Renal function can predict preeclampsia in pregnant women with hypertension

Renal function tests can predict the risk of preeclampsia in pregnant women with hypertension.
Renal function tests can predict the risk of preeclampsia in pregnant women with hypertension.

For pregnant women with chronic hypertension, baseline renal function assessment can be used to predict the risk of adverse events, according to a study published in Obstetrics & Gynecology.

Baseline serum creatinine levels can predict the risk for mild and severe preeclampsia, and baseline urine protein-to-creatinine ratios can predict the risk for mild preeclampsia, severe preeclampsia, and preterm birth.

The study included 755 pregnant women with chronic hypertension who were assessed for renal function (urine protein-to-creatinine ratio and serum creatinine) before 20 weeks of gestation. The primary outcome was severe preeclampsia at less than 34 weeks of gestation. Secondary outcomes were severe preeclampsia at any gestational age, any preeclampsia, preterm birth at less than 35 weeks of gestation, composite perinatal outcomes (perinatal death, assisted ventilation, cord pH <7, 5-minute Apgar score ≤3, or neonatal seizures), and small for gestational age.

Women who had a baseline serum creatinine level of 0.75 mg/dL or greater had an increased risk of developing severe preeclampsia before 34 weeks compared with those who had lower levels (15.7% versus 4.6%, respectively). Baseline serum creatinine levels of 0.75 mg/dL or greater were also associated with mild or severe preeclampsia at any gestational age (35.7% versus 21.6% and 26.9% versus 13.0%, respectively).

Women who had a baseline urine protein-to-creatinine ratio of 0.12 or greater also had an increased risk of developing severe preeclampsia before 34 weeks compared with those who had lower ratios (16.4% versus 2.6%). Higher baseline urine protein-to-creatinine ratios were also associated with an increased risk of mild or severe preeclampsia at any gestational age (49.2% versus 14.2% and 30.3% versus 9.0%, respectively), as well as an increased risk of preterm birth at less than 35 weeks of gestation (31.8% versus 16.4%).

Among women with baseline renal test levels that were greater than the cutoff values, 33.3% developed severe preeclampsia before 34 weeks of gestation (compared with 1.6% of women with normal baseline renal function tests), 50.9% developed severe preeclampsia at any gestational age (compared with 7.9% of those with normal tests), 66.7% developed any type of preeclampsia (compared with 13.0% of those with normal tests), and 47.2% had a preterm birth (compared with 17.1% of those with normal tests).

Reference

  1. Kuper SG. Tita AT, Youngstrom ML, et al. Baseline renal function tests and adverse outcomes in pregnant patients with chronic hypertension. Obstet Gynecol. Published online June 6, 2016. doi:10.1097/AOG.0000000000001453.
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