506: A population-based definition for severe proteinuria and its association with adverse outcomes in preeclampsia

Abstract

sought to examine if race is associated with postpartum readmission due to hypertension in women with pregnancy-associated hypertension. STUDY DESIGN: This was a multi-institutional retrospective cohort study of all women with pregnancy-associated hypertension diagnosed prior to initial discharge from January 2009 to December 2016. Pregnancy-associated hypertension such as gestational hypertension and preeclampsia (with or without severe features) was diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions. Women with chronic hypertension and superimposed pre-eclampsia were excluded. Postpartum readmission due to hypertension was defined as a readmission due to severe hypertension within 6 weeks postpartum. Outcomes including age, gestational age, race/ethnicity (self-reported), body mass index (kg/m 2), marital status, type of pregnancy-associated hypertension, diabetes (gestational or pregestational), use of antihypertensive drugs, mode of delivery, and others were utilized in the comparison. Multivariable logistic regression models were performed to calculate adjusted odds ratios (OR) and 95% confidence interval (95%CI). RESULTS: Of 4,949 women with pregnancy-associated hypertension before initial discharge, 71 (1.4%) had postpartum readmission due to hypertension. Women with postpartum readmission due to hypertension compared to those without were more likely to be older (P <. 001) (Table 1). Other outcomes were comparable. After adjusting for confounders, women with postpartum readmission due to hypertension compared to those without were more likely to be older (adjusted OR 1.04; 95%CI 1.00-1.09) and non-Hispanic black (adjusted OR 2.31; 95%CI 1.05-5.08; non-Hispanic white as referent) (Table 2) CONCLUSION: In women with pregnancy-associated hypertension before initial discharge, non-Hispanic black women were at increased odds of postpartum readmission due to hypertension. Further studies are required to reduce racial disparities in postpartum readmission due to hypertension.

The importance of second-trimester AFP and preconception TSH levels for predicting the severity of proteinuria in patients with preeclampsia

“…In the diagnosis of preeclampsia, hypertension was defined as the first occurrence of a systolic blood pressure ≥ 140 mmHg and a diastolic blood pressure ≥ 90 mmHg after the 20th week of pregnancy, measured at least twice at 4-h intervals in the left lateral decubitus position. A pregnant woman with no kidney disease was determined to have < 0.3 g in a 24-h urine sample for protein measurement in the third trimester [4]. All patients diagnosed with preeclampsia were followed up for 12 weeks after birth.…”

“…Therefore, the accurate determination of the severity of preeclampsia is important for identifying pregnant women at greater risk of complications. Recent publications have shown that severe proteinuria is valuable in the prediction of poor obstetric outcomes in women with preeclampsia [3,4]. In the past, the amount of proteinuria was important to assess the severity of preeclampsia [5].…”

Urinary Protein-to-Creatinine Ratio: An Indicator of Adverse Clinical Outcomes in Preeclampsia With Proteinuria

“…Bharathi et al ( 2019) [43] in their study of 209 antenatal women observed that out of the 157 preeclamptic women, complication rate among women with proteinuria >300 mg/day, >1000 mg/day, and >2000 mg/day were as follows: abruptio placenta: 33.3% vs. 66.7% vs. 0 (p<0.001); HELLP syndrome: 0 vs. 33.3% vs. 66.7% (p<0.001); and eclampsia: 11.7% vs. 77.8% vs. 11.7% respectively (p<0.001), which indicated a very strong significance. Speranza et al ( 2019) [44] in their retrospective study stated that renal complications were significantly more common among cases of preeclampsia with severe proteinuria. Martins-Costa et al ( 2011) [45] stated that hypertensive pregnant women with a PCR ≥0.3 mg/mg had worse maternal and perinatal outcomes than those with PCR <0.3 mg/mg.…”