title: Massive Urinary Protein Excretion Associated with Greater Neonatal Risk in Preeclampsia.
abstract: ObjectiveThe objective of this study was to compare clinical outcomes of preeclamptic pregnancies according to the proteinuria level.Study DesignSecondary 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.ResultsOf 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 < 340/7weeks 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).ConclusionWhile potentially not important diagnostically, massive proteinuria is associated with more severe clinical manifestations of PE prompting earlier delivery.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Julio
authors.initials: J
authors.lastname: Mateus
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Roger
authors.initials: R
authors.lastname: Newman
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.affiliation: Center of Behavioral Epidemiology and Community Health (CBEACH), San Diego State University, San Diego, California.
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Central Baptist Hospital, Lexington, Kentucky.
authors.forename: John R
authors.initials: JR
authors.lastname: Barton
authors.affiliation: Mednax/Obstetrix Medical Group, Campbell, California.
authors.forename: C Andrew
authors.initials: CA
authors.lastname: Combs
authors.affiliation: Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Edwin
authors.initials: E
authors.lastname: Guzman
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Boggess
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gyamfi
authors.affiliation: Department of Obstetrics and Gynaecology, St Geroge's, University of London, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Reproductive Medicine, University of California San Diego, La Jolla, California.
authors.forename: Doug
authors.initials: D
authors.lastname: Woelkers
keywords: PETRA study; complications; preeclampsia; preterm delivery; proteinuria