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Maternal Urine Albumin Excretion and Pregnancy Outcome


Franceschini, Nora; Savitz, David A.; Kaufman, Jay S.; & Thorp, John M., Jr. (2005). Maternal Urine Albumin Excretion and Pregnancy Outcome. American Journal of Kidney Diseases, 45(6), 1010-1018.


Background: Vascular dysfunction has been hypothesized as a causal pathway for preeclampsia, impaired fetal growth, and early parturition. The relationship between increased urine albumin excretion (albuminuria), a marker of endothelial dysfunction, and preterm birth has not been fully evaluated.
Methods: We conducted a nested case-control study of 404 pregnancies from 1998 to 2000 within the Pregnancy, Infection and Nutrition cohort. Cases consisting of live births delivered before 37 weeks of gestation (preterm birth, n = 111) were compared with term births from the same cohort (n = 293). Albumin-creatinine ratio (in milligrams per gram) was measured in urine collected around 27 weeks of gestation. We compared risks for preterm birth in mothers with albuminuria with albumin levels of 3 to 20 mg/g and greater than 20 mg/g relative to those with albumin levels less than 3 mg/g by using logistic regression.
Results: Median albuminuria was albumin level of 2.7 and 4.3 mg/g for term and preterm births, respectively. Albuminuria was strongly associated with preterm birth in a dose-response fashion, with adjusted odds ratios of 1.9 (95% confidence interval, 1.1 to 3.1) and 4.7 (95% confidence interval, 1.7 to 12.6) for albuminuria with albumin of 3 to 20 mg/g and greater than 20 mg/g, respectively. The association was present for both spontaneous and medically induced preterm births, but the effect was decreased and the dose-response relationship was eliminated by excluding high-risk groups and those with pregnancy complications.
Conclusion: Low levels of albuminuria are associated with preterm birth. The mechanism underlying this association warrants additional exploration.


Reference Type

Journal Article

Year Published


Journal Title

American Journal of Kidney Diseases


Franceschini, Nora
Savitz, David A.
Kaufman, Jay S.
Thorp, John M., Jr.