Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2024 Apr;41(6):790-797. doi: 10.1055/s-0042-1748524. Epub 2022 May 29.
The aim of the study is to evaluate the association between the amount of proteinuria at the time of diagnosis of preeclampsia with severe features (severe preeclampsia [SPE]) and duration of expectant management (EM) and other perinatal outcomes.
This is a retrospective cohort study of patients with SPE delivering live, non-anomalous singletons at 23 to 34 weeks' estimated gestational age (EGA) at a single tertiary center 2016 to 2018. Patients with proteinuria assessment (24-hour total urine protein or urine protein-to-creatinine ratio extrapolation) within 3 days of SPE diagnosis were included. Patients delivered for an indication other than SPE were excluded. Patients were categorized by amount of proteinuria (mg): none (≤300), mild (301-1,000), moderate (1,001-3,000), and massive (≥3,001). The primary outcome was the proportion of potential EM time achieved (%EM), i.e., days of EM divided by days from SPE diagnosis to 34 weeks. Secondary outcomes included delivery EGA, days of EM, and perinatal outcomes. Bivariable and multivariable analyses compared outcomes across groups.
Of 295 patients included, 21% had no proteinuria, 33% mild, 19% moderate, and 27% massive. Groups differed by EGA at diagnosis, age, parity, chronic hypertension, and renal disease. %EM was not significantly different between groups (adjusted β coefficient 4.1 [95% CI -5.3, 13.5] for mild proteinuria vs. none, -4.1 [95% CI -14.9, 6.6] for moderate proteinuria vs. none, and -5.6 [95% CI -16.0, 4.7] for massive proteinuria vs. none). Increasing proteinuria was associated with earlier delivery EGA but only days of EM in the mild versus no proteinuria groups. There was no significant association between proteinuria and maternal composite morbidity, but patients with mild and massive proteinuria had higher odds of neonatal composite morbidities compared with no proteinuria.
Among patients with SPE, proteinuria level was not consistently associated with duration of EM. However, patients with the greatest amounts of proteinuria may have worse neonatal and selected maternal outcomes.
· Amount of proteinuria was not associated with the duration of expectant management.. · Greater proteinuria was associated with earlier delivery in severe preeclampsia.. · Massive proteinuria in preeclampsia was associated with select adverse maternal and neonatal outcomes..
本研究旨在评估重度子痫前期（重度子痫前期[SPE]）患者诊断时蛋白尿的量与期待治疗（EM）持续时间及其他围产结局之间的关系。
这是一项回顾性队列研究，纳入了 2016 年至 2018 年期间在一家三级中心分娩的、胎龄为 23 至 34 周且活产、非畸形的单胎患者。研究对象为 SPE 诊断后 3 天内进行蛋白尿评估（24 小时总尿蛋白或尿蛋白/肌酐比值推算）的患者。排除因 SPE 以外的其他指征分娩的患者。根据蛋白尿量（mg）将患者分为四组：无蛋白尿（≤300）、轻度蛋白尿（301-1000）、中度蛋白尿（1001-3000）和大量蛋白尿（≥3001）。主要结局为实现潜在 EM 时间的比例（%EM），即 EM 天数除以 SPE 诊断至 34 周的天数。次要结局包括分娩胎龄、EM 天数和围产儿结局。采用单变量和多变量分析比较各组间的结局。
在 295 名患者中，21%无蛋白尿，33%轻度蛋白尿，19%中度蛋白尿，27%大量蛋白尿。各组在诊断时的胎龄、年龄、产次、慢性高血压和肾脏疾病方面存在差异。各组间%EM 无显著差异（轻度蛋白尿组与无蛋白尿组相比，调整后的β系数为 4.1[95%CI-5.3，13.5]；中度蛋白尿组与无蛋白尿组相比，调整后的β系数为-4.1[95%CI-14.9，6.6]；大量蛋白尿组与无蛋白尿组相比，调整后的β系数为-5.6[95%CI-16.0，4.7]）。蛋白尿增多与分娩胎龄提前相关，但仅在轻度蛋白尿组与无蛋白尿组之间存在 EM 天数差异。蛋白尿与母体复合发病率之间无显著相关性，但与无蛋白尿相比，轻度蛋白尿和大量蛋白尿患者的新生儿复合发病率更高。
在 SPE 患者中，蛋白尿水平与 EM 持续时间无一致性关联。然而，蛋白尿量最大的患者可能会出现更差的新生儿和某些母体结局。
·蛋白尿水平与期待治疗的持续时间无关。·重度子痫前期患者蛋白尿增多与分娩提前有关。·子痫前期患者大量蛋白尿与某些母婴不良结局有关。
