A cross-sectional comparative study to assess the role of spot urinary calcium to creatinine ratio in prediction of preeclampsia
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252342Keywords:
Preeclampsia, Hypertensive disorder, Pregnancy, Maternal and fetal morbidity, Urinary calcium to creatinine ratio, Biochemical marker, Third trimester, Non-invasive test, Early detectionAbstract
Background: Preeclampsia is a hypertensive disorder unique to pregnancy, associated with significant maternal and fetal morbidity and mortality. Early prediction and diagnosis are critical for better clinical outcomes. Biochemical markers such as the spot urinary calcium to creatinine ratio (UCa/Cr) have been proposed as a non-invasive, cost-effective tool for identifying preeclampsia. Objective of the study was to evaluate and compare the spot urinary calcium to creatinine ratio in pregnant women with and without preeclampsia and assess its diagnostic utility.
Methods: This cross-sectional comparative study was conducted on pregnant women in the third trimester attending antenatal clinics or admitted to the obstetric unit. Participants were divided into two groups: women diagnosed with preeclampsia (study group) and normotensive pregnant women (control group). A midstream urine sample was collected from each participant for calcium and creatinine estimation, and the UCa/Cr ratio was calculated. The two groups were statistically compared using appropriate tests.
Results: The mean UCa/Cr ratio was significantly lower in the preeclamptic group compared to the normotensive controls (p<0.001). A UCa/Cr cutoff value of <0.04 demonstrated good sensitivity and specificity in identifying preeclampsia.
Conclusions: The spot urinary calcium to creatinine ratio is a simple, non-invasive, and reliable test that may serve as an adjunct tool for the early detection and diagnosis of preeclampsia. Further large-scale studies are recommended to validate its clinical applicability.
Metrics
References
Balakrishnan S. Textbook of Obstetrics. 3rd edition. New Delhi, India; Paras Medical Publisher. 2020.
Dutt V, Dev NM. Evaluation of urinary calcium creatinine ratio as a diagnostic tool in the management of preeclampsia. Int J Med Sci Public Health. 2016;5:1635-8. DOI: https://doi.org/10.5455/ijmsph.2016.19112015270
Mozdzien G, Schinninger M, Zazgornik J. Kidney function and electrolyte metabolism in healthy pregnant women [German]. Wien Med Worchenschr. 1995;145:12-7.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066-74. DOI: https://doi.org/10.1016/S0140-6736(06)68397-9
Maikranz P, Holley JL, Parks JH, Lindheimer MD, Nakagawa Y, Coe FL. Gestational hypercalciuria causes pathological urine calcium oxalate supersaturations. Kidney Int. 1989;36:108-13.
Belizán JM, Villar J. The relationship between calcium intake and edema-, proteinuria-, and hypertensiongestosis: An hypothesis. Am J Clin Nutr. 1980;33:2202-10.
Kovacs CS. Calcium and Bone Metabolism in Pregnancy and Lactation. J Clin Endocrinol Metabolism. 2001;86(6):2344-8. DOI: https://doi.org/10.1210/jcem.86.6.7575
Ingec M, Nazik H, Kadanali S. Urinary calcium excretion in severe preeclampsia and eclampsia. Clin Chem Lab Med. 2006;44(1):511-3.
Szmidt-Adjide V, Vendittelli F, David S, Bredent-Bangou J, Janky E. Calciuria and preeclampsia: A Case-control study. Eur J Obstet Gynecol Reprod Biol. 2006;125(2):193-8. DOI: https://doi.org/10.1016/j.ejogrb.2005.06.029
Ramos JGL, Martins-Costa SH, Kesseler JB, Costa CA, Barros E. Calciuria and preeclampsia. Braz J Med Biol Res. 1998;31(4):519-22. DOI: https://doi.org/10.1590/S0100-879X1998000400007
Suarez VR, Trelles JG, Miyahira JM. Urinary Calcium in asymptomatic primigravidas who later developed preeclampsia. Obstet Gynecol. 1996;87:79-82. DOI: https://doi.org/10.1016/0029-7844(95)00328-2
Huikeshoven FJM, Zuijderhoudt FMJ. Hypocalciuria in hypertensive disorders of pregnancy and how to measure it? Eu J Obs Gynecol. 1990;36(1-2):81-5. DOI: https://doi.org/10.1016/0028-2243(90)90053-4
American College of Obstetricians and Gynaecologists: Hypertension in pregnancy. Report of American College of Obstetricians and Gynaecologist’s Task force on hypertension in pregnancy. Obstet Gynecol. 2013;122:1122.
Chesley LC. Diagnosis of preeclampsia. Obstet Gynecol. 1985;65:423.
Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K. Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension. 2012;59(6):1241-8. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.111.187039
Vargas Zapata CL, Donangelo CM, Woodhouse LR, Abrams SA, Spencer EM, King JC. Calcium homeostasis during pregnancy and lactation in Brazilian women with low calcium intakes: a longitudinal study. Am J Clin Nutr. 2004;80(2):417-22. DOI: https://doi.org/10.1093/ajcn/80.2.417
Maikranz P, Holley JL, Parks JH, Lindheimer MD, Nakagawa Y, Coe FL. Gestational hypercalciuria causes pathological urine calcium oxalate supersaturations. Kidney Int. 1989;36:108-13. DOI: https://doi.org/10.1038/ki.1989.168
Pedersen EB, Johannesen P, Kristensen S, Rasmussen AB, Emmertsen K, Møller J, et al. Calcium, parathyroid hormone and calcitonin in normal pregnancy and preeclampsia. Gynecol Obstet Invest. 1984;18(3):156-64. DOI: https://doi.org/10.1159/000299073
Belizán JM, Villar J. The relationship between calcium intake and edema-, proteinuria-, and hypertensiongestosis: An hypothesis. Am J Clin Nutr. 1980;33:2202-10. DOI: https://doi.org/10.1093/ajcn/33.10.2202
Taufield PA, Ales KL, Resnick LM, Druzin ML, Gertner JM, Laragh JH. Hypocalcuria in preeclampsia. N Eng J Med. 1987;316:715-8. DOI: https://doi.org/10.1056/NEJM198703193161204
August P, Marcaccio B, Gertner JM, Druzin ML, Resnick LM, Laragh JH. Abnormal 1,25 dihydroxyvitamin D (1,25 OH) 2D3 metabolism in preeclampsia. Am J Obstet Gynecol. 1992;166:1295-9. DOI: https://doi.org/10.1016/S0002-9378(11)90625-5
Seely EW, Wood RJ, Brown EM, Graves SW. Lower serum ionized calcium and abnormal calciotropic hormone levels in preeclampsia. J Clin Endocrinol Metab. 1992;74:1436-40. DOI: https://doi.org/10.1210/jcem.74.6.1592891
Nugent CE, Punch MR, Barr M Jr, LeBlanc L, Johnson MP, Evans MI. Persistence of partial molar placenta and severe preeclampsia after selective termination in a twin pregnancy. Obstet Gynecol. 1996;87(5 Pt 2):829-31.
Roelofsen JM, Berkel GM, Uttendorfsky OT, Slegers JF. Urinary excretion rates of calcium and magnesium in normal and complicated pregnancies. Eur J Obstet Gynecol Reprod Biol. 1988;27:227-36. DOI: https://doi.org/10.1016/0028-2243(88)90127-X
Qublan HS, Ammarin V, Bataineh O, Al-Shraideh Z, Tahat Y, Awamleh I, et al. Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe pre-eclampsia. Med Sci Monit. 2005;11(8):CR393-7.
Begum H, Rahman MN, Ferdous M, Basak SK, Yasmin N, Parveen A. Evaluation of Spot Urinary Calcium to Creatinine Ratio in Preeclampsia: A Cross Sectional Comparative Study. J Natl Inst Neurosci Bangl. 2017;3(1):14-20. DOI: https://doi.org/10.3329/jninb.v3i1.36266
Saudan PJ, Shaw L, Brown MA. Urinary calcium/creatinine ratio as a predictor of preeclampsia. Am J Hypertens. 1998;11(7):839-43. DOI: https://doi.org/10.1016/S0895-7061(98)00054-5
Vural P, Akgul C, Canbaz M. Calcium and Phosphate Excretion in Preeclampsia. Tour J Med Sci. 2000;30(1):39-42.
Growder D, Williams A, Gordon L, Crawford T, Alexander Lindo R, Irving R, et al. Hypocalciuria in preeclampsia and gestational hypertension due to decreased fractional excretion of calcium. Arch Med Sci. 2009;5:80-5.
Marya RK, Rathee S, Manrow M. Urinary calcium excretion in pregnancy. Gynecol Obstet Investig. 1987;23:141-4. DOI: https://doi.org/10.1159/000298851
Pal A, Roy D, Adhikary S, Roy A, Dasgupta M, Mandal AK. A prospective study for the prediction of preeclampsia with urinary calcium level. J Obstet Gynaecol India. 2012;62(3):312-6. DOI: https://doi.org/10.1007/s13224-012-0223-z
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 Gynaecol India. 2016;66(Suppl 1):94-7. DOI: https://doi.org/10.1007/s13224-015-0797-3
Ozcan T, Kaleli B, Ozeren M, Turan C, Zorlu G. Urinary calcium to creatinine ratio for predicting preeclampsia. Am J Perinatol. 1995;12(5):349-51. DOI: https://doi.org/10.1055/s-2007-994494
Gokce C, Gokce O, Baydinc C, Ijhan N, Alasehrli E, Ozkucuk F, et al. Use of random urine sample to estimate total urinary calcium and phosphate excretion. Arch Intern Med. 1991;151(8):1587-8. DOI: https://doi.org/10.1001/archinte.1991.00400080083015
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.
Lamminpää R, Vehviläinen-Julkunen K, Gissler M, Heinonen S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997-2008. BMC Pregnancy Childbirth. 2012;12:47. DOI: https://doi.org/10.1186/1471-2393-12-47
Mrema D, Lie RT, Ostbye T, Mahande MJ, Dalveit AK. The association between prepregnancy body mass index and risk of preeclampsia:a registry based study from Tanzania. BMC Pregnancy Childbirth. 2016;18:56. DOI: https://doi.org/10.1186/s12884-018-1687-3
Ingec M, Nazik H, Kadanali S. Urinary calcium excretion in severe preeclampsia and eclampsia. Clin Chem Lab Med. 2006;44(1):51-3. DOI: https://doi.org/10.1515/CCLM.2006.010
McMaster KM, Kaunitz AM, Burbano de Lara P, Sanchez-Ramos L. A systematic review and metaanalysis of hypocalciuria in preeclampsia. Int J Gynaecol Obstet. 2017;1389(1):3-11. DOI: https://doi.org/10.1002/ijgo.12165
Downloads
Published
How to Cite
Issue
Section
