Urinary calcium to creatinine ratio to predict preeclampsia and use of calcium supplementation to prevent preeclampsia

Anjali M. Munge, Meena N. Satia


Background: Incidence of preeclampsia is around 5-10% of all pregnancies, and in developing countries around 4-18%. There is hypercalciuria during normal pregnancy, while pre-eclampsia is associated with hypocalciuria and low urinary calcium to creatinine ratio. Low calcium intake has been hypothesized to cause increase in blood pressure. The present study was carried out to investigate significance of urinary CCR in prediction of preeclampsia & role of calcium supplementation in reducing preeclampsia.

Methods: 100 pregnant patients were divided into two groups, 50 cases and 50 controls. A spot urine sample was collected for estimation of CCR at around gestational age of 20-24 weeks. Cases were given 2 gm of calcium supplementation. Controls were 1 gm calcium .Then at each visit both the groups, were evaluated for symptoms of preeclampsia. Urinary calcium to creatinine ratio was calculated and those with ratio <or = 0.04 were considered test positive and those with ratio of >0.04 were considered test negative.

Results: The test (urinary CCR <= 0.04) was positive in 16 patients, 9 developed preeclampsia. The test was negative test (urinary CCR >0.04) in 84 patients and in those only 5 developed pre eclampsia. Urinary CCR had sensitivity of 63.63%, specificity of 94.87%. Out of 50 cases, only 3 developed preeclampsia. Out 0f 50 controls, 11 developed preeclampsia.

Conclusions: Urinary CCR between 20-24wks of gestation will be an effective screening method for impending pre-eclampsia. Calcium supplementation (2gms/day) can help in prevention of preeclampsia.


Preeclampsia, Urinary calcium to creatinine ratio (CCR), Calcium supplementation

Full Text:



Zimmer C. Silent struggle: A new theory of pregnancy. The New York Times. 2006:1-4.

WHO, 2004. Bethesda, MD. Global Burden of Disease for the Year 2001 by World Bank Region, for Use in Disease Control Priorities in Developing Countries, National Institutes of Health: WHO. Make every mother and child count. World Health Report, 2005, 2nd ed. Geneva:World Health Organization, 2005.

Villar J, Betran AP, Gulmezoglu M. Epidemiological basis for the planning of maternal health services. WHO/RHR. 2001.

Khedun SM, Moodley J, Naicker T, Maharaj B. Drug management of hypertensive disorders of pregnancy. Pharmacol Ther. 1997;74(2):221-58.

Belizan JM, Villar J. The relationship between calcium intake and edema, proteinuria, and hypertension-gestosis: an hypothesis. Am J Clin Nutr. 1980;33:2202-10.

Hamlin RHJ. Prevention of pre-eclampsia. Lancet. 1962;1:864-5.

ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. No. 33, January 2002. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2002;99:159-67.

Rodriquez-Thompson D, Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy. Am J Obstet Gynecol. 2001;185:808-11.

Kumar A, Gyaneshwori Devi S, Batra S, Singh C, Shukla DK. Calcium supplementation for the prevention of pre-eclampsia International Journal of Gynecology and Obstetrics. 2009;104:32-6.

Curnow KM, Pham T, August P. The L10F mutation of Angiotensinogen is rare in pre-eclampsia. J Hypertension. 2000;18(2):173-8.

Sanchez-Ramas L, Jones DC, Cullen MT. Urinary calcium as an early marker for preeclampsia. Obstet Gynecol. 1991;77:685.

Villar MA, Sibai BM. Clinical significance of elevated mean arterial pressure in II trimester and threshold increase in blood pressure in systolic or diastolic blood pressure during III trimester. Am J Obstet Gynecol. 1989;160(2):419-23.

Leon C, Chesley, Baha M, Sibai. Clinical significance of elevated mean arterial pressure in the second trimester. Am J Obstet Gynecol. 1988;159:275-9.

Ozcan T, Kaleli B, Ozeren M, Turan C, Zorlu G, Dr. Zekai Tahir Burak Maternity Hospital, Ankara, Turkey. Urinary calcium to creatinine ratio for predicting preeclampsia. Am J Perinatol. 1995;12(5):349-51.

Kamra R, Gupta HP, Das K, Natu SM. J Obstet Gyn Ind. 1997;47:353.

Tolaymat A, Sanchez-Ramos L, Yergey AL, Vieira NE, Abrams SA, Edelstein P. Pathophysiology of hypocalciuria in preeclampsia: measurement of intestinal calcium absorption. Obstet Gynecol. 1994;83(2):239-43.

Kar J, Srivastava K, Mishra RK. Role of urinary calcium creatinine ratio in prediction of pregnancy induced hypertension. J Obstet Gynaecol India. 2002;52:39-42.