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To assess the importance of baseline proteinuria in women treated for chronic hypertension (CHTN) during pregnancy.
Study Design
This retrospective cohort study included women with CHTN that required antihypertensive therapy in the first half of pregnancy and completed urine protein quantification prior to 20 weeks gestation. Management of these women includes titration of prenatal antihypertensive therapies in a coordinated fashion within a dedicated high-risk prenatal clinic. Baseline proteinuria was defined as a level >300mg/24 hours identified prior to 20 weeks. Maternal and infant outcomes were analyzed according to the presence or absence of baseline proteinuria.
Results
Between January 2002 and December 2014, a total of 514 women met inclusion criteria. Of these, 63 (12%) had baseline proteinuria. As shown in the Table, women with baseline proteinuria were significantly more likely to develop superimposed preeclampsia (p<0.001), be delivered preterm (p=0.005 <30 weeks, p<0.001 for both <34 and <37 weeks), and to be delivered of a small-for-gestational age infant (p<0.001 for<10th percentile, p=0.02 for <3rd percentile) when compared with women who did not have early proteinuria. The frequency of placental abruption and perinatal loss did not differ between the two groups; and there were no women with eclampsia in either cohort. Rates of neonatal seizures, intubation, and ventilator dependence were also significantly increased in women with baseline proteinuria (Table).
Conclusion
In pregnant women with treated CHTN, baseline proteinuria appears to be an important clinical feature when assessing maternal and fetal risk. Specifically, identification of proteinuria >300 mg/24-hour prior to 20 weeks is associated with significantly increased rates of superimposed preeclampsia, preterm birth, and compromised infant growth. Profound infant growth restriction (<3rd percentile) is found in more than 1 of 5 women with treated CHTN and baseline proteinuria.
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