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Obstetrical outcomes of women with new-onset isolated proteinuria diagnosed after 24 weeks’ gestation

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess a possible association between marked proteinuria and the risk of preeclampsia with severe features, as defined by the American College of Obstetricians and Gynecologists.

Methods

This retrospective study included data recorded at a tertiary university-affiliated hospital between 2017 and 2022. Women at or beyond 24 weeks of gestation with proteinuria (protein levels > 300 mg in a 24 h urine collection) and normal blood pressure during the initial 48 h of admission were included. Obstetrical and neonatal outcomes were compared between women with mild proteinuria (300–1000 mg/24 h) and marked proteinuria (≥ 1000 mg/24 h).

Results

Among the women with marked proteinuria (n = 48) compared to those with mild proteinuria (n = 108), the incidences were higher of preeclampsia (50.0% vs. 22.2%, p = 0.001) and of preeclampsia with severe features (18.8% vs. 2.8%, p < 0.001). In multivariate analysis that adjusted for maternal age, primiparity, multiple pregnancy, uric acid level > 6 mg/dL and aspirin treatment, marked proteinuria was a risk factor for preeclampsia with severe features (adjusted odds ratio [aOR] = 10.2, confidence interval [CI] 95% 1.9–54.0, p = 0.007) and for small-for-gestational-age infants (aOR = 2.4, 95% CI 1.02–5.6, p = 0.001). Among women with marked compared to mild proteinuria, rates were also higher of labor induction (58.3% vs. 25.9%, p < 0.001), indicated preterm delivery (41.7% vs. 25.0%, p = 0.04) and admission to the neonatal intensive care unit (44.1% vs. 25.8%, p = 0.017).

Conclusions

Women with marked compared to mild isolated proteinuria showed higher risk of developing preeclampsia with severe features and of delivering small-for-gestational-age neonates.

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Data availability

Data may be obtained from the corresponding author upon reasonable request.

References

  1. Beers K, Patel N (2020) Kidney physiology in pregnancy. Adv Chron Kidney Dis 27:449–454. https://doi.org/10.1053/j.ackd.2020.07.006

    Article  Google Scholar 

  2. Bartal MF, Lindheimer MD, Sibai BM (2022) Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol 226:S819–S834. https://doi.org/10.1016/j.ajog.2020.08.108

    Article  CAS  Google Scholar 

  3. Osmundson SS, Lafayette RA, Bowen RA, Roque VC, Garabedian MJ, Aziz N (2014) Maternal proteinuria in twin compared with singleton pregnancies. Obstet Gynecol 124:332–337. https://doi.org/10.1097/AOG.0000000000000383

    Article  PubMed  Google Scholar 

  4. Shinar S, Asher-Landsberg J, Schwartz A, Ram-Weiner M, Kupferminc MJ, Many A (2016) Isolated proteinuria is a risk factor for pre-eclampsia: a retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria. J Perinatol 36:25–29. https://doi.org/10.1038/jp.2015.138

    Article  CAS  PubMed  Google Scholar 

  5. Ekiz A, Kaya B, Polat I, Avci ME, Ozkose B, Kicik Caliskan R, Yildirim G (2016) The outcome of pregnancy with new onset proteinuria without hypertension: retrospective observational study. J Matern Fetal Neonat Med 29:1765–1769. https://doi.org/10.3109/14767058.2015.1061497

    Article  CAS  Google Scholar 

  6. Chan P, Brown M, Simpson JM, Davis G (2005) Proteinuria in pre-eclampsia: how much matters? BJOG 112:280–285. https://doi.org/10.1111/j.1471-0528.2004.00395.x

    Article  PubMed  Google Scholar 

  7. Bramham K, Poli-de-Figueiredo CE, Seed PT, Briley AL, Poston L, Shennan AH, Chappell LC (2013) Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high-risk women. PLoS ONE 8:e76083. https://doi.org/10.1371/journal.pone.0076083

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Newman MG, Robichaux AG, Stedman CM, Jaekle RK, Fontenot MT, Dotson T, Lewis DF (2003) Perinatal outcomes in preeclampsia that is complicated by massive proteinuria. Am J Obstet Gynecol 188:264–268. https://doi.org/10.1067/mob.2003.84

    Article  PubMed  Google Scholar 

  9. Nischintha S, Pallavee P, Ghose S (2014) Correlation between 24 h urine protein, spot urine protein/creatinine ratio, and serum uric acid and their association with fetomaternal outcomes in preeclamptic women. J Nat Sci Biol Med 5:255–260. https://doi.org/10.4103/0976-9668.136151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. ACOG Committee Opinion No. 743 (2018) Low-dose aspirin use during pregnancy. Obstet Gynecol 132:e44–e52. https://doi.org/10.1097/AOG.0000000000002708

  11. ACOG Practice Bulletin No. 202. (2019) Gestational hypertension and preeclampsia. Obstet Gynecol 133:1. https://doi.org/10.1097/AOG.0000000000003018

  12. Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES (2005) Birth weight standards in the live-born population in Israel. Isr Med Assoc J 7:311–314

    PubMed  Google Scholar 

  13. Tzur Y, Rimon E, Geva G, Herzlich J, Kupferminc MJ (2021) Progression from isolated gestational proteinuria to preeclampsia with severe features. Acta Obstet Gynecol Scand 100:1620–1626. https://doi.org/10.1111/aogs.14198

    Article  PubMed  Google Scholar 

  14. Thangaratinam S, Coomarasamy A, O’Mahony F, Sharp S, Zamora J, Khan KS, Ismail KMK (2009) Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review. BMC Med. https://doi.org/10.1186/1741-7015-7-10

    Article  PubMed  PubMed Central  Google Scholar 

  15. Morikawa M, Yamada T, Yamada T, Cho K, Yamada H, Sakuragi N, Minakami H (2008) Pregnancy outcome of women who developed proteinuria in the absence of hypertension after mid-gestation. J Perinat Med 36:419–424. https://doi.org/10.1515/JPM.2008.062

    Article  PubMed  Google Scholar 

  16. Akaishi R, Yamada T, Morikawa M, Nishida R, Minakami H (2014) Clinical features of isolated gestational proteinuria progressing to pre-eclampsia: retrospective observational study. BMJ Open 4:e004870. https://doi.org/10.1136/bmjopen-2014-004870

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hu M, Shi I, Lu W (2023) Association between proteinuria and adverse pregnancy outcomes: a retrospective cohort study. J Obstet Gynaecol 43:2126299. https://doi.org/10.1080/01443615.2022.2126299

    Article  PubMed  Google Scholar 

  18. Wolak T, Sergienko R, Wiznitzer A, Paran E, Sheiner E (2012) High uric acid level during the first 20 weeks of pregnancy is associated with higher risk for gestational diabetes mellitus and mild preeclampsia. Hypertens Pregnancy. 31(3):307–15. https://doi.org/10.3109/10641955.2010.507848

    Article  CAS  PubMed  Google Scholar 

  19. Thangaratinam S, Ismail KM, Sharp S, Coomarasamy A, Khan KS, Tests in Prediction of Pre-eclampsia Severity Review Group (2006) Accuracy of serum uric acid in predicting complications of pre-eclampsia: a systematic review. BJOG 113:369–378. https://doi.org/10.1111/j.1471-0528.2006.00908.x

    Article  CAS  Google Scholar 

  20. Wolak T, Shoham-Vardi I, Sergienko R, Sheiner E (2015) High uric acid levels during pregnancy linked to increased risk for future atherosclerotic-related hospitalization. J Clin Hypertens Greenwich 17(6):481–485. https://doi.org/10.1111/jch.12535

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel

    Inshirah Sgayer, Hadas Shasha-Lavsky, Lior Lowenstein & Maya Frank Wolf

  2. Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel

    Inshirah Sgayer, Milton Cohen, Yarden Rosenbaum, Etty Kruzel-Davila, Hadas Shasha-Lavsky, Lior Lowenstein & Maya Frank Wolf

  3. Nephrology Department, Galilee Medical Center, Nahariya, Israel

    Etty Kruzel-Davila

Authors
  1. Inshirah Sgayer
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  2. Milton Cohen
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  3. Yarden Rosenbaum
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  4. Etty Kruzel-Davila
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  5. Hadas Shasha-Lavsky
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  6. Lior Lowenstein
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  7. Maya Frank Wolf
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Contributions

I. Sgayer-Data management and analysis, Manuscript writing. M. Cohen—Data collection. Y. Rosenbaum-Data collection. E. Kruzel-Davila—Manuscript writing and editing. H. Shasha-Lavsky. Manuscript writing and editing. L. Lowenstein- Manuscript editing. M. Frank Wolf- Protocol/project development, Manuscript editing.

Corresponding author

Correspondence to Maya Frank Wolf.

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Conflict of interest

The authors have no relevant financial or non-financial interest to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Galilee Medical Center (NHR-095-22)

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Sgayer, I., Cohen, M., Rosenbaum, Y. et al. Obstetrical outcomes of women with new-onset isolated proteinuria diagnosed after 24 weeks’ gestation. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07535-w

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  • DOI: https://doi.org/10.1007/s00404-024-07535-w

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