Association of Serum Albumin Levels With Preeclampsia Severity and Fetomaternal Outcomes: A Cross-Sectional Study

Serum albumin is frequently reduced in preeclampsia because of urinary protein loss, endothelial dysfunction, capillary leakage, and pregnancy-related haemodilution. Its value as an independent marker of severe disease or adverse pregnancy outcomes remains uncertain.

This hospital-based observational cross-sectional study included 150 women with singleton pregnancies and preeclampsia. The source report classified 99 women as having preeclampsia without severe features and 51 as having preeclampsia with severe features. Serum albumin was the primary biochemical parameter and was grouped as less than 2.5, 2.5 to less than 3.0, and 3.0 to 3.5 g/dL. Urine protein by dipstick, spot urine protein-to-creatinine ratio, and 24-hour urinary protein were also recorded as supportive renal measures. Maternal and perinatal outcomes were compared using chi-square or Fisher exact tests, with unadjusted risk ratios and 95% confidence intervals.

The mean serum albumin concentration was 3.08 ± 0.27 g/dL, and no participant had a value above 3.5 g/dL. Albumin below 3.0 g/dL was reported in 25 of 51 women (49.0%) with severe features and 24 of 99 (24.2%) without severe features (risk ratio 2.02, 95% confidence interval 1.29-3.16; p=0.003). Urine dipstick proteinuria of 3+ or 4+ was more frequent in women with severe features (27.5% versus 9.1%; risk ratio 3.02, 95% confidence interval 1.40-6.50; p=0.007). Severe features were also associated with preterm delivery before 37 weeks, neonatal intensive care admission, birth weight below 2 kg, and impending eclampsia. Caesarean delivery, a five-minute Apgar score below seven, and perinatal death did not differ significantly.

The absence of a higher-albumin comparator limited assessment of the prespecified 3.5 g/dL threshold. Albumin below 3.0 g/dL was associated with severe features in an exploratory unadjusted analysis, but an independent prognostic value was not established. Serum albumin should be interpreted as an adjunct to established clinical and laboratory severity criteria.