Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women.
<h4>Objectives</h4>To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499 mg and ≥500 mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension.<h4>Design</h4>Se...
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0076083 |
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| author | Kate Bramham Carlos E Poli-de-Figueiredo Paul T Seed Annette L Briley Lucilla Poston Andrew H Shennan Lucy C Chappell |
| author_facet | Kate Bramham Carlos E Poli-de-Figueiredo Paul T Seed Annette L Briley Lucilla Poston Andrew H Shennan Lucy C Chappell |
| author_sort | Kate Bramham |
| collection | DOAJ |
| description | <h4>Objectives</h4>To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499 mg and ≥500 mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension.<h4>Design</h4>Secondary analysis of the Vitamins in Pre-Eclampsia Trial.<h4>Setting</h4>25 UK hospitals in ten geographical areas.<h4>Population</h4>946 women with pre-existing risk factors for pre-eclampsia.<h4>Methods</h4>Women with pre-eclampsia and proteinuria 300-499 mg/24 h (PE300, referent group, n=60) or proteinuria ≥500 mg/24 h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110).<h4>Main outcome measures</h4>MATERNAL: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5(th) centile, gestation at delivery.<h4>Results</h4>Severe hypertension occurred more frequently in PE500 (35%) and PE300 (27%) than CHT (5.9%; P≤0.01) and GH (10%; p≤0.001). Gestation at delivery was earlier in PE500 (33.2 w) than PE300 (37.3 w; P≤0.001), and later in CHT (38.3 w; P≤0.05) and GH (39.1 w; P≤0.001). SGA infants were more frequent in PE300 (32%) than in CHT (13.3%; P≤0.001) and GH (16.5%; P≤0.05). Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P≤0.001), and to receive magnesium sulphate (17% vs. 1.7%, P≤0.05).<h4>Conclusion</h4>Women with PE300 have complication rates above those of women managed as out-patients (GH and CHT), meriting closer surveillance and confirming 300 mg/d as an appropriate threshold for determining in-patient management. Adverse perinatal outcomes are higher still in women with PE500. |
| format | Article |
| id | doaj-art-1e2a930c1f43467a89e87f72f30d3a7a |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
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| spelling | doaj-art-1e2a930c1f43467a89e87f72f30d3a7a2025-08-20T03:10:42ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01810e7608310.1371/journal.pone.0076083Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women.Kate BramhamCarlos E Poli-de-FigueiredoPaul T SeedAnnette L BrileyLucilla PostonAndrew H ShennanLucy C Chappell<h4>Objectives</h4>To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499 mg and ≥500 mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension.<h4>Design</h4>Secondary analysis of the Vitamins in Pre-Eclampsia Trial.<h4>Setting</h4>25 UK hospitals in ten geographical areas.<h4>Population</h4>946 women with pre-existing risk factors for pre-eclampsia.<h4>Methods</h4>Women with pre-eclampsia and proteinuria 300-499 mg/24 h (PE300, referent group, n=60) or proteinuria ≥500 mg/24 h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110).<h4>Main outcome measures</h4>MATERNAL: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5(th) centile, gestation at delivery.<h4>Results</h4>Severe hypertension occurred more frequently in PE500 (35%) and PE300 (27%) than CHT (5.9%; P≤0.01) and GH (10%; p≤0.001). Gestation at delivery was earlier in PE500 (33.2 w) than PE300 (37.3 w; P≤0.001), and later in CHT (38.3 w; P≤0.05) and GH (39.1 w; P≤0.001). SGA infants were more frequent in PE300 (32%) than in CHT (13.3%; P≤0.001) and GH (16.5%; P≤0.05). Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P≤0.001), and to receive magnesium sulphate (17% vs. 1.7%, P≤0.05).<h4>Conclusion</h4>Women with PE300 have complication rates above those of women managed as out-patients (GH and CHT), meriting closer surveillance and confirming 300 mg/d as an appropriate threshold for determining in-patient management. Adverse perinatal outcomes are higher still in women with PE500.https://doi.org/10.1371/journal.pone.0076083 |
| spellingShingle | Kate Bramham Carlos E Poli-de-Figueiredo Paul T Seed Annette L Briley Lucilla Poston Andrew H Shennan Lucy C Chappell Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. PLoS ONE |
| title | Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. |
| title_full | Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. |
| title_fullStr | Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. |
| title_full_unstemmed | Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. |
| title_short | Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. |
| title_sort | association of proteinuria threshold in pre eclampsia with maternal and perinatal outcomes a nested case control cohort of high risk women |
| url | https://doi.org/10.1371/journal.pone.0076083 |
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