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van Rensburg EJ, Seopela LB, Snyman LC. Determining the relationship between severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia. Pregnancy Hypertens 2024; 38:101155. [PMID: 39243692 DOI: 10.1016/j.preghy.2024.101155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/06/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVES To investigate the relationship between the severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia (PE). DESIGN Prospective cohort study conducted in Gauteng, South Africaover 12 months. Patientswith PE 18 years or olderwith singleton pregnancieswere recruited. Weincluded248in the final analysis. METHODS Proteinuria was quantified using urine protein: creatinine ratio (UPCR). Preeclamptic patients' outcomeswere compared according to the UPCR values using regression models and by generating receiver operator characteristic (ROC) curves. Primary maternal outcomes were gestational age (GA) at diagnosis, GA at delivery, development of eclampsia, development of severe features and the need for more than one antihypertensiveagent. Neonatal outcomes were admission to neonatal unit, 5-min APGAR score, need for ventilatory support and early neonatal death. RESULTS There was a weak but significant negative correlation between GA at delivery and UPCR (Spearman's correlation coefficient (SCC) -0.191, p = 0.002). Most patients (77 %) required >1 agent to control their blood pressure, however there was no correlation between UPCR and the need for additional agents (SCC -0.014, p = 0.828). There was a statistically significant correlation between UPCR and severe features, especially the development of haemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (p = 0.005). There was no significant correlation between neonatal outcomes and UPCR. CONCLUSION Severity of proteinuria correlated with earlier delivery and development of severe features, specifically HELLP syndrome and pulmonary oedema. There was no correlation between UPCR and requiring additional antihypertensiveagentsor neonatal outcomes.
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Affiliation(s)
- Elizabeth Jansen van Rensburg
- Department of Obstetrics and Gynaecology, University of Pretoria Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, 10 Kalafong Road, Atteridgeville, Gauteng 0008, South Africa.
| | - Louisa B Seopela
- Department of Obstetrics and Gynaecology, University of Pretoria Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, 10 Kalafong Road, Atteridgeville, Gauteng 0008, South Africa
| | - Leon C Snyman
- Department of Obstetrics and Gynaecology, University of Pretoria Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, 10 Kalafong Road, Atteridgeville, Gauteng 0008, South Africa
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Sgayer I, Cohen M, Rosenbaum Y, Kruzel-Davila E, Shasha-Lavsky H, Lowenstein L, Wolf MF. Obstetrical outcomes of women with new-onset isolated proteinuria diagnosed after 24 weeks' gestation. Arch Gynecol Obstet 2024; 310:1063-1070. [PMID: 38739292 DOI: 10.1007/s00404-024-07535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To assess a possible association between marked proteinuria and the risk of preeclampsia with severe features, as defined by the American College of Obstetricians and Gynecologists. METHODS This retrospective study included data recorded at a tertiary university-affiliated hospital between 2017 and 2022. Women at or beyond 24 weeks of gestation with proteinuria (protein levels > 300 mg in a 24 h urine collection) and normal blood pressure during the initial 48 h of admission were included. Obstetrical and neonatal outcomes were compared between women with mild proteinuria (300-1000 mg/24 h) and marked proteinuria (≥ 1000 mg/24 h). RESULTS Among the women with marked proteinuria (n = 48) compared to those with mild proteinuria (n = 108), the incidences were higher of preeclampsia (50.0% vs. 22.2%, p = 0.001) and of preeclampsia with severe features (18.8% vs. 2.8%, p < 0.001). In multivariate analysis that adjusted for maternal age, primiparity, multiple pregnancy, uric acid level > 6 mg/dL and aspirin treatment, marked proteinuria was a risk factor for preeclampsia with severe features (adjusted odds ratio [aOR] = 10.2, confidence interval [CI] 95% 1.9-54.0, p = 0.007) and for small-for-gestational-age infants (aOR = 2.4, 95% CI 1.02-5.6, p = 0.001). Among women with marked compared to mild proteinuria, rates were also higher of labor induction (58.3% vs. 25.9%, p < 0.001), indicated preterm delivery (41.7% vs. 25.0%, p = 0.04) and admission to the neonatal intensive care unit (44.1% vs. 25.8%, p = 0.017). CONCLUSIONS Women with marked compared to mild isolated proteinuria showed higher risk of developing preeclampsia with severe features and of delivering small-for-gestational-age neonates.
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Milton Cohen
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Etty Kruzel-Davila
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Nephrology Department, Galilee Medical Center, Nahariya, Israel
| | - Hadas Shasha-Lavsky
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Everett BG, Philbin MM, Homan P. Structural heteropatriarchy and maternal cardiovascular morbidities. Soc Sci Med 2024; 351 Suppl 1:116434. [PMID: 38825374 PMCID: PMC11149902 DOI: 10.1016/j.socscimed.2023.116434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 06/04/2024]
Abstract
The United States has some of the poorest maternal health outcomes of any developed nation. Existing research on maternal cardiovascular morbidities has focused predominantly on individual- and clinic-level drivers, but we know little about community- and structural-level factors that shape these outcomes. We use a composite measure of "structural heteropatriarchy" which includes measures of structural sexism and structural LGB-stigma to examine the relationship between structural heteropatriarchy and three cardiovascular-related maternal morbidities using the National Longitudinal Study of Adolescent to Adult Health (n = 3928). Results using multivariate regressions show that structural heteropatriarchy is associated with increased risk of reporting maternal morbidities. Our findings provide further evidence that sexuality- and gender-based stigma operate together to shape health disparities, including maternal health.
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Affiliation(s)
| | - Morgan M Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California at San Francisco, United States
| | - Patricia Homan
- Department of Sociology, Florida State University, United States
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Sentilhes L, Schmitz T, Arthuis C, Barjat T, Berveiller P, Camilleri C, Froeliger A, Garabedian C, Guerby P, Korb D, Lecarpentier E, Mattuizzi A, Sibiude J, Sénat MV, Tsatsaris V. [Preeclampsia: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:3-44. [PMID: 37891152 DOI: 10.1016/j.gofs.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To identify strategies to reduce maternal and neonatal morbidity related to preeclampsia. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and recommendations were formulated as a (i) strong, (ii) weak or (iii) no recommendation. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Preeclampsia is defined by the association of gestational hypertension (systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg) and proteinuria≥0.3g/24h or a Proteinuria/Creatininuria ratio≥30mg/mmol occurring after 20 weeks of gestation. Data from the literature do not show any benefit in terms of maternal or perinatal health from implementing a broader definition of preeclampsia. Of the 31 questions, there was agreement between the working group and the external reviewers on 31 (100%). In general population, physical activity during pregnancy should be encouraged to reduce the risk of preeclampsia (Strong recommendation, Quality of the evidence low) but an early screening based on algorithms (Weak recommendation, Quality of the evidence low) or aspirin administration (Weak recommendation, Quality of the evidence very low) is not recommended to reduce maternal and neonatal morbidity related to preeclampsia. In women with preexisting diabetes or hypertension or renal disease, or multiple pregnancy, the level of evidence is insufficient to determine whether aspirin administration during pregnancy is useful to reduce maternal and perinatal morbidity (No recommendation, Quality of the evidence low). In women with a history of vasculo-placental disease, low dose of aspirin (Strong recommendation, Quality of the evidence moderate) at a dosage of 100-160mg per day (Weak recommendation, Quality of the evidence low), ideally before 16 weeks of gestation and not after 20 weeks of gestation (Strong recommendation, Quality of the evidence low) until 36 weeks of gestation (Weak recommendation, Quality of the evidence very low) is recommended. In a high-risk population, additional administration of low molecular weight heparin is not recommended (Weak recommendation, Quality of the evidence moderate). In case of preeclampsia (Weak recommendation, Quality of the evidence low) or suspicion of preeclampsia (Weak recommendation, Quality of the evidence moderate, the assessment of PlGF concentration or sFLT-1/PlGF ratio is not routinely recommended) in the only goal to reduce maternal or perinatal morbidity. In women with non-severe preeclampsia antihypertensive agent should be administered orally when the systolic blood pressure is measured between 140 and 159mmHg or diastolic blood pressure is measured between 90 and 109mmHg (Weak recommendation, Quality of the evidence low). In women with non-severe preeclampsia, delivery between 34 and 36+6 weeks of gestation reduces severe maternal hypertension but increases the incidence of moderate prematurity. Taking into account the benefit/risk balance for the mother and the child, it is recommended not to systematically induce birth in women with non-severe preeclampsia between 34 and 36+6 weeks of gestation (Strong recommendation, Quality of evidence high). In women with non-severe preeclampsia diagnosed between 37+0 and 41 weeks of gestation, it is recommended to induce birth to reduce maternal morbidity (Strong recommendation, Low quality of evidence), and to perform a trial of labor in the absence of contraindication (Strong recommendation, Very low quality of evidence). In women with a history of preeclampsia, screening maternal thrombophilia is not recommended (Strong recommendation, Quality of the evidence moderate). Because women with a history of a preeclampsia have an increased lifelong risk of chronic hypertension and cardiovascular complications, they should be informed of the need for medical follow-up to monitor blood pressure and to manage other possible cardiovascular risk factors (Strong recommendation, Quality of the evidence moderate). CONCLUSION The purpose of these recommendations was to reassess the definition of preeclampsia, and to determine the strategies to reduce maternal and perinatal morbidity related to preeclampsia, during pregnancy but also after childbirth. They aim to help health professionals in their daily clinical practice to inform or care for patients who have had or have preeclampsia. Synthetic information documents are also offered for professionals and patients.
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Affiliation(s)
- Loïc Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - Thomas Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Chloé Arthuis
- Service d'obstétrique et de médecine fœtale, Elsan Santé Atlantique, 44819 Saint-Herblain, France
| | - Tiphaine Barjat
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Paul Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy St-Germain, Poissy, France
| | - Céline Camilleri
- Association grossesse santé contre la pré-éclampsie, Paris, France
| | - Alizée Froeliger
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Charles Garabedian
- Service de gynécologie-obstétrique, University Lille, ULR 2694-METRICS, CHU de Lille, 59000 Lille, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Diane Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Edouard Lecarpentier
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Créteil, Créteil, France
| | - Aurélien Mattuizzi
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Marie-Victoire Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, hôpital Cochin, GHU Centre Paris cité, AP-HP, FHU PREMA, Paris, France
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Hu M, Shi J, Lu W. Association between proteinuria and adverse pregnancy outcomes: a retrospective cohort study. J OBSTET GYNAECOL 2023; 43:2126299. [PMID: 36178502 DOI: 10.1080/01443615.2022.2126299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Proteinuria during pregnancy is closely related to the occurrence of adverse pregnancy outcomes. One hundred and forty-two women with proteinuria during pregnancy and followed between January 2018 and December 2020 were evaluated. Based on the 24-h proteinuria value, they were divided as mild (n = 76, 300-1000 mg/day), moderate (n = 39, 1000-3500 mg/day) and severe (n = 27, >3500 mg/day) proteinuria. The rates of prematurity, low birth weight and neonatal asphyxia were significantly higher in the severe proteinuria group than in the mild and moderate groups, while the rates of foetal growth restriction and neonatal intensive care unit admission were significantly higher in the severe compared with the mild proteinuria group (all p < .05). Logistic regression analysis showed that moderate proteinuria (OR = 97.2, 95%CI: 7.1-1334.2, p = .001) and severe proteinuria (OR = 34.0, 95%CI: 1.6-711.0, p = .023) were associated with adverse perinatal outcomes. Compared with mild proteinuria, moderate and severe proteinuria are associated with adverse pregnancy outcomes in perinatal infants.Impact StatementWhat is already known on this subject? The production of proteinuria is closely related to the filtration function of the glomerulus, the reabsorption and secretion function of the renal tubules. For women with normal renal function before pregnancy, such physiological changes are less likely to cause adverse symptoms; however, for women with chronic kidney disease before pregnancy, especially those with significantly impaired renal function, the kidneys often cannot compensate for these physiological changes, which can lead to serious complications for both mother and infant.What do the results of this study add? In our study, logistic regression analysis showed that the severity of proteinuria was independently associated with adverse perinatal outcomes. The ROC curve showed that 24-h proteinuria had a predictive value for adverse perinatal outcomes. Therefore, for patients with urine protein quantification ≥0.3 g/24 h, regular 24-h urine protein quantification during pregnancy could help predict adverse perinatal outcomes and improve prognosis.What are the implications of these findings for clinical practice and/or further research? Proteinuria quantification can be used as one of the factors predicting adverse pregnancy outcomes. Thus, monitoring of urinary protein quantification in women during pregnancy should be strengthened for early detection of renal impairment, then interventions be used to improve maternal and infant outcomes.
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Affiliation(s)
- Minjie Hu
- Department of Nephrology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junfeng Shi
- Department of Nephrology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Lu
- Department of Nephrology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Amakye D, Gyan PO, Santa S, Aryee NA, Adu-Bonsaffoh K, Quaye O, Tagoe EA. Extracellular matrix metalloproteinases inducer gene polymorphism and reduced serum matrix metalloprotease-2 activity in preeclampsia patients. Exp Biol Med (Maywood) 2023; 248:1550-1555. [PMID: 37937473 PMCID: PMC10676128 DOI: 10.1177/15353702231199464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/20/2023] [Indexed: 11/09/2023] Open
Abstract
Preeclampsia increases the risk of pregnancy-related complications, nevertheless a successful spiral vessel remodeling, and trophoblast invasion reduces disorders of pregnancy. Matrix metalloproteinase-2 (MMP-2) clears the path for trophoblast invasion, and activation of MMP-2 largely depends on extracellular matrix metalloproteinases inducer (EMMPRIN) protein. This study aimed to investigate EMMPRIN gene polymorphism and MMP-2 activity in preeclampsia patients. Archival whole blood and serum samples of 74 preeclampsia and 66 normotensive pregnant women age-matched were used in this case-control study. Genomic DNA was extracted from the whole blood samples and EMMPRIN gene amplified with specific primers following fragments sequence mutation analysis. Serum MMP-2 activity was determined using enzyme-linked immunosorbent assay (ELISA) and socio-demographic data of participants retrieved from the database. Age of preeclampsia patients (32.78 ± 6.39) years and body mass index (BMI) (33.09 ± 7.27) kg/m2 compared with the normotensive counterparts (32.33 ± 5.56) years and (32.33 ± 5.56) kg/m2,respectively, were not statistically significant (P > 0.05). Serum matrix metalloprotease-2 (MMP-2) activity was significantly reduced in preeclampsia group (16.34 ± 7.07) compared with the normotensives (25.63 ± 4.56) (P < 0.001), and rs424243T/G variant (55.6%) was overrepresented among the cases compared with the normotensives (16.7%). The single-nucleotide polymorphism T/G was found to be associated with preeclampsia (odds ratio [OR] = 7.63; 95% confidence interval [CI] = 3.95-14.75; P < 0.0001). Decreased activity of MMP-2 and rs424243T/G SNP of EMMPRIN gene was reported in preeclampsia. These preliminary data warrant a further investigation into the relationship between EMMPRIN gene polymorphism and MMP-2 activity in preeclampsia.
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Affiliation(s)
- Daniel Amakye
- Department of Medical Laboratory Sciences, University of Ghana, Accra 00233, Ghana
- Department of Biochemistry, Cell and Molecular Biology, West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra 00233, Ghana
| | - Priscilla O Gyan
- Department of Medical Laboratory Sciences, University of Ghana, Accra 00233, Ghana
- Department of Biochemistry, Cell and Molecular Biology, West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra 00233, Ghana
| | - Sheila Santa
- Department of Medical Laboratory Sciences, University of Ghana, Accra 00233, Ghana
- Department of Biochemistry, Cell and Molecular Biology, West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra 00233, Ghana
| | - Nii Ayite Aryee
- Department of Medical Biochemistry, University of Ghana Medical School, University of Ghana, Accra 00233, Ghana
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, University of Ghana, Accra 00233, Ghana
| | - Osbourne Quaye
- Department of Biochemistry, Cell and Molecular Biology, West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra 00233, Ghana
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Jiao Y, Liu Y, Li H, Song Z, Wang S, Zhang J, Li J, Liu J, Wang P, Chen Y. Value of proteinuria in evaluating the severity of HELLP and its maternal and neonatal outcomes. BMC Pregnancy Childbirth 2023; 23:591. [PMID: 37596554 PMCID: PMC10436574 DOI: 10.1186/s12884-023-05862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND HELLP syndrome refers to a group of clinical syndromes characterized by hemolysis, elevated liver enzymes and low platelet, and the evidence on the association between proteinuria and the severity of HELLP and its maternal and neonatal outcomes is rare. METHODS 106 pregnant women were assigned to the proteinuric group (24-hUPro ≥ 0.3 g, 79 cases) and the non-proteinuric group (24-hUPro < 0.3 g, 27 cases). The proteinuric group was further divided into three subgroups: mild group (24-hUPro:0.3-2.0 g, 33 cases), moderate group (24-hUPro:2.0-5.0 g, 21 cases) and severe group (24-hUPro: ≥5.0 g, 25 cases). The general clinical data, laboratory indexes, complications and pregnancy outcome and adverse neonatal outcomes of HELLP with or without proteinuric were analyzed. RESULTS Compared with proteinuric group, the non-albuminuric group or in the three proteinuric subgroups of HELLP pregnant women's, increased proteinuria was associated with earlier onset gestations, higher incidence of abdominal pain, skin jaundice, headache, blurred vision (p < 0.05 respectively), and also the higher levels of ALT, AST, LDH, Fib, APTT, ATII, proportions of tubular urine and lower levels of ALB, PLT (p < 0.05 respectively). In the three subgroups of the proteinuric group, the ratio of fetal growth restriction, cesarean section and postpartum hemorrhage were compared, and the difference was statistically significant (p < 0.05 respectively). Compared with the proteinuric group, the non-proteinuric group had higher birth weight, birth length, and lower SGA, admission rate in NICU (p < 0.05 respectively). In the three subgroups of the proteinuric group, significant differences were identified in the adverse outcomes of newborns (p < 0.05 respectively), and the incidence of adverse outcomes in neonates tended to be higher. Significant differences were identified in birth weight, birth length, and lower SGA and NICU occupancy rate among the three subgroups (p < 0.05 respectively). CONCLUSIONS HELLP syndrome is a severe complication of pregnancy, involving multiple systems of the whole body. It has posed a great challenge to obstetricians for its acute onset, dangerous condition, rapid progress, and great harm. Thus, insights into HELLP syndrome should be gained, and early diagnosis, early treatment and timely termination of pregnancy should be conducted to reduce the incidence of maternal and fetal adverse outcomes and improve maternal and fetal prognosis.
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Affiliation(s)
- Yan Jiao
- Department of obstetrics and gynecology of Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Yan Liu
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Hongyuan Li
- Department of neurology, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Zimeng Song
- School of medical technology, Xuzhou Medical University, Xuzhou No.209, Tong Shan Road, Xuzhou, 221000, Jiangsu, People's Republic of China
| | - Shiliang Wang
- Department of obstetrics and gynecology of Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jiao Zhang
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jian Li
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jia Liu
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Peng Wang
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China.
| | - Yanhong Chen
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China.
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8
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Wang L, Yuan X, Zhou X. Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features. J Perinat Med 2022; 50:1142-1149. [PMID: 35596257 DOI: 10.1515/jpm-2021-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Preeclampsia with severe features (PECsf) is a common disease in pregnant women. let-7a and IFN-gamma (interferon-gamma) are involved in diagnosis and prognosis of preeclampsia. This study explored effects of let-7a and IFN-gamma on PECsf patients. METHODS The placental tissue of 21 PECsf, 19 preeclampsia without severe features (PEC), and 20 normal pregnant women were collected, and clinical data were recorded. let-7a and IFN-gamma expressions in placental tissue were detected. The correlation between let-7a/IFN-gamma expression and clinical indexes was analyzed. According to let-7a and IFN-gamma expressions, PECsf patients were assigned into Hlet-7a group (let-7a high expression group), Llet-7a group (let-7a low expression group), HIFN-gamma group (IFN-gamma high expression group) and LIFN-gamma group (IFN-gamma low expression group). The incidence of adverse prognosis was compared. RESULTS let-7a and IFN-gamma were highly expressed in placental tissue of preeclampsia patients, with significant differences between PEC and PECsf. The high expressions of let-7a and IFN-gamma were positively correlated with mean arterial pressure, lactate dehydrogenase, and 24 h urinary protein in placental tissues of PECsf patients. High let-7a and IFN-gamma expressions were correlated with adverse outcomes of PECsf. CONCLUSIONS High let-7a and IFN-gamma expressions were correlated with clinical features, and could be used as biomarkers for treatment and poor prognosis of PECsf.
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Affiliation(s)
- Liping Wang
- Department of Obstetrics and Gynecology, Daqing Longnan Hospital, Daqing, Heilongjiang, P.R. China
| | - Xiaojie Yuan
- Department of Obstetrics and Gynecology, Daqing Longnan Hospital, Daqing, Heilongjiang, P.R. China
| | - Xuewu Zhou
- Department of Obstetrics and Gynecology, Daqing Longnan Hospital, Daqing, Heilongjiang, P.R. China
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Aynaoğlu Yıldız G, Topdağı Yılmaz EP. The association between protein levels in 24-hour urine samples and maternal and neonatal outcomes of pregnant women with preeclampsia. J Turk Ger Gynecol Assoc 2022; 23:190-198. [PMID: 36065980 PMCID: PMC9450919 DOI: 10.4274/jtgga.galenos.2022.2022-4-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Hypertensive diseases of pregnancy are one of the leading causes of maternal and perinatal mortality worldwide. The aim of this study was to evaluate the association between protein levels in 24-hour urine samples and maternal and perinatal outcomes in preeclamptic patients. Material and Methods This retrospective cohort study was conducted with pregnant women who were diagnosed with preeclampsia (PE) and delivered in our clinic between 2010 and 2018. Patients were divided into those with a proteinuria value below 300 mg/24 h (non-proteinuria), proteinuria value between 300-2000 mg/24 h (mild proteinuria), proteinuria value between 2000-5000 mg/24 h (severe proteinuria) and proteinuria value >5000 mg/24 h (massive proteinuria) and were compared in terms of maternal and perinatal outcomes. Demographic characteristics (age, body mass index in kg/m2, gravidity), PE-related clinical symptoms (epigastric pain, neurological and respiratory symptoms), laboratory findings (24 h protein level, lactate dehydrogenase, aspartate aminotransferase, platelet count and creatine levels) were recorded in all patients. Results A total of 1,379 patients meeting the study criteria were included. There were 315 (23%) patients in the non-proteinuria group, 704 (51%) in the mild proteinuria group, 234 (17%) patients in the severe group and 126 (9%) patients in the massive proteinuria group. The massive proteinuria group was found to have the highest rates of maternal and prenatal complications. The Apgar score, umbilical cord pH value, birth weight, gestational week at delivery, intrauterine growth restriction and intrauterine fetal death were significantly higher in the massive proteinuria group. Conclusion Our data showed that the degree of proteinuria appears to be associated with maternal, fetal and neonatal outcomes among women diagnosed with PE. Women with proteinuria of >5000 mg/24 hours had notably poorer natal outcomes.
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Affiliation(s)
- Gülşah Aynaoğlu Yıldız
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
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10
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Amount of proteinuria as associated with severity classification of pregnant women with preeclampsia. Pregnancy Hypertens 2022; 29:30-35. [DOI: 10.1016/j.preghy.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022]
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11
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Xiao J, Fan W, Zhu Q, Shi Z. Diagnosis of proteinuria using a random urine protein-creatinine ratio and its correlation with adverse outcomes in pregnancy with preeclampsia characterized by renal damage. J Clin Hypertens (Greenwich) 2022; 24:652-659. [PMID: 35333432 PMCID: PMC9106075 DOI: 10.1111/jch.14467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/16/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
Based on a limited number of studies, a random urine protein‐creatinine ratio (uPCR) value of ≥ 0.3 indicates abnormal proteinuria in preeclampsia with renal damage. However, current guidelines do not recommend a reasonable diagnostic threshold of uPCR for severe preeclampsia with renal damage. Furthermore, the correlation between the uPCR value and clinical adverse outcomes remains poorly understood. The aim of the present study was to evaluate the value of uPCR in the diagnosis of significant proteinuria and to assess its correlation with adverse pregnancy outcomes in preeclampsia characterized by renal damage. In all, 1837 women were enrolled in this retrospective cohort study. Eventually, 961 women were enrolled under the exclusion criteria. First, the authors found that uPCR and 24‐hour proteinuria showed a significant association (r = 0.901). The optimal threshold of uPCR for diagnosing preeclampsia was 0.295, and for diagnosing severe preeclampsia the cut‐off was 0.625. Meanwhile, the adjusted odds ratio per 1 unit increase in ln (uPCR) was 1.679 (95% confidence interval [CI]:1.142–2.469) for severe adverse perinatal outcomes; 1.456 (95% CI: 1.242–1.705) for small for gestational age; 1.380 (95% CI: 1.051–1.811) for severe small for gestational age; 1.672 (95% CI: 1.210–2.310) for very early preterm birth; 1.989 (95% CI 1.726–2.293) for severe hypertension; and 2.279 (95% CI 1.906–2.724) for preterm birth. This study indicated that there was a significant and positive correlation between uPCR and 24‐hour urine protein. For neonatal and maternal adverse outcomes, uPCR is an independent predictor of prognosis.
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Affiliation(s)
- Jiangbo Xiao
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital Nanjing, Jiangsu, China
| | - Weiming Fan
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital Nanjing, Jiangsu, China
| | - Qingyi Zhu
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital Nanjing, Jiangsu, China
| | - Zhonghua Shi
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital Nanjing, Jiangsu, China
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12
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Chadha A, Tayade S. Urinary Protein-to-Creatinine Ratio: An Indicator of Adverse Clinical Outcomes in Preeclampsia With Proteinuria. Cureus 2022; 14:e23341. [PMID: 35464597 PMCID: PMC9017718 DOI: 10.7759/cureus.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background and objective Preeclampsia is a major contributor to morbidity and mortality among pregnant women and leads to poor fetomaternal outcomes. Predicting fetal and maternal health outcomes will enable early interventions so as to reduce further damage. Various biochemical tests like beta-human chorionic gonadotropin (β-HCG), inhibin A, activin A, pregnancy-associated plasma protein-A (PAPP-A), fetal DNA, and color Doppler have been studied for their ability to predict fetal and maternal health outcomes; however, most of these tests are complex and costly. Among the many variables that indicate the severity of outcomes in hypertensive disorders of pregnancy, the urinary protein-to-creatinine ratio (UPCR) is an important index. The aim of the study was to find out the association between UPCR and fetomaternal outcomes in preeclampsia. Material and methods A prospective observational study was conducted among 141 women with preeclampsia presenting with proteinuria, who were divided into two groups: 11% with UPCR <0.3 and 89% with UPCR ≥0.3. These patients were followed up till delivery to look for maternal and fetal outcomes. Results The sensitivity of UPCR for predicting adverse maternal outcomes was 79.37% (95% CI: 71.25-86.06), specificity was 46.67% (95% CI: 21.27-73.41), positive predictive value (PPV) was 92.59% (95% CI: 88.53-95.29), negative predictive value (NPV) was 21.21% (95% CI: 12.43-33.81), and the accuracy was 75.79% (95% CI: 67.97-82.69); for adverse fetal outcomes, the sensitivity was 76.98% (95% CI: 68.65-84.01), specificity was 13.33% (95% CI: 1.66-40.46), PPV was 88.18% (95% CI: 85.69-90.29), NPV was 6.45% (95% CI: 1.79-20.67), and the accuracy was 70.21% (95% CI: 61.94-77.62). Conclusion Based on our findings, UPCR is a simple laboratory tool that can help predict abnormal fetomaternal outcomes in preeclampsia with good sensitivity and PPV and can be used as an adjunct to assist in clinical decisions.
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Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol 2022; 226:S819-S834. [PMID: 32882208 DOI: 10.1016/j.ajog.2020.08.108] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
Qualitative and quantitative measurement of urine protein excretion is one of the most common tests performed during pregnancy. For more than 100 years, proteinuria was necessary for the diagnosis of preeclampsia, but recent guidelines recommend that proteinuria is sufficient but not necessary for the diagnosis. Still, in clinical practice, most patients with gestational hypertension will be diagnosed as having preeclampsia based on the presence of proteinuria. Although the reference standard for measuring urinary protein excretion is a 24-hour urine collection, spot urine protein-to-creatinine ratio is a reasonable "rule-out" test for proteinuria. Urine dipstick screening for proteinuria does not provide any clinical benefit and should not be used to diagnose proteinuria. The classic cutoff cited to define proteinuria during pregnancy is a value of >300 mg/24 hours or a urine protein-to-creatinine ratio of at least 0.3. Using this cutoff, the rate of isolated proteinuria in pregnancy may reach 8%, whereas preeclampsia occurs among 3% to 8% of pregnancies. Although this threshold is widely accepted, its origin is not based on evidence on adverse pregnancy outcomes but rather on expert opinion and results of small studies. After reviewing the available data, the most important factor that influences maternal and neonatal outcome is the severity of blood pressures and presence of end organ damage, rather than the excess protein excretion. Because the management of gestational hypertension and preeclampsia without severe features is almost identical in frequency of surveillance and timing of delivery, the separation into 2 disorders is unnecessary. If the management of women with gestational hypertension with a positive assessment of proteinuria will not change, we believe that urine assessment for proteinuria is unnecessary in women who develop new-onset blood pressure at or after 20 weeks' gestation. Furthermore, we do not recommend repeated measurement of proteinuria for women with preeclampsia, the amount of proteinuria does not seem to be related to poor maternal and neonatal outcomes, and monitoring proteinuria may lead to unindicated preterm deliveries and related neonatal complications. Our current diagnosis of preeclampsia in women with chronic kidney disease may be based on a change in protein excretion, a baseline protein excretion evaluation is critical in certain conditions such as chronic hypertension, diabetes, and autoimmune or other renal disorders. The current definition of superimposed preeclampsia possesses a diagnostic dilemma, and it is unclear whether a change in the baseline proteinuria reflects another systemic disease such as preeclampsia or whether women with chronic disease such as chronic hypertension or diabetes will experience a different "normal" pattern of protein excretion during pregnancy. Finally, limited data are available regarding angiogenic and other biomarkers in women with chronic kidney disease as a potential aid in distinguishing the worsening of baseline chronic kidney disease and chronic hypertension from superimposed preeclampsia.
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Tanner MS, Davey MA, Mol BW, Rolnik DL. The evolution of the diagnostic criteria of preeclampsia-eclampsia. Am J Obstet Gynecol 2022; 226:S835-S843. [PMID: 35177221 DOI: 10.1016/j.ajog.2021.11.1371] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 01/01/2023]
Abstract
As the understanding of the pathophysiology of preeclampsia has improved, its diagnostic criteria have evolved. The classical triad of hypertension, edema, and proteinuria has become hypertension and organ dysfunction-renal, hepatic, neurologic, hematological, or uteroplacental. However, the most recent definitions have largely been based off consensus and expert opinion, not primary research. In this review, we explore how the criteria have evolved, particularly through the second half of the 20th and the beginning of the 21st century and offer a critical appraisal of the evidence that has led the criteria to where they stand today. Some key themes are the following: the debate between having a simple and convenient blood pressure cutoff vs a blood pressure cutoff that accounts for influencing factors such as age and weight; whether a uniform blood pressure threshold, a rise in blood pressure, or a combination is most discriminatory; whether existing evidence supports blood pressure and proteinuria thresholds in diagnosing preeclampsia; and whether using flow-charts and decision trees might be more appropriate than a single set of criteria. We also discuss the future of a preeclampsia diagnosis. We challenge the move toward a broad (vs restrictive) diagnosis, arguing instead for criteria that directly relate to the prognosis of preeclampsia and the response to treatments.
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Genest DS, Dal Soglio D, Girard S, Rey E. Association between proteinuria and placental pathology in preeclampsia: A retrospective study. SAGE Open Med 2021; 9:20503121211058053. [PMID: 34925835 PMCID: PMC8673865 DOI: 10.1177/20503121211058053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Preeclampsia develops due to placental insufficiency and systemic proinflammatory and antiangiogenic mediator release, with ensuing systemic endothelial dysfunction. Nephrotic-range proteinuria appears to be associated with worse pregnancy outcomes. The relationship between differing degrees of proteinuria and the severity of placental alterations has not been studied. Methods: This is a single-centre retrospective comparison of 150 singleton pregnancies complicated by preeclampsia and varying degrees of proteinuria. Maternal demographic, obstetrical and fetal outcome data were obtained from chart review. The placental histologic evaluations were performed by a placental pathologist blinded to all other clinical information. Results: Preeclamptic women with massive proteinuria had evidence of more severe maternal vascular malperfusion lesions. The severity of the lesions was progressive through mild, moderate and massive proteinuria. Women with massive proteinuria had a higher incidence of renal dysfunction and severe hypertension, and had earlier preterm deliveries compared to preeclamptic women with mild and moderate proteinuria (p < 0.05). Conclusion: Preeclampsia with more severe proteinuria is associated with a higher prevalence of placental maternal vascular malperfusion.
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Affiliation(s)
| | - Dorothée Dal Soglio
- Department of Pathology and Clinical Laboratory Medicine, CHU Sainte-Justine, Montreal, QC, Canada
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Université de Montréal, Centre de Recherche, CHU Sainte-Justine, Montreal, QC, Canada
| | - Evelyne Rey
- Department of Obstetrics and Gynecology, Université de Montréal, Centre de Recherche, CHU Sainte-Justine, Montreal, QC, Canada
- Division of Obstetric Medicine, Department of Medicine, University of Montreal, CHU Sainte-Justine, Montreal, QC, Canada
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Al Khalaf SY, O'Reilly ÉJ, McCarthy FP, Kublickas M, Kublickiene K, Khashan AS. Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a National cohort study. Am J Obstet Gynecol 2021; 225:298.e1-298.e20. [PMID: 33823152 DOI: 10.1016/j.ajog.2021.03.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Maternal chronic kidney disease and chronic hypertension have been linked with adverse pregnancy outcomes. We aimed to examine the association between these conditions and adverse pregnancy outcomes over the last 3 decades. OBJECTIVE We conducted this national cohort study to assess the association between maternal chronic disease (CH, CKD or both conditions) and adverse pregnancy outcomes with an emphasis on the effect of parity, maternal age, and BMI on these associations over the last three decades. We further investigated whether different subtypes of CKD had differing effects. STUDY DESIGN We used data from the Swedish Medical Birth Register, including 2,788,490 singleton births between 1982 and 2012. Women with chronic kidney disease and chronic hypertension were identified from the Medical Birth Register and National Patient Register. Logistic regression models were performed to assess the associations between maternal chronic disease (chronic hypertension, chronic kidney disease, or both conditions) and pregnancy outcomes, including preeclampsia, in-labor and prelabor cesarean delivery, preterm birth, small for gestational age, and stillbirth. RESULTS During the 30-year study period, 22,397 babies (0.8%) were born to women with chronic kidney disease, 13,279 (0.48%) to women with chronic hypertension and 1079 (0.04%) to women with both conditions. Associations with chronic hypertension were strongest for preeclampsia (adjusted odds ratio, 4.57; 95% confidence interval, 4.33-4.84) and stillbirth (adjusted odds ratio, 1.65; 95% confidence interval, 1.35-2.03) and weakest for spontaneous preterm birth (adjusted odds ratio, 1.07; 95% confidence interval, 0.96-1.20). The effect of chronic kidney disease varied from (adjusted odds ratio, 2.05; 95% confidence interval, 1.92-2.19) for indicated preterm birth to no effect for stillbirth (adjusted odds ratio, 1.16; 95% confidence interval, 0.95-1.43). Women with both conditions had the strongest associations for in-labor cesarean delivery (adjusted odds ratio, 1.86; 95% confidence interval, 1.49-2.32), prelabor cesarean delivery (adjusted odds ratio, 2.68; 95% confidence interval, 2.18-3.28), indicated preterm birth (adjusted odds ratio, 9.09; 95% confidence interval, 7.61-10.7), and small for gestational age (adjusted odds ratio, 4.52; 95% confidence interval, 3.68-5.57). The results remained constant over the last 3 decades. Stratified analyses of the associations by parity, maternal age, and body mass index showed that adverse outcomes remained independently higher in women with these conditions, with worse outcomes in multiparous women. All chronic kidney disease subtypes were associated with higher odds of preeclampsia, in-labor cesarean delivery, and medically indicated preterm birth. Different subtypes of chronic kidney disease had differing risks; strongest associations of preeclampsia (adjusted odds ratio, 3.98; 95% confidence interval, 2.98-5.31) and stillbirth (adjusted odds ratio, 2.73; 95% confidence interval, 1.13-6.59) were observed in women with congenital kidney disease, whereas women with diabetic nephropathy had the most pronounced increase odds of in-labor cesarean delivery (adjusted odds ratio, 3.54; 95% confidence interval, 2.06-6.09), prelabor cesarean delivery (adjusted odds ratio, 7.50; 95% confidence interval, 4.74-11.9), and small for gestational age (adjusted odds ratio, 4.50; 95% confidence interval, 2.92-6.94). In addition, women with renovascular disease had the highest increased risk of preterm birth in both spontaneous preterm birth (adjusted odds ratio, 3.01; 95% confidence interval, 1.57-5.76) and indicated preterm birth (adjusted odds ratio, 8.09; 95% confidence interval, 5.73-11.4). CONCLUSION Women with chronic hypertension, chronic kidney disease, or both conditions are at an increased risk of adverse pregnancy outcomes which were independent of maternal age, body mass index, and parity. Multidisciplinary management should be provided with intensive clinical follow-up to support these women during pregnancy, particularly multiparous women. Further research is needed to evaluate the effect of disease severity on adverse pregnancy outcomes.
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Affiliation(s)
- Sukainah Y Al Khalaf
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
| | - Éilis J O'Reilly
- School of Public Health, University College Cork, Cork, Ireland; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Marius Kublickas
- Department of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
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Tzur Y, Rimon E, Geva G, Herzlich J, Kupferminc MJ. Progression from isolated gestational proteinuria to preeclampsia with severe features. Acta Obstet Gynecol Scand 2021; 100:1620-1626. [PMID: 34043807 DOI: 10.1111/aogs.14198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The association between the degree of isolated gestational proteinuria and preeclampsia with severe features and other placental-mediated complications is controversial. The aim of this study was to evaluate whether a higher isolated proteinuria level is associated with an increased frequency of preeclampsia with severe features. MATERIAL AND METHODS This retrospective cohort study included pregnant women who were past 24 weeks of gestation and were diagnosed as having new-onset proteinuria ≥300 mg in a 24-h urine collection. Exclusion criteria included diagnosis of preeclampsia within 72 h from admission, chronic renal disease or chronic hypertension. The study population was divided into tertiles by proteinuria level and the association with preeclampsia with severe features was assessed in both bivariable and multivariable analysis. The main outcome measures was the development of preeclampsia with severe features. RESULTS Overall, 165 women were diagnosed with isolated gestational proteinuria, and 38 (23.0%) of them developed preeclampsia with severe features. Women in the increasing proteinuria tertile were more likely to develop preeclampsia with severe features (5.5%, 21.8%, 41.8%, respectively; p = 0.004). A multivariable logistic regression model controlling for background characteristics as well as gestational age at diagnosis, blood pressure, and kidney and liver function tests showed an increased risk of 14% to develop preeclampsia with severe features for every 500-mg rise in proteinuria level (adjusted odds ratio = 1.14, 95% confidence interval 1.03-1.27). CONCLUSIONS A higher isolated gestational proteinuria level was associated with an increased risk to develop preeclampsia with severe features among pregnant women past 24 weeks of gestation.
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Affiliation(s)
- Yossi Tzur
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Eli Rimon
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Gil Geva
- The Hebrew University Hadassah Medical School, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacky Herzlich
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
| | - Michael J Kupferminc
- Department of Obstetrics & Gynecology, Tel Aviv Sourasky Medical Center, Lis Hospital for Women, Tel Aviv University, Tel Aviv, Israel
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Lei T, Qiu T, Liao W, Li K, Lai X, Huang H, Yuan R, Chen L. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reprod Biol Endocrinol 2021; 19:71. [PMID: 33990220 PMCID: PMC8120921 DOI: 10.1186/s12958-021-00751-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Proteinuria is one of the common manifestations of patients with preeclampsia (PE), but whether the severity of proteinuria is related to the pregnancy outcome of patients with preeclampsia remains controversial. The present study aimed to determine the relationship between 24-h proteinuria and adverse outcomes in patients with preeclampsia. METHODS The present retrospective study included 329 pregnant women in Chongqing, China. Patients were divided into PE group and non-PE group. PE group was stratified into three subgroups based on the level of 24-h proteinuria. Correlation analysis was used to analyze the correlation between biochemical indexes and adverse pregnancy outcome, and Logistic regression analysis was used to analyze the risk factors of adverse pregnancy outcome. The receiver operating characteristic curve (ROC) was used to evaluate the ability of 24-h urinary protein to distinguish the adverse pregnancy outcome in patients with preeclampsia. RESULTS (1) Between PE and non-PE group, cesarean section rate in PE group was significantly higher than that in non-PE group (84.4% vs. 25.9%, p < 0.001). Laboratory findings such as uric acid and creatinine level in PE group were higher than those in non-PE group. (2) Among mild (proteinuria < 0.3 g/24 h), moderate (0.3 g/24 h ≦ proteinuria < 2 g/24 h) and massive (proteinuria ≧ 2 g/24 h) groups, the frequencies of induced labor (p = 0.006) and stillbirth (p = 0.002) increased with the increase of 24-h proteinuria. (3) Adverse outcomes were positively correlated with 24-h proteinuria (adverse maternal outcomes: r = 0.239, p = 0.002; adverse fetal outcomes: r = 0.336, p < 0.001). (4) The best 24-h proteinuria cutoff values to determine stillbirth, premature and fetal distress were 3965.0 mg/24 h, 984.75 mg/24 h and 1503.85 mg/24 h and their odds ratio (95% confidence interval) were 12.46 (3.46-44.88), 2.48 (1.15-5.37) and 10.02 (2.14-46.80), respectively. CONCLUSIONS The severity of 24-h proteinuia may forecast adverse outcomes in women with preeclampsia. We suggest proteinuria should be retained as one of the monitoring indexes in patients with preeclampsia. TRIAL REGISTRATION Retrospectively registered. (LTMCMTS202001).
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Affiliation(s)
- Tingting Lei
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Ting Qiu
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Wanyu Liao
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Kangjie Li
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xinyue Lai
- First Clinical College, Chongqing Medical University, Chongqing, China
| | - Hongbo Huang
- Second Clinical College, Chongqing Medical University, Chongqing, China
| | - Rui Yuan
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing Univ-ersity Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Ling Chen
- The Center of Experimental Teaching Management, Chongqing Medical University, Chongqing, China.
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Xu X, Wang Y, Xu H, Kang Y, Zhu Q. Association between proteinuria and maternal and neonatal outcomes in pre-eclampsia pregnancy: a retrospective observational study. J Int Med Res 2021; 48:300060520908114. [PMID: 32339047 PMCID: PMC7218474 DOI: 10.1177/0300060520908114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives To evaluate the association between proteinuria and maternal and neonatal outcomes in pregnant women with pre-eclampsia. Methods This retrospective study included patients beyond 20 weeks of gestation diagnosed with pre-eclampsia, who were admitted to Suzhou Municipal Hospital between December 2013 and December 2015. Demographic and clinical data were extracted from clinical records, including age, body mass index, newborn weight and Apgar score. Pre-eclampsia risk factors and perinatal outcomes were analysed. Results A total of 407 patients were enrolled, of whom, 402 with pre-eclampsia were included in the final analyses, divided into two groups: patients with proteinuria (n = 364 [90.55%]) and patients without proteinuria (n = 38 [9.45%]). Newborn 5-min Apgar scores were statistically lower in the proteinuria group versus the group without proteinuria (9.77 versus 9.95). Compared with patients without proteinuria, patients with proteinuria had a significantly higher rate of births before 37 weeks of gestation (50.80% versus 31.60%), but the incidence of preterm membrane rupture was significantly lower (3.8% versus 13.2%). Conclusion Proteinuria may be associated with adverse maternal and neonatal outcomes in cases of pre-eclampsia.
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Affiliation(s)
- Xiangxiang Xu
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Yun Wang
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Hui Xu
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Yan Kang
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Qin Zhu
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
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Yılmaz Baran Ş, Alemdaroğlu S, Durdağ GD, Yetkinel S, Yüksel Şimşek S, Kalaycı H, Şimşek E. Reappraisal of the relationship between 24-hour proteinuria and preeclampsia in terms of the maternal and perinatal outcomes. Hypertens Pregnancy 2020; 39:82-88. [PMID: 32037908 DOI: 10.1080/10641955.2020.1725038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This study evaluated the association between proteinuria levels and maternal, and perinatal outcomes of preeclampsia patients and determined the cutoff values for predicting severe complications.Methods: We retrospectively evaluated the records of 412 patients with proteinuric preeclampsia.Results: Median proteinuria levels were significantly higher in patients with severe maternal and adverse perinatal outcomes than in those without such outcomes, except in cases of placental abruption and late preterm delivery.Conclusion: Proteinuria levels may aid in diagnosing preeclampsia and indicating early intervention. The revised guidelines do not suggest that proteinuria encountered during pregnancy is clinically insignificant.
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Affiliation(s)
- Şafak Yılmaz Baran
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Songül Alemdaroğlu
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Gülşen Doğan Durdağ
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Selçuk Yetkinel
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Hakan Kalaycı
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Erhan Şimşek
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
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Morikawa M, Mayama M, Saito Y, Nakagawa-Akabane K, Umazume T, Chiba K, Kawaguchi S, Cho K, Watari H. Severe proteinuria as a parameter of worse perinatal/neonatal outcomes in women with preeclampsia. Pregnancy Hypertens 2020; 19:119-126. [PMID: 31972468 DOI: 10.1016/j.preghy.2019.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The present study aimed to determine the relationship between the severity of proteinuria and maternal/neonatal outcomes among women with preeclampsia. STUDY DESIGN Proteinuria severity was measured at preeclampsia diagnosis and at delivery in 94 women with preeclampsia (among 2904 women with singleton pregnancies, who delivered after 22 gestational weeks). Preeclampsia was defined as hypertension with proteinuria. MAIN OUTCOME MEASURES Protein:creatinine (P/C) ratio to worse the maternal outcome was 4.8 among women with preeclampsia. RESULTS The frequencies of HELLP syndrome and maternal pulmonary edema in women with a P/C ratio ≥5.0 (35.5% and 35.5%, respectively) were significantly higher than those in women with a P/C ratio <5.0 (12.7%, P = 0.014 and 6.4%, P < 0.001, respectively). The best P/C ratio cutoff value to determine early-onset preeclampsia and early preterm birth (EPB) was 4.1 (P < 0.001 and P < 0.001, respectively). The best P/C ratio cutoff values to determine the interval between the preeclampsia diagnosis and delivery <7 days and the need to undergo cesarean section were 1.8 and 1.5, respectively. The best P/C ratio cutoff value to determine maternal pulmonary edema and central serous chorioretinopathy (CSC) was 4.8 (P = 0.020 and P = 0.014, respectively). Finally, the best P/C ratio cutoff values to determine EPB and maternal CSC in women with preeclampsia were 4.1 (odds ratio, 10.9; 95% confidence interval; 4.08 to 29.2, P < 0.0001) and 4.8 (odds ratio, 17.6; 95% confidence interval; 0.898 to 344, P = 0.0008), respectively, according to the multivariate analysis. CONCLUSIONS A higher P/C ratio at delivery in women with preeclampsia might cause EPB and CSC.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Michinori Mayama
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiro Saito
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kinuko Nakagawa-Akabane
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Chiba
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kawaguchi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazutoshi Cho
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Farrar D, Santorelli G, Lawlor DA, Tuffnell D, Sheldon TA, West J, Macdonald-Wallis C. Blood pressure change across pregnancy in white British and Pakistani women: analysis of data from the Born in Bradford cohort. Sci Rep 2019; 9:13199. [PMID: 31520065 PMCID: PMC6744423 DOI: 10.1038/s41598-019-49722-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022] Open
Abstract
The incidence of gestational hypertension (GH) and pre-eclampsia (PE) is increasing. Use of blood pressure (BP) change patterns may improve early detection of BP abnormalities. We used Linear spline random-effects models to estimate BP patterns across pregnancy for white British and Pakistani women. Pakistani women compared to white British women had lower BP during the first two trimesters of pregnancy, irrespective of the development of GH or PE or presence of a risk factor. Pakistani compared to white British women with GH and PE showed steeper BP increases towards the end of pregnancy. Pakistani women were half as likely to develop GH, but as likely to develop PE than white British women. To conclude; BP trajectories differ by ethnicity. Because GH developed evenly from 20 weeks gestation, and PE occurred more commonly after 36 weeks in both ethnic groups, the lower BP up to the third trimester in Pakistani women resulted in a lower GH rate, whereas PE rates, influenced by the steep third trimester BP increase were similar. Criteria for diagnosing GH and PE may benefit from considering ethnic differences in BP change across pregnancy.
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Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol National Institute for Health Research Biomedical Resource Centre, Bristol, UK
| | | | | | - Jane West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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Mistry HD, Kurlak LO, Gardner DS, Torffvit O, Hansen A, Broughton Pipkin F, Strevens H. Evidence of Augmented Intrarenal Angiotensinogen Associated With Glomerular Swelling in Gestational Hypertension and Preeclampsia: Clinical Implications. J Am Heart Assoc 2019; 8:e012611. [PMID: 31237175 PMCID: PMC6662362 DOI: 10.1161/jaha.119.012611] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/17/2019] [Indexed: 12/19/2022]
Abstract
Background AGT (angiotensinogen) synthesis occurs in renal proximal tubular epithelial cells, independent from systemic AGT , as a component of the intrarenal renin-angiotensin system. We investigated urinary AGT , as a biomarker for renin-angiotensin system activation, and electrolyte concentrations, in relation to glomerular volume, as a proxy for glomerular endotheliosis in renal biopsy tissue from pregnant normotensive control and hypertensive women. Methods and Results Urine samples were collected from normotensive control (n=10), gestational hypertensive (n=6), and pre-eclamptic (n=16) women at the time a renal biopsy was obtained. Samples were collected from Lund University Hospital between November 1999 and June 2001. Urinary AGT , potassium, and sodium were measured, normalized to urinary creatinine. Mean glomerular volume was estimated from biopsy sections. AGT protein expression and localization were assessed in renal biopsies by immunohistochemistry. Urinary AGT concentrations were higher in hypertensive pregnancies (median, gestational hypertension: 11.3 ng/mmol [interquartile range: 2.8-13.6]; preeclampsia: 8.4 ng/mmol [interquartile range: 4.2-29.1]; normotensive control: 0.6 ng/mmol [interquartile range: 0.4-0.8]; P<0.0001) and showed a positive relationship with estimated mean glomerular volume. Urinary potassium strongly correlated with urinary AGT ( P<0.0001). Although numbers were small, AGT protein was found in both glomeruli and proximal tubules in normotensive control but was present only in proximal tubules in women with hypertensive pregnancy. Conclusions This study shows that pregnant women with gestational hypertension or preeclampsia have increased urinary AGT and potassium excretion associated with signs of glomerular swelling. Our data suggest that the kidneys of women with hypertensive pregnancies and endotheliosis have inappropriate intrarenal renin-angiotensin system activation, which may contribute toward the pathogenesis of hypertension and renal injury.
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Affiliation(s)
- Hiten D. Mistry
- Division of Child Health, Obstetrics & GynaecologySchool of MedicineUniversity of NottinghamUnited Kingdom
| | - Lesia O. Kurlak
- Division of Child Health, Obstetrics & GynaecologySchool of MedicineUniversity of NottinghamUnited Kingdom
| | - David S. Gardner
- School of Veterinary Medicine and ScienceUniversity of NottinghamUnited Kingdom
| | | | - Alastair Hansen
- Department of PathologyHerlev University HospitalHerlevDenmark
| | - Fiona Broughton Pipkin
- Division of Child Health, Obstetrics & GynaecologySchool of MedicineUniversity of NottinghamUnited Kingdom
| | - Helena Strevens
- Department of ObstetricsSkåne University HospitalLund UniversityLundSweden
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Ukah UV, De Silva DA, Payne B, Magee LA, Hutcheon JA, Brown H, Ansermino JM, Lee T, von Dadelszen P. Prediction of adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of pregnancy: A systematic review. Pregnancy Hypertens 2017; 11:115-123. [PMID: 29198742 DOI: 10.1016/j.preghy.2017.11.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity. The ability to predict these complications using simple tests could aid in management and improve outcomes. We aimed to systematically review studies that reported on potential predictors of adverse maternal outcomes among women with a hypertensive disorder of pregnancy. METHODS We searched MEDLINE, Embase and CINAHL (inception - December 2016) for studies of predictors of severe maternal complications among women with a hypertensive disorder of pregnancy. Studies were selected in a two-stage process by two independent reviewers, excluding those reporting only on adverse fetal outcomes. We extracted data on study and test(s) characteristics and outcomes. Accuracy of prediction was assessed using sensitivity, specificity, likelihood ratios and area under the receiver operating curve (AUROC). Strong evidence of prediction was taken to be a positive likelihood ratio >10 or a negative likelihood ratio <0.1, and for multivariable models, an AUROC ≥0.70. Bivariate random effects models were used to summarise performance when possible. RESULTS Of 32 studies included, 28 presented only model development and four examined external validation. Tests included symptoms and signs, laboratory tests and biomarkers. No single test was a strong independent predictor of outcome. The most promising prediction was with multivariable models, especially when oxygen saturation, or chest pain/dyspnea were included. CONCLUSION Future studies should investigate combinations of tests in multivariable models (rather than single predictors) to improve identification of women at high risk of adverse outcomes in the setting of the hypertensive disorders of pregnancy.
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Affiliation(s)
- U Vivian Ukah
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada.
| | - Dane A De Silva
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Beth Payne
- Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada; Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Helen Brown
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - J Mark Ansermino
- Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada
| | - Tang Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Healthy Starts Theme, BC Children's Hospital Research, Vancouver, BC, Canada
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Dong X, Gou W, Li C, Wu M, Han Z, Li X, Chen Q. Proteinuria in preeclampsia: Not essential to diagnosis but related to disease severity and fetal outcomes. Pregnancy Hypertens 2017; 8:60-64. [PMID: 28501282 DOI: 10.1016/j.preghy.2017.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 11/20/2022]
Abstract
Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality globally and proteinuria can be one of the cardinal features of this disease. However, studies about the association of the amount of proteinuria and the severity of preeclampsia, and perinatal outcomes are limited. Data on 239 women with preeclampsia were retrospectively collected from a university teaching hospital from September 2011 to June 2013 and analysed. Data included all clinical parameters and proteinuria in a 24h urine collection. In cases of severe preeclampsia, significantly fewer patients had proteinuria levels <0.3g/L in comparison to any of the other groups with proteinuria >0.3g/L, but there was no difference in cases of severe preeclampsia when proteinuria levels were >0.3g/L. Furthermore, when proteinuria levels were >0.3g/L, the frequency of severe preeclampsia in each group was significantly higher than the frequency of mild pre-eclampsia cases. Time of onset was significantly earlier in patients with proteinuria >3g/L in a 24h urine collection, but time between the onset of preeclampsia and delivery was not correlated with the amount of proteinuria. The birth weight was significantly lower in patients with proteinuria >3g/L. The incidence of fetal growth restriction or stillbirth was significantly higher in patients with proteinuria >5g/L. Our data demonstrate that the amount of proteinuria is not associated with the severe of preeclampsia, once proteinuria is detected, but is related to the severity of preeclampsia. The adverse fetal outcomes appear to be the function of prematurity rather than proteinuria itself.
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Affiliation(s)
- Xin Dong
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Wenli Gou
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Chunfang Li
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Min Wu
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Zhen Han
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Xuelan Li
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University, China.
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand.
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26
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Mateus J, Newman R, Sibai BM, Li Q, Barton JR, Combs CA, Guzman E, Boggess KA, Gyamfi C, von Dadelszen P, Woelkers D. Massive Urinary Protein Excretion Associated with Greater Neonatal Risk in Preeclampsia. AJP Rep 2017; 7:e49-e58. [PMID: 28348923 PMCID: PMC5365400 DOI: 10.1055/s-0037-1601866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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 < 340/7 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.
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Affiliation(s)
- Julio Mateus
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Roger Newman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Baha M Sibai
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Qing Li
- Center of Behavioral Epidemiology and Community Health (CBEACH), San Diego State University, San Diego, California
| | - John R Barton
- Department of Obstetrics and Gynecology, Central Baptist Hospital, Lexington, Kentucky
| | | | - Edwin Guzman
- Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Kim A Boggess
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Cynthia Gyamfi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St Geroge's, University of London, London, United Kingdom
| | - Doug Woelkers
- Department of Reproductive Medicine, University of California San Diego, La Jolla, California
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Isolated proteinuria is a risk factor for pre-eclampsia: a retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria. J Perinatol 2016; 36:25-9. [PMID: 26513453 DOI: 10.1038/jp.2015.138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine maternal and neonatal outcomes of isolated proteinuria and define maternal characteristics for progression to pre-eclampsia. STUDY DESIGN Retrospective cohort study. Data from all hospitalized pregnant women between 2009 and 2014 with new onset isolated proteinuria of over 300 mg/24 h at admission were obtained. Follow-up was performed from the time of admission to the hospital to the time of discharge postpartum. Obstetrical, maternal and neonatal outcomes were obtained. RESULT Ninety-five pregnant women diagnosed with new onset isolated proteinuria were followed to term. Thirteen women developed pre-eclampsia during pregnancy and eight developed pre-eclampsia postpartum. Maternal characteristics for progression to pre-eclampsia were greater maximal values of proteinuria. Earlier pre-eclampsia onset was associated with early-onset proteinuria and multiple gestation. Although greater values of proteinuria were associated with increased risk for intrauterine growth restriction and lower Apgar scores, maternal outcome was favorable, regardless of pre-eclampsia progression. Isolated proteinuria progressing to pre-eclampsia was associated with late pre-eclampsia onset and favorable maternal and neonatal outcomes. CONCLUSION A significant proportion of women with new onset isolated proteinuria will develop pre-eclampsia. In these women, close follow-up is recommended until after delivery.
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Abstract
Pre-eclampsia remains the second leading direct cause of maternal death, >99 % of which occurs in less developed countries. Over 90 percent of the observed reduction in pre-eclampsia-related maternal deaths in the UK (1952-2008) occurred with antenatal surveillance and timed delivery. In this review, we discuss the pathogenesis, diagnostic criteria, disease prediction models, prevention and management of pre-eclampsia. The Pre-eclampsia Integrated Estimate of RiSk (PIERS) models and markers of angiogenic imbalance identify women at incremental risk for severe pre-eclampsia complications. For women at high risk of developing pre-eclampsia, low doses of aspirin (especially if started <17 weeks) and calcium are evidence-based preventative strategies; heparin is less so. Severe hypertension must be treated and the Control of Hypertension In Pregnancy (CHIPS) Trial (reporting: 2014) will guide non-severe hypertension management. Magnesium sulfate prevents and treats eclampsia; there is insufficient evidence to support alternative regimens. Pre-eclampsia predicts later cardiovascular disease; however, at this time we do not know what to do about it.
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Affiliation(s)
- Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Rm V3-339, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada,
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Palacios de Franco Y, Velazquez K, Segovia N, Acosta C, Yanosky D, Franco Palacios YV, Ramos A, Franco Palacios CR. Urinary podocalyxin as a marker of preeclampsia in a Hispanic population. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2014; 6:115-124. [PMID: 25057338 PMCID: PMC4106648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Preeclampsia is associated with significant materno-fetal morbidity and mortality. Podocyturia due to podocyte damage seems to be associated with the disease. The objective of this study was to evaluate the usefulness of urinary podocalyxin as a marker of preeclampsia in a Hispanic population. METHODS 63 patients were studied. 25 patients had preeclampsia/eclampsia (PE-E). 38 patients had normal pregnancies and served as control group. 24 hour proteinuria, urine protein/creatinine (UPC), urinary podocalyxin and perinatal outcomes were measured. A Podocalyxin ELISA test was used to detect podocyturia. RESULTS Mean age (years), mean±SD was 30.5±5.4 in normal patients vs 30.6±5.8 in PE-E, p=0.98. Median gestational age (weeks) was, 38 (range 21-42) for normal pregnancies and 36 (range 24-40) for patients with PE-E, <0.001. Urine podocalyxin/creatinine on admission (ng/mg), median [IQR] in normal patients was 55.9 [29.4, 74.9] vs 109.7 [63.8, 234.1] in PE-E, p=0.001. After adjusting for admission proteinuria, urinary podocalyxin remained independently associated with preeclampsia: OR=1.0040 (95% CI 1.0003-1.0078), p=0.03. There was low to moderate correlation between UPC and urinary podocalyxin, Spearman's =0.31, p=0.01. In PE-E, post-partum urine podocalyxin was lower, median [IQR]: 69.7 [32.7, 184.8] p=0.19 vs admission. There was a trend towards more podocyturia and proteinuria in patients with eclampsia, comparing to those with preeclampsia. There was no association observed between podocyturia and neonatal mortality, IUGR or Apgar scores. CONCLUSIONS Significantly higher levels of urinary podocalyxin are seen in preeclampsia/eclampsia. They tend to normalize after delivery.
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Affiliation(s)
- Ylbe Palacios de Franco
- Catholic University of Asuncion School of MedicineAsuncion, Paraguay
- Department of Obstetrics and Gynecology, Instituto de Prevision Social (IPS) HospitalAsuncion, Paraguay
| | - Karina Velazquez
- Department of Laboratory Medicine, Instituto de Prevision Social (IPS) HospitalAsuncion, Paraguay
| | - Natalia Segovia
- Department of Clinical Immunology, Instituto de Prevision Social (IPS) HospitalAsuncion, Paraguay
| | - Carolina Acosta
- Department of Obstetrics and Gynecology, Instituto de Prevision Social (IPS) HospitalAsuncion, Paraguay
| | - Deborah Yanosky
- Department of Obstetrics and Gynecology, Instituto de Prevision Social (IPS) HospitalAsuncion, Paraguay
| | - Ylbe V Franco Palacios
- Department of Obstetrics and Gynecology, Complete Care Health Network, South Jersey General HospitalVineland, NJ. USA
| | - Amanda Ramos
- Department of Gynecology and Obstetrics, Johns Hopkins HospitalBaltimore, MD. USA
| | - Carlos R Franco Palacios
- Department of Nephrology, Affiliated Community Medical Centers, Rice Memorial HospitalWillmar, MN. USA
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Akaishi R, Yamada T, Morikawa M, Nishida R, Minakami H. Clinical features of isolated gestational proteinuria progressing to pre-eclampsia: retrospective observational study. BMJ Open 2014; 4:e004870. [PMID: 24747797 PMCID: PMC3996810 DOI: 10.1136/bmjopen-2014-004870] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Some women with isolated gestational proteinuria (IGP) later develop hypertension and are diagnosed with pre-eclampsia (PE). This study was performed to determine whether clinical features of such proteinuria preceding PE (P-PE) differ from those of other PE (O-PE). DESIGN Retrospective observational study after approval of the institutional review board of ethics. SETTING A single university hospital. Proteinuria was defined as a protein-to-creatinine ratio (mg/mg; P/Cr) of ≥0.27 in the spot urine specimen. IGP was defined as proteinuria in the absence of hypertension. P-PE was defined as PE in which proteinuria preceded hypertension by more than 2 days. PARTICIPANTS All of 10 and 18 consecutive women with P-PE and O-PE, respectively, who gave birth between January 2008 and August 2013. RESULTS Proteinuria appeared earlier (at 30.2±3.0 vs 35.3±4.3 weeks, p=0.001), the P/Cr level was greater at birth (7.28±2.14 vs 3.19±2.49, p<0.001), net maternal weight gain during the last antenatal 1 week was greater (3.1±1.8 vs 1.3±1.7 kg, p=0.023) and length of pregnancy was shorter (32.5±1.9 vs 36.1±3.6 weeks, p=0.001) in women with P-PE than in O-PE. The duration of IGP was 10.0±5.9 days (range 3-20), and the time interval until delivery after diagnosis of PE was 6.1±8.2 days (range 0-23) in 10 women with P-PE. The P/Cr levels at birth were significantly inversely correlated with the antenatal lowest antithrombin activity and fibrinogen levels among the 28 women with PE. CONCLUSIONS Women with P-PE were likely to exhibit greater proteinuria in the urine, greater water retention in the interstitial space and more enhanced coagulation-fibrinolysis, thus suggesting that they may constitute a more severe form of PE than women with O-PE do.
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Affiliation(s)
- Rina Akaishi
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Maternofoetal complications and their association with proteinuria in a tertiary care hospital of a developing country. J Pregnancy 2014; 2014:431837. [PMID: 24829801 PMCID: PMC4009128 DOI: 10.1155/2014/431837] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/20/2014] [Accepted: 02/20/2014] [Indexed: 01/09/2023] Open
Abstract
Objective. To investigate association between maternofoetal complications and the amount of proteinuria measured by spot urine protein creatinine ratio in patients with preeclampsia. Methods. 200 consecutive patients with preeclampsia were recruited in the study. The complications like first episode of severe hypertension, renal insufficiency, raised level of aspartate transaminase, signs of neurological involvement, thrombocytopenia, eclampsia, and need to shift in intensive care units were studied. The maternal outcome was studied in terms of type of labour, outcome of pregnancy, mode of delivery, indication of cesarean section, and maternal mortality. The foetal complications and outcome parameters were birth weight, Apgar score at the time of birth and at five minutes, need of high dependency unit care, and perinatal mortality. Result. The frequency of various maternal and foetal complications was between 14–53% and 22–92%, respectively. Maternal mortality was 3%, whereas perinatal mortality was 23%. Statistically significant association was found between the frequencies of various complications in mother and newborn and spot UPCR. Conclusion. The rate of various maternofoetal complications in preeclampsia is higher in developing countries than in developed world. Maternofoetal complications and outcome correlate with maternal spot UPCR.
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