Earlier onset of proteinuria or hypertension is a predictor of progression from gestational hypertension or gestational proteinuria to preeclampsia

Abstract

Although gestational hypertension (GH) is a well-known disorder, gestational proteinuria (GP) has been far less emphasized. According to international criteria, hypertensive disorders of pregnancy include GH but not GP. Previous studies have not revealed the predictors of progression from GP to preeclampsia or those of progression from GH to preeclampsia. We aimed to determine both sets of predictors. A retrospective cohort study was conducted with singleton pregnant women who delivered at 22 gestational weeks or later. Preeclampsia was divided into three types: new onset of hypertension/proteinuria at 20 gestational weeks or later and additional new onset of other symptoms at < 7 days or at ≥ 7 days later. Of 94 women with preeclampsia, 20 exhibited proteinuria before preeclampsia, 14 experienced hypertension before preeclampsia, and 60 exhibited simultaneous new onset of both hypertension and proteinuria before preeclampsia; the outcomes of all types were similar. Of 34 women with presumptive GP, 58.8% developed preeclampsia; this proportion was significantly higher than that of 89 women with presumptive GH who developed preeclampsia (15.7%). According to multivariate logistic regression models, earlier onset of hypertension/proteinuria (before or at 34.7/33.9 gestational weeks) was a predicator for progression from presumptive GH/GP to preeclampsia (odds ratios: 1.21/1.21, P value: 0.0044/0.0477, respectively).

Figure 1

Trends of laboratory findings at onset of gestational proteinuria (GP) or gestational hypertension (GH), onset of preeclampsia, and delivery: systolic blood pressure (A), diastolic blood pressure (B), urine protein/creatine ratio (C), body weight gain for last 1 week (D), hemoglobin (E), and hematocrit (F). All data shown are median values. ○, at GP onset (appearance of proteinuria); ●, at GH onset (appearance of hypertension); ▲, at preeclampsia onset (hypertension plus proteinuria); ×, at delivery. *P < 0.05 versus proteinuria preceding preeclampsia (P-PE); ^†P < 0.05 versus hypertension preceding preeclampsia (H-PE); ^‡P < 0.05 versus simultaneous onset of proteinuria and hypertension before preeclampsia (S-PE); ^§P < 0.05 versus GH.

Figure 2

Trends of laboratory findings at onset of gestational proteinuria (GP) or gestational hypertension (GH), onset of preeclampsia, and delivery: platelet count (A), fibrinogen (B), antithrombin activity (C), d-dimer (D), total protein (E), and total bilirubin (F). All data shown are median values (or mean values). ○, at GP onset (appearance of proteinuria); ●, at GH onset (appearance of hypertension); ▲, at preeclampsia onset (hypertension plus proteinuria); ×, at delivery. *P < 0.05 versus proteinuria preceding preeclampsia (P-PE); ^†P < 0.05 versus hypertension preceding preeclampsia (H-PE); ^‡P < 0.05 versus simultaneous onset of proteinuria and hypertension before preeclampsia (S-PE); ^§P < 0.05 versus GH.

Figure 3

Trends of laboratory findings at onset of gestational proteinuria (GP) or gestational hypertension (GH), onset of preeclampsia, and delivery: aspartate aminotransferase (AST; A) alanine aminotransferase (ALT; B), lactate dehydrogenase (LDH; C), uric acid (D), creatinine (E), and estimated glomerular filtration rate (GFR; F). All data shown are median values. ○, at GP onset (appearance of proteinuria); ●, at GH onset (appearance of hypertension); ▲, at preeclampsia onset (hypertension plus proteinuria); ×, at delivery. *P < 0.05 versus proteinuria preceding preeclampsia (P-PE); ^†P < 0.05 versus hypertension preceding preeclampsia (H-PE); ^‡P < 0.05 versus simultaneous onset of proteinuria and hypertension before preeclampsia (S-PE); ^§P < 0.05 versus GH.