Zen Monica, Padmanabhan Suja, Cheung Ngai Wah, Kirby Adrienne, Jesudason Shilpa, Alahakoon Thushari I, Lee Vincent W
Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia.
Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia; The University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia.
Pregnancy Hypertens. 2019 Jan;15:182-188. doi: 10.1016/j.preghy.2019.01.010. Epub 2019 Jan 28.
To determine if microalbuminuria can be used as a predictive marker of preeclampsia and adverse pregnancy and neonatal outcomes in women with pre-existing diabetes and to compare the prognostic utility of urinary albumin to creatinine ratio (uACR) and urinary protein to creatinine ratio (uPCR).
Multicentre prospective cohort study. Antenatal Diabetes in Pregnancy clinics at three tertiary referral hospitals in Western Sydney, Australia. 158 women with pre-existing diabetes requiring insulin in pregnancy. A spot uPCR and uACR was performed in each trimester. Pregnancy and fetal outcomes were investigated using linear models and receiver-operating characteristic (ROC) curves.
The primary outcome was preeclampsia (PE). Secondary outcomes investigated were other adverse pregnancy and neonatal outcomes.
Increased levels of both uPCR and uACR in trimester 3 were associated with the occurrence of PE (p = 0.007, 0.010 respectively). In the 113 patients with normal pregnancy uPCR (<30 mg/mmol) in trimester 1, microalbuminuria was found to be predictive of PE (p = 0.01) and need for operative delivery (p = 0.03).
In women with pre-existing diabetes, uPCR and uACR appear to have similar ability to diagnose PE, but microalbuminuria demonstrates prognostic ability at a much earlier gestation, prior to the onset of other signs or symptoms of PE. We therefore suggest that assessing microalbuminuria rather than overt proteinuria in trimester 1 provides prognostic information in women with pre-existing diabetes requiring insulin and should be used routinely to evaluate risk of PE in this high-risk cohort of women.
确定微量白蛋白尿是否可作为孕前糖尿病女性先兆子痫及不良妊娠和新生儿结局的预测指标，并比较尿白蛋白与肌酐比值（uACR）和尿蛋白与肌酐比值（uPCR）的预后效用。
多中心前瞻性队列研究。澳大利亚悉尼西部三家三级转诊医院的妊娠糖尿病产前诊所。158例孕期需要胰岛素治疗的孕前糖尿病女性。在每个孕期进行一次随机尿PCR和uACR检测。使用线性模型和受试者工作特征（ROC）曲线研究妊娠和胎儿结局。
主要结局为先兆子痫（PE）。研究的次要结局为其他不良妊娠和新生儿结局。
孕晚期uPCR和uACR水平升高均与PE的发生相关（分别为p = 0.007，0.010）。在孕1期uPCR（<30 mg/mmol）正常的113例妊娠患者中，发现微量白蛋白尿可预测PE（p = 0.01）和需要剖宫产（p = 0.03）。
对于孕前糖尿病女性，uPCR和uACR诊断PE的能力似乎相似，但微量白蛋白尿在更早的孕期，即在PE的其他体征或症状出现之前就具有预后判断能力。因此，我们建议，对于需要胰岛素治疗的孕前糖尿病女性，在孕1期评估微量白蛋白尿而非显性蛋白尿可提供预后信息，并且应常规用于评估这一高危女性群体中PE的风险。
