Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Isolated proteinuria is a risk factor for pre-eclampsia: a retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria

Abstract

Objective:

To examine maternal and neonatal outcomes of isolated proteinuria and define maternal characteristics for progression to pre-eclampsia.

Study Design:

Retrospective cohort study. Data from all hospitalized pregnant women between 2009 and 2014 with new onset isolated proteinuria of over 300 mg/24 h at admission were obtained. Follow-up was performed from the time of admission to the hospital to the time of discharge postpartum. Obstetrical, maternal and neonatal outcomes were obtained.

Result:

Ninety-five pregnant women diagnosed with new onset isolated proteinuria were followed to term. Thirteen women developed pre-eclampsia during pregnancy and eight developed pre-eclampsia postpartum. Maternal characteristics for progression to pre-eclampsia were greater maximal values of proteinuria. Earlier pre-eclampsia onset was associated with early-onset proteinuria and multiple gestation. Although greater values of proteinuria were associated with increased risk for intrauterine growth restriction and lower Apgar scores, maternal outcome was favorable, regardless of pre-eclampsia progression. Isolated proteinuria progressing to pre-eclampsia was associated with late pre-eclampsia onset and favorable maternal and neonatal outcomes.

Conclusion:

A significant proportion of women with new onset isolated proteinuria will develop pre-eclampsia. In these women, close follow-up is recommended until after delivery.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Evdokia Dimitriadis, Daniel L. Rolnik, … Ellen Menkhorst

References

  1. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Report of the ACOG task force on hypertension in pregnancy. Obstet Gynecol 2013; 122: 1122–1131.

    Article  Google Scholar 

  2. Airoldi J, Weinstein L . Clinical significance of proteinuria in pregnancy. Obstet Gynecol Surv 2007; 62 (2): 117–124.

    Article  Google Scholar 

  3. Morikawa M, Yamada T, Minakami H . Outcome of pregnancy in patients with isolated proteinuria. Curr Opin Obstet Gynecol 2009; 21 (6): 491–495.

    Article  Google Scholar 

  4. Akaishi R, Yamada T, Morikawa M, Nishida R, Minakami H . Clinical features of isolated gestational proteinuria progressing to pre-eclampsia: retrospective observational study. BMJ Open 2014; 4 (4): e004870.

    Article  Google Scholar 

  5. Morikawa M, Yamada T, Yamada T, Cho K, Yamada H, Sakuragi N et al. Pregnancy outcome of women who developed proteinuria in the absence of hypertension after mid-gestation. J Perinat Med 2008; 36: 419–424.

    Article  Google Scholar 

  6. Masuyama H, Suwaki N, Nakatsukasa H, Masumoto A, Tateishi Y, Hiramatrsu Y . Circulating angiogenic factors in pre-eclampsia, gestational proteinuria, and pre-eclampsia superimposed on chronic glomerulonephritis. Am J Obstet Gynecol 2006; 194 (2): 551–556.

    Article  CAS  Google Scholar 

  7. Jim B, Mehta S, Qipo A, Kim K, Cohen HW, Moore RM et al. A comparison of podocyturia, albuminuria and nephrinuria in predicting the development of pre-eclampsia: a prospective study. PLoS One 2014; 9 (7): e101445.

    Article  Google Scholar 

  8. Duckitt K, Harrington D . Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005; 330: 565–567.

    Article  Google Scholar 

  9. Dolberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES . Birth weight standards in the live-born population in Israel. Isr Med Assoc J. 2005; 7 (5): 311–314.

    Google Scholar 

  10. Narasimha A, Vasudeva DS . Spectrum of changes in placenta in toxemia of pregnancy. Indian J Pathol Microbiol 2011; 54 (1): 15–20.

    Article  Google Scholar 

  11. Roberts DJ, Post MD . The placenta in pre-eclampsia and intrauterine growth restriction. J Clin Pathol 2008; 61 (12): 1254–1260.

    Article  CAS  Google Scholar 

  12. Macdonald-Wallis C, Tilling K, Fraser A, Nelson SM, Lawlor DA . Established pre-eclampsia risk factors are related to patterns of blood pressure change in normal term pregnancy: findings from the Avon Longitudinal Study of Parents and Children. J Hypertens 2011; 29 (9): 1703–1711.

    Article  CAS  Google Scholar 

  13. Smith NA, Lyons JG, McElrath TF . Protein:creatinine ratio in uncomplicated twin pregnancy. Am J Obstet Gynecol 2010; 203 (4): 381.e1–4.

    Article  Google Scholar 

  14. Hladunewich MA, Schaefer F . Proteinuria in special populations: pregnant women and children. Adv Chronic Kidney Dis 2011; 18 (4): 267–272.

    Article  Google Scholar 

  15. Poon LC, Kametas N, Bonino S, Vercellotti E, Nicolaides KH . Urine albumin concentration and albumin-to-creatinine ratio at 11+0 to 13+6 weeks in the prediction of pre-eclampsia. BJOG 2008; 115: 866–873.

    Article  CAS  Google Scholar 

  16. McCowan LM, Thompson JM, Taylor RS, North RA, Poston L, Baker PN et al, SCOPE Consortium. Clinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohort. PLoS One 2013; 8 (8): e70917.

    Article  CAS  Google Scholar 

  17. Hantush Zadeh S, Khosravi D, Shahbazi F, Kaviani Jebeli Z, Ahmadi F, Shirazi M . Idiopathic urinary findings and fetal growth restriction in low risk pregnancy. Eur J Obstet Gynecol Reprod Biol 2013; 171 (1): 57–60.

    Article  Google Scholar 

  18. Stettler RW, Cunningham FG . Natural history of chronic proteinuria complicating pregnancy. Am J Obstet Gynecol. 1992; 167 (5): 1219–1224.

    Article  CAS  Google Scholar 

  19. Bramham K, Poli-de-Figueiredo CE, Seed PT, Briley AL, Poston L, Shennan AH et al. Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. PLoS One 2013; 8 (10): e76083.

    Article  CAS  Google Scholar 

  20. Stubert J, Ullmann S, Dieterich M, Diedrich D, Reimer T . Clinical differences between early- and late-onset severe pre-eclampsia and analysis of predictors for perinatal outcome. J Perinat Med 2014; 42: 617–627.

    Article  Google Scholar 

Download references

Acknowledgements

Special thanks to Liraz Olmer, biostatistician, Gertner Institute, for guidance and assistance in the statistical analysis. No funding was required for this study. The local institution has approved human experimentation.

Ethical Statement

The local institution has approved human experimentation. IRB project number 0284-08-TLV was approved in July 2008.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Shinar.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shinar, S., Asher-Landsberg, J., Schwartz, A. et al. Isolated proteinuria is a risk factor for pre-eclampsia: a retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria. J Perinatol 36, 25–29 (2016). https://doi.org/10.1038/jp.2015.138

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2015.138

This article is cited by

Search

Quick links