Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

Abstract

Aims: The Japanese Society for the Study of Hypertension in Pregnancy revised the diagnostic criteria for pre-eclampsia (PE) to conform to those of the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018. This study aimed to investigate whether pregnancy outcomes differ based on the presence of proteinuria and validate the adoption of the ISSHP criteria in Japan. Methods: This is a retrospective study involving 308 women diagnosed with hypertensive disorders of pregnancy at a tertiary center. They were divided into the following groups: PE with proteinuria (n = 218), PE without proteinuria (n = 45) and gestational hypertension (n = 45) according to the ISSHP criteria for comparison of pregnancy outcomes. Results: Applying the ISSHP criteria increased the number of pregnant women diagnosed as having PE by 14.6% (45 women). The difference in the rate of composite maternal complications between the two groups was unremarkable, with 33 cases (15.1%) in the PE with proteinuria group and 9 cases (20%) in the PE without proteinuria group. Moreover, composite neonatal complications occurred in 37 cases (17%) of PE with proteinuria group and 6 cases (13.3%) of PE without proteinuria group, showing remarkably similar incidence rate in the two groups. Women with PE with and without proteinuria had significantly earlier deliveries and lower neonatal birth weight than those with gestational hypertension. Conclusion: Pregnancy outcomes of PE with and without proteinuria were almost similar although their incidence increased, confirming its validity for adaptation of the ISSHP criteria in Japan.

Impact of new definitions of pre‐eclampsia on incidence and performance of first‐trimester screening

“…A study from Japan examined 308 women diagnosed with hypertensive disorders of pregnancy at a tertiary center and divided them, according to the new criteria of the ISSHP (including neurological complications and uteroplacental dysfunction), into three groups: PE with proteinuria (n = 218), PE without proteinuria (n = 45) and GH (n = 45); in 69% (31/45) of cases of PE without proteinuria, there was uteroplacental dysfunction 35 . Applying the ISSHP-new criteria increased the number of pregnant women diagnosed as having PE by 15%; 54 Khan et al the cases with and without proteinuria had a similar incidence of maternal complications, composite neonatal complications, gestational age at delivery and birth weight and these outcomes were worse than in the group with GH.…”

Preeclampsia. Eclampsia. Anesthesia and intensive care in childbirth and the puerperium. Review

“…При наличии симптомов критического состояния (тяжелая АГ, тромбоцитопения, церебральная, почечная, печеночная дисфункция, отек легких) наличие протеинурии необязательно для постановки диагноза «тяжелая преэклампсия» [6,7].…”

Use of the angiogenic biomarker profile to risk stratify patients with fetal growth restriction

“…1,2 New advances in understanding the pathophysiology of PE have resulted in an evolution of the diagnostic criteria. [3][4][5][6][7][8] In 2013, the American Congress of Obstetricians and Gynecologists (ACOG) did not include fetal growth restriction (FGR) in their criteria due to a lack of diagnostic specificity. 9,10 However, FGR is a known manifestation of PE resulting from impaired uteroplacental blood flow due to placental vascular insults and dysfunctional remodeling of the maternal spiral arteries.…”