Preeclampsia: should plasma albumin level be a criterion for severity?

To determine whether plasma albumin level (ALB) is associated with preeclampsia (PE) complications and to define its role in the evaluation of the severity of PE.

We conducted a retrospective study of women with PE at CHU Ste-Justine from January 2005 to December 2008 who had an ALB measurement before delivery. Severe PE was defined according to the Society of Obstetricans and Gynaecologists of Canada guidelines, except for the ALB and gestational age at diagnosis. We compared ALB between women with non-severe PE and with severe PE. The rates of maternal complications and adverse perinatal outcomes associated with PE were compared between women with an ALB < 20 g/L and those with an ALB ≥ 20 g/L.

Among the 459 women included, 62.7% met the criteria for a diagnosis of severe PE. The mean gestational age was 33.8 ± 4.1 weeks at diagnosis of PE and 34.6 ± 3.9 weeks at delivery. After adjustment for gestational age and number of fetuses, ALB was found to be lower in women with severe PE (23.5 ± 3.7 vs. 25.9 ± 2.8 g/L; P < 0.05). Thrombocytopenia, increased serum ALT, severe proteinuria, and a need for platelet transfusion were more frequent among the 44 women with an ALB < 20 g/L (P < 0.05). Two women who had an ALB < 20 g/L and no other criteria for PE developed PE before 34 weeks' gestation.

A plasma albumin level below 20 g/L was not found to be an independent marker for severe preeclampsia because all women with a low plasma albumin level had other adverse conditions.