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Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women

OBJECTIVES: To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ≥500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension. DESIGN: Secondary analysis of the Vitamins in Pre...

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Autores principales: Bramham, Kate, Poli-de-Figueiredo, Carlos E., Seed, Paul T., Briley, Annette L., Poston, Lucilla, Shennan, Andrew H., Chappell, Lucy C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794944/
https://www.ncbi.nlm.nih.gov/pubmed/24130760
http://dx.doi.org/10.1371/journal.pone.0076083
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author Bramham, Kate
Poli-de-Figueiredo, Carlos E.
Seed, Paul T.
Briley, Annette L.
Poston, Lucilla
Shennan, Andrew H.
Chappell, Lucy C.
author_facet Bramham, Kate
Poli-de-Figueiredo, Carlos E.
Seed, Paul T.
Briley, Annette L.
Poston, Lucilla
Shennan, Andrew H.
Chappell, Lucy C.
author_sort Bramham, Kate
collection PubMed
description OBJECTIVES: To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ≥500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension. DESIGN: Secondary analysis of the Vitamins in Pre-Eclampsia Trial. SETTING: 25 UK hospitals in ten geographical areas. POPULATION: 946 women with pre-existing risk factors for pre-eclampsia. METHODS: Women with pre-eclampsia and proteinuria 300-499mg/24h (PE300, referent group, n=60) or proteinuria ≥500 mg/24h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110). MAIN OUTCOME MEASURES: Maternal: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5(th) centile, gestation at delivery. RESULTS: 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 (33.2w) than PE300 (37.3w; P≤0.001), and later in CHT (38.3w; P≤0.05) and GH (39.1w; 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). CONCLUSION: 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.
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spelling pubmed-37949442013-10-15 Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women Bramham, Kate Poli-de-Figueiredo, Carlos E. Seed, Paul T. Briley, Annette L. Poston, Lucilla Shennan, Andrew H. Chappell, Lucy C. PLoS One Research Article OBJECTIVES: To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ≥500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension. DESIGN: Secondary analysis of the Vitamins in Pre-Eclampsia Trial. SETTING: 25 UK hospitals in ten geographical areas. POPULATION: 946 women with pre-existing risk factors for pre-eclampsia. METHODS: Women with pre-eclampsia and proteinuria 300-499mg/24h (PE300, referent group, n=60) or proteinuria ≥500 mg/24h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110). MAIN OUTCOME MEASURES: Maternal: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5(th) centile, gestation at delivery. RESULTS: 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 (33.2w) than PE300 (37.3w; P≤0.001), and later in CHT (38.3w; P≤0.05) and GH (39.1w; 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). CONCLUSION: 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. Public Library of Science 2013-10-10 /pmc/articles/PMC3794944/ /pubmed/24130760 http://dx.doi.org/10.1371/journal.pone.0076083 Text en © 2013 Bramham et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Bramham, Kate
Poli-de-Figueiredo, Carlos E.
Seed, Paul T.
Briley, Annette L.
Poston, Lucilla
Shennan, Andrew H.
Chappell, Lucy C.
Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women
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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794944/
https://www.ncbi.nlm.nih.gov/pubmed/24130760
http://dx.doi.org/10.1371/journal.pone.0076083
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