Abstract
BackgroundThe Finnish Pre-eclampsia Consortium (FINNPEC) case-control cohort consisting of 1447 pre-eclamptic and 1068 non-pre-eclamptic women was recruited during 2008–2011 to study genetic background of pre-eclampsia and foetal growth. Pre-eclampsia was defined by hypertension and proteinuria according to the American College of Obstetricians and Gynecologists (ACOG) 2002 classification. The ACOG Task Force Report on Hypertension in Pregnancy (2013) and The International Society for the Study of Hypertension in Pregnancy (ISSHP) (2014) have published new classifications, in which proteinuria is not necessary for diagnosis when specific symptoms are present. For diagnoses based on proteinuria, the ISSHP 2014 criteria raised its threshold to 2+ on dipstick. We studied how the new classifications would affect pre-eclampsia diagnoses in the FINNPEC cohort.MethodsWe re-evaluated pre-eclampsia diagnosis using the ACOG 2013 and the ISSHP 2014 classifications in pre-eclamptic women whose proteinuria did not exceed 1+ on dipstick (n = 68), in women with gestational hypertension (n = 138) and in women with chronic hypertension (n = 66).ResultsThe number of women with pre-eclampsia increased 0.8 % (1459/1447) according to the ACOG 2013 criteria and 0.6 % (1455/1447) according to the ISSHP 2014 criteria. All 68 women with the amount of proteinuria not exceeding 1+ on dipstick diagnosed originally pre-eclamptic met the ACOG 2013 criteria but only 20 women (29.4 %) met the ISSHP 2014 criteria. Seven (5.1 %) and 35 (25.4 %) women with gestational hypertension were diagnosed with pre-eclampsia according to the ACOG 2013 and the ISSHP 2014 criteria, respectively. Correspondingly five (7.6 %) and 21 (31.8 %) women with chronic hypertension were diagnosed with pre-eclampsia according to the ACOG 2 013 and the ISSHP 2014 criteria.ConclusionsOnly minor changes were observed in the total number of pre-eclamptic women in the FINNPEC cohort when comparing the ACOC 2002 classification with the ACOG 2013 and ISSHP 2014 classifications.
Highlights
The Finnish Pre-eclampsia Consortium (FINNPEC) case-control cohort consisting of 1447 pre-eclamptic and 1068 non-pre-eclamptic women was recruited during 2008–2011 to study genetic background of pre-eclampsia and foetal growth
The summary of the findings in women with hypertension and proteinuria 1+ on dipstick and women with gestational or chronic hypertension diagnosed with PE according to the ACOG 2013 and the ISSHP 2014 classifications is presented in Tables 2, 3 and 4
All 68 women with the amount of proteinuria not exceeding 1+ on dipstick diagnosed originally with PE met the ACOG 2013 criteria but only 20 women (29.4 %) met the ISSHP 2014 criteria. Of those 20 women diagnosed with PE according to the ISSHP 2014 criteria, 13 had abnormal laboratory measurements, four women had an infant with growth restriction, two women had abnormal laboratory measurements and an infant with growth restriction, and one woman had subjective signs
Summary
The Finnish Pre-eclampsia Consortium (FINNPEC) case-control cohort consisting of 1447 pre-eclamptic and 1068 non-pre-eclamptic women was recruited during 2008–2011 to study genetic background of pre-eclampsia and foetal growth. According to the two new diagnostic criteria by The American College of Obstetricians and Gynecologists (ACOG) in 2013 [8] and International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2014 [7], new onset hypertension in the absence of proteinuria but combined with haematological complications, renal insufficiency, impaired liver function, neurological symptoms, or uteroplacental dysfunction fulfil diagnostic criteria for PE. This is to provide a more broad definition of PE for clinical practice leaving proteinuria to ensure specificity of the diagnosis in scientific purposes [7]. PE is diagnosed based on clinical characteristics but biomarkers and genetic variants are expected to provide more specific criteria in the future
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