Spot Urine Albumin to Creatinine Ratio versus Urine Protein to Creatinine Ratio for the Diagnosis of Proteinuria in Pregnancy

Objectives: To evaluate the correlation of the spot urine albumin to creatinine ratio (UACR) and the urine protein to creatinine ratio (UPCR) with 24-hour urine protein (UP-24) collection and to explore the diagnostic performances of these parameters for detecting significant proteinuria in pregnancyMaterials and Methods: This cross-sectional study was conducted on pregnant women at gestational ages 20-41 weeks who had clinically suspected proteinuria and were prospectively enrolled from November 2015 to April 2016. Random urine samples for UACR, UPCR and 24-hour urine collection for protein and creatinine were examined. Results: A total of 115 pregnant women were evaluated. Using UP-24 as the reference standard, significant proteinuria was identified in 39 cases (33.9%). UACR had a higher level of correlation than UPCR with UP-24 (r = 0.884 and 0.834, respectively). The areas under the receiver characteristics curves (ROC-AUC) of UACR and UPCR were 96.6% (95%CI; 93.8-99.9) and 94.5% (95%CI; 90.4-98.6), respectively. The diagnostic threshold of UACR for significant proteinuria was 42 mg/g. (94.9% sensitivity and 86.8% specificity), whereas the UPCR cutoff value was 0.26, (87.2% sensitivity and 90.8% specificity). Predicted UP-24 using spot UACR adjusted by maternal age had the highest ROC-AUC of 97.4% (95%CI; 95.1-99.6), with a sensitivity of 94.9% and a specificity of 90.8%.Conclusion: Spot UACR showed better correlation with UP-24 than UPCR. Spot UACR adjusted for maternal age, yielded a good diagnostic performance that was not associated with the time of urine collection and underlying diseases

Tolerability of trivalent inactivated influenza vaccine among pregnant women, 2015

Abstract Background Thailand recommends influenza vaccination among pregnant women. We conducted a cohort study to determine if the prevalence of adverse events following immunization (AEFIs) with influenza vaccine among Thai pregnant women was similar to that often cited among healthy adults. Methods Women who were ≥17 gestational weeks and ≥18 years of age were recruited. Demographic and health history data were collected using structured questionnaires. Women were provided with symptom diary, ruler to measure local reaction(s), and thermometer to measure body temperature. AEFIs were defined as any new symptom/abnormality occurring within four weeks after vaccination. The diaries were abstracted for frequency, duration, and level of discomfort/inconvenience of the AEFIs. Serious adverse events (SAEs) and the likelihood of AEFIs being associated with vaccination were determined using standard definitions. Results Among 305 women enrolled between July–November 2015, median age was 29 years. Of these, 223 (73%) were in their third trimester, 271 (89%) had completed secondary school or higher, and 20 (7%) reported ≥1 pre-existing conditions. AEFIs were reported in 134 women (44%; 95% confidence interval [CI] 38–50%). Soreness at the injection site (74, 24%; CI 19–29%), general weakness (50, 16%; CI 12–21%), muscle ache (49, 16%; CI 12–21%), and headache (45, 15%; CI 1–19%) were most common. Of those with AEFIs, 120 (89%) reported symptom/abnormality occurred on day 0 or day 1 following vaccination. Ten women (7%) reported the AEFIs affected daily activities. The AEFIs generally spontaneously resolved within 24 h of onset. There were two vaccine-unrelated SAEs. Of 294 women with complete follow-up, 279 (95%) had term deliveries, 12 (4%) had preterm deliveries, and 3 (1%) had miscarriage or stillbirth. Conclusion In our cohort, AEFIs with influenza vaccine occurred with similar frequency to those reported among healthy adults in other studies, and were generally mild and self-limited. No influenza vaccine-associated SAEs were identified