Maternal complications and perinatal outcomes associated with gestational hypertension and severe preeclampsia in Taiwanese women.

BACKGROUND/PURPOSE: The role of proteinuria in disease severity of preeclampsia and gestational hypertension has not been determined. The objective of this study was to compare the effects of disease severity on maternal complications and pregnancy outcome between women with severe preeclampsia and women with gestational hypertension.

METHODS

A retrospective case-control study using daily records from the birth registry for the years 1994 to 2003 was conducted. Cases (n = 364) were defined as women with severe preeclampsia. Controls (n = 249) were selected from women with gestational hypertension. The outcome measures were maternal complications and perinatal-related factors.

RESULTS

Women with severe preeclampsia had an increased risk of intrauterine growth restriction (adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.10-4.24; p = 0.026). Risk factors associated with severe preeclampsia patients were lack of prenatal care (aOR, 2.95; 95% CI, 1.45-5.99), systolic blood pressure >or= 180 mmHg (aOR, 14.3; 95% CI, 1.69-121.0), and diastolic blood pressure >or= 105mmHg (aOR, 21.2; 95% CI, 6.99-64.3) compared with women with gestational hypertension in Model I. When we added proteinuria as a variable, two significant risk factors, diastolic blood pressure >or= 105mmHg (aOR, 18.2; 95% CI, 4.85-68.3) and significant proteinuria (aOR, 1.01; 95% CI, 1.006-1.014), were associated with severe preeclampsia patients in Model II. A subgroup of women with gestational hypertension and proteinuria had an increased risk of placental abruption (unadjusted OR, 4.36; 95% CI, 1.05-18.1) and disseminated intravascular coagulation (unadjusted OR, 6.46; 95% CI, 1.05-39.8). Finally, maternal complications (aOR, 2.59; 95% CI, 1.34-5.04) became the single significant factor associated with gestational hypertension and proteinuria.

CONCLUSION

Proteinuria may play a role in the progression of gestational hypertension to severe forms of preeclampsia associated with subsequent maternal complications and extremely-low-birth-weight babies.