Proteinuric and Non-proteinuric Pre-eclampsia: A Comparative Analysis of Risk Factor Profile, Clinical Picture, Laboratory Parameters and Pregnancy Outcome.

Abstract

Background: Pre-eclampsia, a hypertensive disorder of pregnancy remains a challenge worldwide despite advance in the medical science and research due to its adverse impact on pregnancy.

Objectives: To compare the clinical characteristics, sociodemographic risk factors and the pregnancy outcomes between proteinuric and non-proteinuric pre-eclampsia incorporating the revised definition.

Methodology: A prospective observational study consisting of 147 case of pre-eclampsia as per ISSHP-2018 diagnostic criteria of which 91 (63.6%) with proteinuria and 52 (36.4%) were without proteinuria. The maternal characteristics and pregnancy outcome were studied in both the groups and analyzed using appropriate statistical method.

Results: Use of revised definition lead to 1.5% increase in the incidence of pre-eclampsia (PE). A significantly higher proportion of non-proteinuric PE were ≤ 30 years as compared to proteinuric PE (78.8% vs. 61.5%, p value: 0.033). The proteinuric PE had significantly higher mean systolic and mean arterial pressure (p value: 0.011), higher association with clinically severe disease (p value: 0.008), higher values of serum creatinine (p value: 0.024) and serum LDH levels (p value: 0.004), higher rate of growth retarded fetus (p value: 0.029), low birth weight (p value: 0.014) and peri-natal mortality (p value: 0.018) as compared to non-proteinuric PE. However, the binary logistic regression analysis failed to demonstrate any significant difference between the two groups in any of the maternal characteristics or pregnancy outcome measures.

Conclusion: PE with or without proteinuria can be equally severe compromising the pregnancy outcome and hence demands for increase supervision and monitoring once diagnosis of PE is established.