Proceedings of The Physiological Society

Obesity (2014) Proc Physiol Soc 32, PC038

Poster Communications

The role of microalbuminura as a predictor of gestational diabetes in obese pregnant women from the UK Pregnancies Better Eating and Activity (UPBEAT) pilot trial

N. Patel1, A. Briley1, M. Homsy1, K. Bramham1, N. Dalton2, D. Pasupathy1, L. Poston1

1. Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St. Thomas' Hospital, London, United Kingdom. 2. WellChild Laboratory, , King's College London, Evelina Children's Hospital, London, United Kingdom.

Introduction - Albumin:creatinine ratio (ACR), a marker for endothelial dysfunction, is an established independent predictor for cardiovascular and renal disease. Recent evidence suggests that a relationship also exists between obesity, early insulin resistance and microalbuminuria. However, the role of ACR as a predictor of gestational diabetes (GDM) in obese pregnant women is unknown. Aim - To explore the role of ACR in the prediction of GDM in obese pregnant women participating in the UPBEAT pilot study. Methods - Fasting mid-stream urine samples were obtained from 63 obese pregnant women participating in a pilot study of a complex intervention of dietary advice and physical activity recruited at 15+0 to 17+6 weeks. Demographic characteristics were recorded at recruitment. Albumin (mg/L) was analysed by laser immunonephelometry on a Siemens BN Prospec and creatinine (mmol/L) by stable isotope dilution tandem mass spectrometry in spot urine samples. Univariate analyses were performed to determine independent predictors for GDM and an area under the receiver-operating curve (ROC) was calculated for the model. Results - Of the 63 participants, 39.7% (n=25) developed GDM. Participants with GDM were significantly older (34.2 vs 30.6 years; p =0.01), with lower parity ≤1 ( 68% vs. 32%; p=0.004) and tended to be black in comparison to those without GDM. ACR at 15+0 to 17+6 was independently associated with GDM in univariate analyses (0.92 g/mol vs 0.73 g/mol; p=0.012). The area under the receiver-operating curve for the prediction of GDM for clinical factors, significant within the univariate analyses alone was 0.70 (CI 0.56 to 0.85) and increased further with the addition of ACR at 15+0 to 17+6 (ROC AUC 0.77; CI 0.65 to 0.89; chi2 = 0.16). Conclusions - These findings suggest there is an association between early second trimester urine ACR and subsequent development of GDM in obese pregnant women. Routinely recorded clinical data with ACR measured in early pregnancy may add to the known biochemical predictors of GDM. Further study in a large prospective cohort is now required, in order to develop a panel of predictive markers for GDM with high predictive performance suitable for clinical practice.

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