93 Maternal and perinatal outcomes in preeclampsia according to the magnitude of proteinuria: Results from a high risk referral center in Brazil

Abstract

Preeclampsia (PE) is one of the leading causes of maternal and neonatal morbidity and mortality worldwide. It is defined as new onset hypertension developing ⩾20 weeks and proteinuria or evidence of maternal organ dysfunction. The magnitude of proteinuria was a marker for severity and when higher than 2 g/24 h indicated aggressive treatment. This was recently revised and no longer defines severity, but there are still gaps in understanding how different levels of increased proteinuria impact on maternal and perinatal outcomes and its long term consequences. To review all cases of PE with proteinuria ⩾2 g/24 h followed at the State University of Campinas (UNICAMP) in a 5 year period, and compare maternal and perinatal outcomes according to the magnitude of proteinuria. Retrospective cohort of all pregnant women with proteinuria ⩾2 g/24 h followed at UNICAMP from January 2009 to December 2013. Women with previous nephropathy, without diagnosis of PE or delivery elsewhere were excluded from the analysis. Data on demographic characteristics, onset of symptoms, laboratory findings, maternal and fetal/neonatal outcomes were recorded. Data were stored and analyzed using the Epi-Info 7; continuous variables were compared using ANOVA and categorical variables analyzed by x2 or Fisher exact tests. 269 women were screened for review, 19 were excluded for delivering elsewhere, 41 were excluded due to previous nephropathy, 8 due to absence of PE and 5 for post-partum PE (with normal proteinuria during gestation). The current analysis included 196 women. The median age was 28 (±7.1), majority white (69%) and nearly half primigravidas. The average overall magnitude of proteinuria was 5.1 g/24 h (±3.7). Cesarean delivery was the most frequent route of delivery (84%) and the mean gestational age at delivery 33 weeks (±3.8). The majority of cases presented severe PE (80%). Less then half of the women attended postpartum care and among those, most remained with abnormal proteinuria in early (80%) and late (76%) puerperium (followed up to 3 months postpartum). We considered 3 groups of cases according to the magnitude of proteinuria: ⩾2 and <5 g/24 h (n = 124), ⩾5 and <10 g/24 h (n = 43) and ⩾10 g/24 h (n = 18). A summarized comparison among these groups is in Table 1. Quantification of proteinuria remains an important tool in the diagnosis of PE but its magnitude alone, should not guide management. Massive proteinuria presented significantly more in primigravida and proteinuria ⩾5 g/24 h presented decreased gestational age at resolution. Future studies must address systematic follow-up of these women during pregnancy, latency from diagnosis to resolution, and the women’s perspective upon diagnosis of massive proteinuria. A postpartum follow-up is critical, to assess long term consequences of massive proteinuria during pregnancy.