association of proteinuria threshold in pre eclampsia with maternal and perinatal.pdf

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association of proteinuria threshold in pre eclampsia with maternal and perinatal.pdf

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association of proteinuria threshold in pre eclampsia with maternal and perinatal

Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women Kate Bramham1?, Carlos E. Poli-de-Figueiredo1,2?, Paul T. Seed1, Annette L. Briley1, Lucilla Poston1, Andrew H. Shennan1, Lucy C. Chappell1* 1 Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, London, United Kingdom, 2 School of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul, Rio de Janeiro, Brazil Abstract Objectives: To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ≥500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension. Design: Secondary analysis of the Vitamins in Pre-Eclampsia Trial. Setting: 25 UK hospitals in ten geographical areas. Population: 946 women with pre-existing risk factors for pre-eclampsia. Methods: Women with pre-eclampsia and proteinuria 300-499mg/24h (PE300, referent group, n=60) or proteinuria ≥500 mg/24h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110). Main Outcome Measures: Maternal: progression to severe hypertension. Perinatal: small for gestational age (SGA) 5th centile, gestation at delivery. Results: Severe hypertension occurred more frequently in PE500 (35%) and PE300 (27%) than CHT (5.9%; P≤0.01) and GH (10%; p≤0.001). Gestation at delivery was earlier in PE500 (33.2w) than PE300 (37.3w; P≤0.001), and later in CHT (38.3w; P≤0.05) and GH (39.1w; P≤0.001). SGA infants were more frequent in PE300 (32%) than in CHT (13.3%; P≤0.001) and GH (16.5%; P≤0.05). Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P≤0.001), and to receive magnesium sulphate (17% vs. 1.7%, P≤0.05). Conclusion: Women with PE300 have complication rates above those of women managed as out-pa