Questioning the Value of Urine Protein for the Diagnosis of Hypertensive Disorders of Pregnancy [ID 2683605

Abstract

INTRODUCTION: Preeclampsia with severe features (PreE w/SF) is often preceded with a diagnosis of gestational hypertension (gHTN) or preeclampsia without severe features (PreE w/o SF). These diagnoses remain differentiated via a 24-hour urine protein (24 UP) or a urine–protein creatinine ratio (PCR). We examine the utility of the 24 UP/PCR in differentiating the progression of gHTN or PreE w/o SF to PreE w/SF. METHODS: We created a retrospective cohort study of 1,687 patients who delivered a live-born neonate at our urban, academic hospital between September 2011 and September 2021. All patients had an initial diagnosis of either gHTN or PreE w/o SF. Patients with chronic hypertension or an initial diagnosis of PreE w/SF were excluded. We performed descriptive and inferential statistics including chi-square. RESULTS: We identified 910 (54%) patients initially diagnosed with gHTN and 777 (46%) PreE w/o SF. A total of 972 (57.7%) reported to be Black and 518 (30.1%) Hispanic. The rate of progression to PreE w/SF did not differ across those with an initial diagnosis of gHTN (n=147 [16%]) or PreE w/o SF (n=153 [19%]; X2 (1)=3.55, P>.05). Timing of initial diagnosis being antenatal or postnatal was not predictive of disease progression. CONCLUSION: We found no clinical significance of a 24 UP/PCR in predicting progression to PreE w/SF from gHTN or PreE w/o SF. Performing a 24 UP or PCR takes health care dollars and patients' time, which has economic and social effects. Although further investigation is needed, our findings support eliminating 24 UP/PCR as a diagnostic criterion.