Background
Micro‐albuminuria has been established as a marker for micro‐vascular disease. Spot urine albumin‐to‐creatinine ratio (UACR), even in the high normal range, predicts future cardiovascular events. The value of UACR in women with gestational diabetes mellitus (GDM) during pregnancy is uncertain.

Aim
The objectives of this study were to assess the associations between UACR (performed at the time of GDM diagnosis) and various maternal parameters and to evaluate its correlation with pregnancy outcomes.

Materials and Methods
We conducted a retrospective review of women with GDM who attended antenatal clinics at a single centre between March 2010 and September 2013.

Results
Among 1015 women included in this study, high UACR levels were associated with advancing maternal age, maternal obesity, gestational hypertension, elevated glycosylated haemoglobin (HbA1c) and high fasting glucose level. After adjustments for various maternal factors, only advancing age, HbA1c and fasting glucose level were associated with UACR. In terms of pregnancy outcomes, elevated UACR was not associated with adverse events, but was a predictor for pre‐eclampsia.

Conclusions
The finding that UACR was associated with glycaemic status in women with GDM suggests early micro‐vascular disease may be present in women who had greater degree of hyperglycaemia. This raises the question of whether women with GDM and elevated UACR may be at higher risk of developing cardiovascular disease in the future. Long‐term follow‐up of this subgroup of women would be worthwhile.