# Maternal and Neonatal Outcomes in Preeclampsia With and Without Proteinuria

## TL;DR

This study compares maternal and neonatal outcomes in preeclampsia cases with and without proteinuria, finding that both groups face significant risks, though proteinuria is linked to more complications.

## Contribution

The study provides empirical evidence on the differential impact of proteinuria in preeclampsia on maternal and neonatal outcomes.

## Key findings

- Preeclampsia with proteinuria was associated with higher maternal complications like eclampsia and HELLP syndrome.
- Neonatal complications, including stillbirths and IUGR, were more common in the proteinuric group.
- Non-proteinuric preeclampsia also showed significant biochemical issues and management challenges.

## Abstract

Objective

Preeclampsia is the commonest medical complication of pregnancy and can be associated with significant maternal as well as neonatal morbidity and mortality. Proteinuria is the most consistent finding of preeclampsia, though it's not a must, according to the latest guidelines. However, proteinuria is considered one of the features of preeclampsia, and it is associated with adverse pregnancy outcomes. The role of proteinuria remains controversial as a prognostic marker due to variable correlation with severity; it may appear late in renal involvement. Also, gestational age and other end-organ involvement may influence the management decisions. This comparative study aims to examine whether the presence of proteinuria correlates with poorer maternal and neonatal outcomes.

Material and methods

A prospective observational study was conducted at a referral hospital. Six hundred women with preeclampsia after 24 weeks of gestation were included in the study, 300 in each group A & B, that is, preeclampsia with & without proteinuria, respectively. Proteinuria was assessed using a urine dipstick value of 2+ or more. All women were evaluated for end-organ involvement or uteroplacental insufficiency. Women were treated according to hospital protocol. Maternal and neonatal outcomes were studied and statistically analyzed. Quantitative variables were compared using an unpaired t-test. Qualitative variable has been compared using the Chi-square test /Fisher’s exact test.

Results

Overall maternal complications, where all complications were weighted equally, were significantly higher in Group A (96.3% vs 70.3%, p<0.0001).With a higher incidence of eclampsia (p=0.012), abruptio placenta (p=0.002), and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Renal, hepatic, and hematological dysfunctions were more prevalent in Group B, posing serious challenges. Group A had a significantly higher percentage of overall neonatal complications: 44.6% vs 23.9% (p<0.0001), stillbirths (7.67% vs 1.67%), and intrauterine growth restrictions (IUGR) (12.33% vs 3.33%). Group B had higher rates of intrauterine deaths (IUD) (5.33% vs 0%), and neonatal intensive care unit (NICU) admissions were higher in Group B (p<0.0001). Thus, proteinuria appears to be a strong marker of poor neonatal health.

Conclusion

The study emphasizes that proteinuria, while important, is not the single most important factor in determining maternal and neonatal outcomes. Maternal and fetal outcomes also depend on other clinical factors, including systemic organ involvement and maternal comorbidities. This study affirms that women with proteinuria showed more neonatal and obstetric maternal complications, but women with non-proteinuric preeclampsia can still be associated with significant biochemical derangements and pose difficulties in management.