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

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 Africa over 12 months. Patients with PE 18 years or older with singleton pregnancies were recruited. We included 248 in the final analysis.

Methods

Proteinuria was quantified using urine protein: creatinine ratio (UPCR). Preeclamptic patients’ outcomes were 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 antihypertensive agent. 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 antihypertensive agents or neonatal outcomes.