Takahiro Yamada1, Mana Obata-Yasuoka2, Hiromi Hamada2, Yosuke Baba3, Akihide Ohkuchi3, Shun Yasuda4, Kosuke Kawabata5, Shiori Minakawa6, Chihiro Hirai7, Hideto Kusaka8, Nao Murabayashi9, Yusuke Inde10, Michikazu Nagura11, Takeshi Umazume1, Atsuo Itakura7, Makoto Maeda8, Norimasa Sagawa11, Yasumasa Ohno12, Soromon Kataoka5, Keiya Fujimori4, Yoshiki Kudo6, Tomoaki Ikeda9, Akihito Nakai10, Hisanori Minakami1. 1. Department of Obstetrics and Gynecology, Hokkaido University Hospital, Sapporo, Japan. 2. Department of Obstetrics and Gynecology, University of Tsukuba Hospital, Tsukuba, Japan. 3. Department of Obstetrics and Gynecology, Jichi Medical University Hospital, Shimotsuke, Japan. 4. Department of Obstetrics and Gynecology, Fukushima Medical University Hospital, Fukushima, Japan. 5. Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan. 6. Department of Obstetrics and Gynecology, Hiroshima University Hospital, Hiroshima, Japan. 7. Department of Obstetrics and Gynecology, Juntendo University Hospital, Tokyo, Japan. 8. Department of Obstetrics and Gynecology, Mie Chuo Medical Center, Tsu, Japan. 9. Department of Obstetrics and Gynecology, Mie University Hospital, Tsu, Japan. 10. Department of Obstetrics and Gynecology, Medical School Tama Nagayama Hospital, Tama, Japan. 11. Department of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto, Japan. 12. Department of Obstetrics and Gynecology, Ohno Ladies Clinic, Iwakura, Japan.
Abstract
INTRODUCTION: Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP-PE) among all PE cases. MATERIAL AND METHODS: This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein-to-creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH-PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S-PE) was defined as PE in which both SPIP and hypertension occurred simultaneously. RESULTS: IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2-18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S-PE than in those with IGP-PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031]. CONCLUSIONS: IGP is a risk factor for PE, and IGP-PE accounts for a considerable proportion (20%) of all PE.
INTRODUCTION: Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP-PE) among all PE cases. MATERIAL AND METHODS: This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein-to-creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH-PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S-PE) was defined as PE in which both SPIP and hypertension occurred simultaneously. RESULTS: IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2-18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S-PE than in those with IGP-PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031]. CONCLUSIONS: IGP is a risk factor for PE, and IGP-PE accounts for a considerable proportion (20%) of all PE.
Authors: Laura A Magee; Sumedha Sharma; Esperança Sevene; Rahat N Qureshi; Ashalata Mallapur; Salésio E Macuácua; Shivaprasad Goudar; Mrutunjaya B Bellad; Olalekan O Adetoro; Beth A Payne; John Sotunsa; Anifa Valá; Jeffrey Bone; Andrew H Shennan; Marianne Vidler; Zulfiqar A Bhutta; Peter von Dadelszen Journal: Bull World Health Organ Date: 2020-09-09 Impact factor: 9.408