Comparison of proteinuria assessment methods and their association with maternal-fetal outcomes in preeclampsia

Abstract

Introduction

Preeclampsia is a multisystem, progressive disorder in pregnancy characterized by new-onset hypertension and proteinuria. Early detection and treatment are crucial to prevent adverse maternal and fetal outcomes. The current gold standard for proteinuria assessment is the 24-hour urine protein test. This study aimed to compare the assessment of proteinuria using the dipstick test and urine protein-to-creatinine ratio (UPCR) against the 24-hour urine protein test in women with preeclampsia.

Methodology

This prospective analytical study was conducted over 18 months in tertiary care centers in southern and central India. Pregnant women after 20 weeks of gestation with preeclampsia were included. Proteinuria assessments using the dipstick test and UPCR were compared with the 24-hour urine protein test.

Results

A positive linear relationship was observed between UPCR and 24-hour urine protein levels. Adverse maternal and fetal outcomes were more frequent in women with UPCR > 0.3, although the association was statistically significant only in women having preeclampsia with severe features. The best cut-off of UPCR to predict 24-hour urine protein > 300 mg/dl in women with preeclampsia was 1.29, and it showed 100 % sensitivity and 58.2 % specificity.

Conclusion

The spot urine protein:creatinine ratio is not only quick and accurate method for measuring proteinuria in preeclampsia, but also very sensitive and quite specific, showing a strong correlation with the 24-hour urine protein test. The best cut-off value to predict significant proteinuria in our study was 1.29.