252 Degree of proteinuria and duration of expectant management in women with severe preeclampsia

Abstract

To evaluate the association between the degree of proteinuria and duration of expectant management (EM) and other perinatal outcomes in women with severe preeclampsia (SPE). Retrospective cohort study of women with SPE delivering live, non-anomalous singletons at 23-34 weeks gestational age (GA) at a single tertiary center (2016-2018). Women with proteinuria assessment (24-hour total urine protein or urine protein:creatinine ratio extrapolation) within 3 days of SPE diagnosis were included. Women delivered for an indication other than SPE, i.e., preterm labor, were excluded. Women were categorized by degree of proteinuria (mg): none (less than or equal to 300), mild (301-1000), moderate (1001-3000), and massive (greater than or equal to 3001). The primary outcome was the proportion of potential EM time achieved (%EM), i.e., days of EM achieved divided by maximum potential EM time (days from SPE diagnosis to 34 weeks). Secondary outcomes included delivery GA, days of EM, and perinatal outcomes. Bivariable and multivariable analyses compared outcomes across groups. Of 285 women included, 21% had no proteinuria, 33% mild, 19% moderate, and 27% massive. Demographics differed between groups with respect to GA at diagnosis, age, parity, chronic hypertension, and kidney function (Table 1). %EM was not significantly different between groups (Table 2; adjusted β coefficient 0.5 (95% CI -0.5, 1.4) for mild proteinuria vs none, -0.5 (95% CI -1.6, 0.6) for moderate proteinuria vs none, and -0.6 (95% CI -1.6, 0.5) for massive proteinuria vs none). Increasing proteinuria was associated with earlier delivery GA but not days of EM (Table 2). However, massive proteinuria was associated with an increased odds of maternal (aOR 2.3, 95% CI 1.0, 5.3) and neonatal (aOR 2.5, 95% CI 1.2, 5.4) composite morbidities, compared to no proteinuria (Table 2). Among women with SPE, the degree of proteinuria was not associated with duration of EM. However, massive proteinuria, compared to no proteinuria, was associated with higher odds of maternal and neonatal adverse outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)