Maternal Urine Albumin Excretion and Pregnancy Outcome

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.