ratio (CCR) In A Spot Sample Of Urine For Early Prediction Of Preeclampsia . IOSR J Dent Med Sci. 2016;15(5):101–4. Available from: doi: 10.9790/0853-150508101104
Black MA, Taylor RS, Walker JJ. Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. BMJ. 2011;342(1875):1–11. doi: 10.1136/bmj.d1875 DOI: https://doi.org/10.1136/bmj.d1875
Bartoš V, Dastych M, Dastych M, Franěk T, Jirsa M, Kalousová M. Metabolism of Calcium, Phosphorus and Magnesium. In: Racek J, Rajdl D, editors. Clinical biochemistry. 1st ed. Prague: Charles University; 2016.
Endres D, Rude R. Mineral and bone metabolism. In: Burtis C, Ashwood E, Bruns D, editors. Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed. Philadelphia: W.B Saunders; 2006. p. 1892–905.
Tenny S, Hoffman MR. Prevalence. StatPearls. Nebraska: Statpearls Publishing LCC; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430867
Mandira D, Amitava P, Debobroto R, Sudhir A, Anita R, Kumar MA. A Prospective Study for the Prediction of Preeclampsia with Urinary Calcium Level. J Obstet Gynecol India. 2012;62(3):312–6. doi: 10.1007/s13224-012-0223-z DOI: https://doi.org/10.1007/s13224-012-0223-z
Ozcan T, Kaleli B, Ozeren M, Turan C, Zorlu G. Urinary Calcium to Creatinine Ratio for Predicting Pre-eclampsia. Am J Perinatol. 1995;12(5):349–51. doi: 10.1055/s-2007-994494 DOI: https://doi.org/10.1055/s-2007-994494
Kazemi AFN, Sehhatie F, Sattarzade N, Mameghani ME. The predictive Value of Urinary Calcium to Creatinine Ratio, Roll-Over Test ad BMI in Early Daignosis of Pre-Eclampsia. Res J Biol Sci. 2010;5(2):183–6. DOI: https://doi.org/10.3923/rjbsci.2010.183.186
Beccera J, Binkin NJ, Eaker ED, Goldberg HI. Sample Size and Power. In: Wingo PA, Higgins JE, Rubin GL, Zahniser SC, editors. An Epidermiologic Approach to Reproductive Health. Geneva, Switzerland: WHO/HRP/EPI; 1994. p. 151–200.
Downloads
- 423 675
Published
Issue
Section
How to Cite
License
Copyright (c) 2022 Lloyd Jagu, V. Peter Orugbo, Patrick Okonta
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.