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Determining the relationship between severity of proteinuria and adverse maternal and neonatal outcomes in patients

Elizabeth Jansen van Rensburg¹, Louisa B Seopela¹, Leon C Snyman¹

¹Department of Obstetrics and Gynaecology, University of Pretoria Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, 10 Kalafong Road, Atteridgeville, Gauteng 0008, South Africa.

Pregnancy Hypertension

|September 7, 2024

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.

Keywords:

Hypertension Maternal outcome Neonatal outcome Preeclampsia Pregnancy Proteinuria

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