Diagnostic value of urinary albumin-to-creatinine ratio among women with pre-eclampsia at Amana regional referral hospital in Dar es Salaam
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Date
2025
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Kairuki University
Abstract
Background: Pre-eclampsia remains a leading cause of maternal and neonatal morbidity, in particularly in resource-limited settings. Proteinuria is among the most predictive indicators of preeclampsia and eclampsia. The Gold standard method for evaluating proteinuria in pre-eclampsia being 24hours urinary protein level. However, Urine dipsticks method has been used as an alternative for 24-hours protein in diagnosis of PE under clinical settings in resource limited areas. Urine dipstick is unjustifiably cumbersome and inaccurate. Urinary albumin-for-creatinine can be an alternative test and accurate but its application in local environment of Tanzania has not been reported before.
Objective: To determine diagnostic value of urine albumin-to-creatinine ratio among women with Preeclampsia from January 2025 to May 2025.
Methodology: A prospective cohort hospital-based study was conducted at Amana regional referral hospital in Dar es Salaam. Structured questionnaires were the main tool of data collection and data was analyzed using SPSS version 25.0. Sensitivity, specificity and predictive values were assessed. Neonatal, maternal, and other factors associated with maternal UACR were
analyzed using multivariable binary logistic regression model. UACR ≥0.3 mg/mmoL was used as cut-off point for elevated UACR and used to signify significant proteinuria in the studied sample.
Results: We recruited and analyzed a total of 576 different expectant women. There were 288 women with pre-eclampsia (exposed) and 288women without pre-eclampsia (unexposed). Median age of study participants was 28 (IQR): 24 – 33) years. Median gestation age at entry into the followup study among study participants was 24 (IQR: 22- 25) weeks. The present study findings demonstrated Urine Albumin to Creatinine Ratio (UACR) sensitivity of 90.7 % and specificity of 90.1 %. Negative predictive value of UACR was 95.8% while the positive predictive value was 75.7%. Both neonatal (Apgar score at 5th minute –Adjusted Odd Ratio (AOR): 1.07, 95% 1.0 – 1.3; neonatal birth weight – AOR.: 2.0, 95% C.I.: 1.2 – 2.9 kgs) as well as maternal (gestational age at delivery – AOR.: 1.1, 95% C.I.: 1.0 – 1.62 weeks; SBP – AOR.: 1.01, 95% C.I.: 1.0 – 1.7; DBP – AOR.: 1.12, 95% C.I.: 1.0 – 1.97) were statistically significantly associated with maternal urinary albumin to creatinine ratio.
Conclusion
Urine albumin-to-creatinine ratio (UACR) has yielded appreciable predictive values, sensitivity and specificity indices for diagnosis of pre-eclampsia in the second trimester in this study population. Maternal systolic and diastolic BP as well as gestational age at delivery were found to be significant risks associated with UACR.
Recommendations: Urine albumin-to-creatinine ratio can be used as an alternative method in the diagnosis of pre-eclampsia in resource limited settings.
Description
Dissertation submitted to the faculty of medicine in partial fulfillment of the requirements for the award of the degree of maters of medicine in obstetrics and gynecology of Kairuki university
Keywords
preeclampsia, gestational hypertension
Citation
Mboya, Theresia 2025. Diagnostic value of urinary albumin-to-creatinine ratio among women with pre-eclampsia at Amana regional referral hospital in Dar es Salaam. Dissertation. Kairuki University