Massive Urinary Protein Excretion Associated with Greater Neonatal Risk in Preeclampsia

Julio Mateus; Roger Newman; Baha M. Sibai; Qing Li; John R. Barton; C. Andrew Combs; Edwin Guzman; Kim A. Boggess; Cynthia Gyamfi; Peter von Dadelszen; Doug Woelkers

doi:10.1055/s-0037-1601866

American Journal of Perinatology Reports, Table of Contents

CC-BY-NC-ND 4.0 · AJP Rep 2017; 07(01): e49-e58
DOI: 10.1055/s-0037-1601866

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Massive Urinary Protein Excretion Associated with Greater Neonatal Risk in Preeclampsia

Julio Mateus

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina

,

Roger Newman

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina

,

Baha M. Sibai

²Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas

,

Qing Li

³Center of Behavioral Epidemiology and Community Health (CBEACH), San Diego State University, San Diego, California

,

John R. Barton

⁴Department of Obstetrics and Gynecology, Central Baptist Hospital, Lexington, Kentucky

,

C. Andrew Combs

⁵Mednax/Obstetrix Medical Group, Campbell, California

,

Edwin Guzman

⁶Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey

,

Kim A. Boggess

⁷Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina

,

Cynthia Gyamfi

⁸Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York

,

Peter von Dadelszen

⁹Department of Obstetrics and Gynaecology, St Geroge's, University of London, London, United Kingdom

,

Doug Woelkers

¹⁰Department of Reproductive Medicine, University of California San Diego, La Jolla, California

› Author Affiliations

Abstract

Objective The objective of this study was to compare clinical outcomes of preeclamptic pregnancies according to the proteinuria level.

Study Design Secondary analysis of a multicenter prospective cohort study of women with preeclampsia (PE) symptomatology. Nonproteinuria, mild-proteinuria, and massive-proteinuria PEs were defined as: < 165 mg in 12 hours or < 300 mg in 24 hours, 165 mg to 2.69 g in 12 hours or 300 mg to 4.99 g in 24 hours, and ≥ 2.7 g in 12 hours or ≥ 5.0 g in 24 hours, respectively. Individual and composite maternal, fetal, and neonatal outcomes were compared among the PE groups.

Results Of the 406 analyzed pregnancies, 36 (8.8%) had massive-proteinuria PE, 268 (66.0%) mild-proteinuria PE, and 102 (25.1%) nonproteinuria PE. Compared with the other groups, massive-proteinuria PE women had significantly higher blood pressures (p < 0.001), epigastric pain (p = 0.007), and uric acid serum levels (p < 0.001) prior to delivery. Composite maternal morbidity was similar across the groups. Delivery < 34^0/7 weeks occurred in 80.6, 49.3, and 22.5% of massive-proteinuria, mild-proteinuria, and nonproteinuria PE groups, respectively (p < 0.0001). Composite adverse neonatal outcomes were significantly higher in the massive-proteinuria PE compared with the other groups (p = 0.001).

Conclusion While potentially not important diagnostically, massive proteinuria is associated with more severe clinical manifestations of PE prompting earlier delivery.

Keywords

proteinuria - PETRA study - preeclampsia - complications - preterm delivery

Full Text

References

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