title: Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women.
abstract: OBJECTIVE
  To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499 mg and ≥500 mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension.
  
  
  METHODS
  Secondary analysis of the Vitamins in Pre-Eclampsia Trial.
  
  
  METHODS
  25 UK hospitals in ten geographical areas.
  
  
  METHODS
  946 women with pre-existing risk factors for pre-eclampsia.
  
  
  METHODS
  Women with pre-eclampsia and proteinuria 300-499 mg/24 h (PE300, referent group, n=60) or proteinuria ≥500 mg/24 h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110).
  
  
  METHODS
  MATERNAL: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5(th) centile, gestation at delivery.
  
  
  RESULTS
  Severe hypertension occurred more frequently in PE500 (35%) and PE300 (27%) than CHT (5.9%; P≤0.01) and GH (10%; p≤0.001). Gestation at delivery was earlier in PE500 (33.2 w) than PE300 (37.3 w; P≤0.001), and later in CHT (38.3 w; P≤0.05) and GH (39.1 w; P≤0.001). SGA infants were more frequent in PE300 (32%) than in CHT (13.3%; P≤0.001) and GH (16.5%; P≤0.05). Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P≤0.001), and to receive magnesium sulphate (17% vs. 1.7%, P≤0.05).
  
  
  CONCLUSIONS
  Women with PE300 have complication rates above those of women managed as out-patients (GH and CHT), meriting closer surveillance and confirming 300 mg/d as an appropriate threshold for determining in-patient management. Adverse perinatal outcomes are higher still in women with PE500.
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Bramham
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Poli-de-Figueiredo
authors.forename: Paul T
authors.initials: PT
authors.lastname: Seed
authors.forename: Annette L
authors.initials: AL
authors.lastname: Briley
authors.forename: Lucilla
authors.initials: L
authors.lastname: Poston
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Shennan
authors.forename: Lucy C
authors.initials: LC
authors.lastname: Chappell
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011507:Proteinuria / Q000196:embryology* / Q000503:physiopathology; D012307:Risk Factors