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75: Adverse outcomes are similar in preeclampsia with or without proteinuria: validation of a newly proposed definition of preeclampsia

      Objective

      To investigate the clinical performance of a newly proposed definition of preeclampsia by comparing outcomes of women with nonproteinuric preeclampsia to those with a traditional diagnosis.

      Study Design

      Women with any signs or symptoms of preeclampsia (PE) were enrolled in a prospective, multicenter, observational study between 20 and 41 weeks. Blood was collected for biomarker development and subjects were managed according to local institutional protocols. Final diagnoses were adjudicated by an independent expert panel. Maternal and perinatal outcomes were compared between subjects with a traditional diagnosis of preeclampsia (Tr PE - mild, severe, or superimposed PE, eclampsia, or HELLP syndrome, per ACOG, 2002), and subjects with nonproteinuric preeclampsia (NP PE) who represent a new component in the 2013 ACOG diagnostic guidelines (gestational or chronic hypertension with any of the following, BP > 160/110, plts<100K, LFTs >70, Cr > 1.1, or persistent CNS or abdominal symptoms). Data stratified by gestational age and compared by X2, p<0.05.

      Results

      Of 1,223 evaluable subjects, 661 were diagnosed with Tr PE (54% of cohort), and 837 by the revised PE criteria (68%), representing a 27% increase. As compared to women with Tr PE, subjects with NP PE experienced the same rates of C/S, preterm birth <37 wk, SGA, perinatal mortality, and maternal adverse outcomes, regardless of gestational age category (Table 1). Only the rate of early preterm birth < 34 wks was lower in the women with NP PE (44 vs 60%).

      Conclusion

      The inclusion of nonproteinuric preeclampsia in the revised preeclampsia guidelines is justified by high rates of adverse outcomes equal to those women with traditional preeclampsia. This study confirms that proteinuria is sufficient, but not necessary, to identify women at risk of adverse outcome. The effect of an expanded definition of preeclampsia on rates of intervention (e.g. preterm birth) and adverse outcomes is unknown, and deserves further study.
      Tabled 1Pregnancy outcome for traditional vs nonproteinuric preeclampsia
      Figure thumbnail fx1
      Data reported as N (%). *p<0.05 by X2. SGA, BW < 10%; MAO-maternal adverse outcome (abruption, renal failure, pulmonary edema/distress, fatty liver, TTP, DIC, stroke, and retinal detachment).