Blood pressure, edema and proteinuria in pregnancy. 6. Proteinuria relationships

1. The blood pressures of pregnant patients with proteinuria seem to be no higher than the levels of blood pressure in patients with no proteinuria. The presence of proteinuria and pregnancy in the absence of blood pressure elevation increases perinatal mortality above the values where blood pressure elevation occurs alone. This relationship is most prominent among nulliparous median-age pregnant patients. Even though the number of patients is small, the highest rates occur in the young white nullipara from the sixteenth to twenty-third week of pregnancy. Attempts to compare black and white median-aged nulliparas are meaningless because of the tremendous variability of data. 2. The findings in all cohorts with proteinuria were essentially the same as those in Cohorts I, II and III. Proteinuria of 2+ or greater occurs more frequently in black than in white gravidas. 3. Our observations indicate that perinatal mortality rates in patients with proteinuria are, for the most part, at least twice the rates of patients without proteinuria. 4. The volume of data available is insufficient to determine whether proteinuria influences prematurity rates or mean birth weights. However, our data suggest that some vascular or renal lesion must be affecting perinatal mortality. 5. The small number of patients in the proteinuria study group does not permit meaningful comparisons with the patient group presenting no edema or proteinuria. 6. Adherence to suitable criteria for discovering and measuring proteinuria is necessary to make the diagnosis of preeclampsia. These criteria include careful collection of urine in the clinic or hospital, utilization of acceptable standard testing methods, and the application of uniform principles of medical practice to the overall care of obstetric patients. 7. The data are presented, not interpreted. However, we cannot discount the value of the present data in suggesting the urgent need to restudy more of the current data available. It also seems desirable to initiate another program to investigate a smaller group of patients made up of the same sequential cohorts where it may be possible and more practical to apply strict supervision of statistical design, patient care, personnel, laboratory testing, data recording, data processing and reporting and statistical analysis.