Earlier onset of proteinuria or hypertension is a predictor of progression from gestational hypertension or gestational proteinuria to preeclampsia

Mamoru Morikawa,Yoshihiro Saito,Michinori Mayama,Satoshi Kawaguchi,Kinuko Nakagawa-Akabane,Hidemichi Watari,Takeshi Umazume,Kentaro Chiba,Kiwamu Noshiro

doi:10.1038/s41598-021-92189-w

Mamoru Morikawa, Yoshihiro Saito + Show 7 more

Open Access

https://doi.org/10.1038/s41598-021-92189-w

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Journal: Scientific Reports	Publication Date: Jun 16, 2021
Citations: 6	License type: open-access

Affiliation: Hokkaido University

Abstract

Although gestational hypertension (GH) is a well-known disorder, gestational proteinuria (GP) has been far less emphasized. According to international criteria, hypertensive disorders of pregnancy include GH but not GP. Previous studies have not revealed the predictors of progression from GP to preeclampsia or those of progression from GH to preeclampsia. We aimed to determine both sets of predictors. A retrospective cohort study was conducted with singleton pregnant women who delivered at 22 gestational weeks or later. Preeclampsia was divided into three types: new onset of hypertension/proteinuria at 20 gestational weeks or later and additional new onset of other symptoms at < 7 days or at ≥ 7 days later. Of 94 women with preeclampsia, 20 exhibited proteinuria before preeclampsia, 14 experienced hypertension before preeclampsia, and 60 exhibited simultaneous new onset of both hypertension and proteinuria before preeclampsia; the outcomes of all types were similar. Of 34 women with presumptive GP, 58.8% developed preeclampsia; this proportion was significantly higher than that of 89 women with presumptive GH who developed preeclampsia (15.7%). According to multivariate logistic regression models, earlier onset of hypertension/proteinuria (before or at 34.7/33.9 gestational weeks) was a predicator for progression from presumptive GH/GP to preeclampsia (odds ratios: 1.21/1.21, P value: 0.0044/0.0477, respectively).

Highlights

Gestational hypertension (GH) is a well-known disorder, gestational proteinuria (GP) has been far less emphasized
According to the conventional criteria of hypertensive disorders of pregnancy, women with proteinuria alone or hypertension alone are not diagnosed to be experiencing preeclampsia until they exhibit additional hypertension or proteinuria; those who do not develop hypertension or proteinuria are diagnosed with GP or gestational hypertension (GH), respectively, at 12 weeks postpartum[1]
Women with GP or GH are commonly diagnosed with preeclampsia with additional hypertension or proteinuria until 12 weeks postpartum

Summary

Introduction

Gestational hypertension (GH) is a well-known disorder, gestational proteinuria (GP) has been far less emphasized. According to the conventional criteria of hypertensive disorders of pregnancy, women with proteinuria alone (gestational proteinuria; GP) or hypertension alone (gestational hypertension; GH) are not diagnosed to be experiencing preeclampsia until they exhibit additional hypertension or proteinuria; those who do not develop hypertension or proteinuria are diagnosed with GP or GH, respectively, at 12 weeks postpartum[1]. In 2013, the American College of Obstetricians and Gynecologists revised its criteria of preeclampsia[3], and in 2014, the International Society for the Study of Hypertension in Pregnancy revised its criteria of hypertensive disorders of pregnancy[4]. According to both sets of criteria, hypertensive disorders of pregnancy include GH but not GP. In the progression of GH to severe preeclampsia, the presence of proteinuria was associated with subsequent maternal and neonatal complications[8]

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