1
|
Jones C, Jakubowski BE, Stevens R, Roberts N, McManus RJ, Tucker KL. The diagnostic Accuracy of Visual versus automated dipstick proteinuria testing in Pregnancy: A systematic review and Meta-Analysis. Pregnancy Hypertens 2024; 35:73-81. [PMID: 38262144 DOI: 10.1016/j.preghy.2024.01.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of point-of-care (POC) tests for detecting proteinuria in pregnant women. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE and EMBASE databases were searched from inception to 13 November 2020. ELIGIBILITY CRITERIA AND DATA ANALYSIS Included studies measured the sensitivity and specificity ofPOC proteinuria testing compared to laboratory reference standards (protein-creatinine ratio (PCR), 24-hour urine collection). Bivariate meta-analyses determined pooled sensitivity and specificity. Random-effects inverse-variance model determinedheterogeneity. MAIN OUTCOME MEASURES The primary outcome was overall sensitivity and specificity, stratified by method of POC testing and reference standard. Secondary outcomes were sensitivity and specificity within thesubgroupstest brand, reference standard, and hypertension status. RESULTS 1078 studies were identified, 17 studies comprising 23 comparisons were included. The meta-analysis included 13 studies with 19 comparisons. Pooled sensitivity and specificity of visual dipsticks against PCR was 72 % (95 % CI: 56 % to 84 %) and 92 % (95 % CI: 76 % to 98 %), respectively. Pooled sensitivity and specificity of visual dipsticks against 24-hour collection was 69 % (55 % to 80 %) and 70 % (51 % to 84 %), respectively. Pooled sensitivity and specificity for automated readers against PCR was 73 % (53 % to 86 %) and 91 % (83 % to 95 %), respectively. Pooled sensitivity and specificity of automated readers against 24-hour collection was 65 % (42 % to 83 %) and 82 % (46 % to 96 %), respectively. CONCLUSION Visual dipsticks have comparable accuracy to automated readers, yet are notadequate as a rule-out test for proteinuria. Proteinuria POC testing maybe beneficial inantenatal care when repeatfollow-up tests are performed. PROSPERO Registration Number: CRD42021231914.
Collapse
Affiliation(s)
- C Jones
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - B E Jakubowski
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R Stevens
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - N Roberts
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R J McManus
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - K L Tucker
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
| |
Collapse
|
2
|
Umazume T, Yamada T, Furuta I, Iwano H, Morikawa M, Watari H, Minakami H. Morphofunctional cardiac changes in singleton and twin pregnancies: a longitudinal cohort study. BMC Pregnancy Childbirth 2020; 20:750. [PMID: 33267789 PMCID: PMC7709235 DOI: 10.1186/s12884-020-03452-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/22/2020] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to compare the echocardiographic changes and cardiac biomarkers between women with singleton and twin pregnancies. Methods From April 2014 to March 2016, this longitudinal cohort study invited pregnant women who were scheduled to give birth at Hokkaido University Hospital. We analyzed prospectively collected data on simultaneously determined echocardiographic parameters and blood cardiac markers of 44 women with singleton and 22 women with twin pregnancies. Furthermore, we tested the mixed-effect models for echocardiographic parameters and cardiac biomarkers. Results During the third trimester and immediately postpartum (within 1 week after childbirth), the mean left atrial volume index and brain natriuretic peptide (BNP) level were significantly higher in women with twin pregnancies than in those with singleton pregnancies. Women with twin pregnancies also had significantly smaller second-trimester inferior vena cava diameters and significantly higher third−trimester creatinine levels than those with singleton pregnancies. BNP positively correlated with the left atrial volume index (β = 0.49, p < 0.01) and the ratio of early diastolic transmitral to mitral annular velocity (E/e’) (β = 0.41, p < 0.01). At 1 month after childbirth in women with singleton pregnancies, BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum negatively correlated with the later E/e’ (r = − 0.33, p = 0.02 and r = − 0.36, p < 0.01, respectively). Conclusions The intravascular cardiac load reached maximum within 1 week after childbirth and was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP significantly positively correlated with LA volume index and E/e’. In women with singleton pregnancies, BNP secreted immediately after childbirth might improve the diastolic functions 1 month after childbirth.
Collapse
Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Takahiro Yamada
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Itsuko Furuta
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hisanori Minakami
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| |
Collapse
|
3
|
Baba Y, Furuta I, Zhai T, Ohkuchi A, Yamada T, Takahashi K, Matsubara S, Minakami H. Effect of urine creatinine level during pregnancy on dipstick test. J Obstet Gynaecol Res 2017; 43:967-973. [DOI: 10.1111/jog.13327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/24/2017] [Accepted: 02/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Yosuke Baba
- Department of Obstetrics and Gynecology; Jichi Medical University Hospital; Shimotsuke Japan
| | - Itsuko Furuta
- Department of Obstetrics; Hokkaido University Hospital; Sapporo Japan
| | - Tianyue Zhai
- Department of Obstetrics; Hokkaido University Hospital; Sapporo Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology; Jichi Medical University Hospital; Shimotsuke Japan
| | - Takahiro Yamada
- Department of Obstetrics; Hokkaido University Hospital; Sapporo Japan
| | - Kayo Takahashi
- Department of Obstetrics and Gynecology; Jichi Medical University Hospital; Shimotsuke Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology; Jichi Medical University Hospital; Shimotsuke Japan
| | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Hospital; Sapporo Japan
| |
Collapse
|
4
|
Yamada T, Obata-Yasuoka M, Hamada H, Baba Y, Ohkuchi A, Yasuda S, Kawabata K, Minakawa S, Hirai C, Kusaka H, Murabayashi N, Inde Y, Nagura M, Umazume T, Itakura A, Maeda M, Sagawa N, Ohno Y, Kataoka S, Fujimori K, Kudo Y, Ikeda T, Nakai A, Minakami H. Isolated gestational proteinuria preceding the diagnosis of preeclampsia - an observational study. Acta Obstet Gynecol Scand 2016; 95:1048-54. [DOI: 10.1111/aogs.12915] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Takahiro Yamada
- Department of Obstetrics and Gynecology; Hokkaido University Hospital; Sapporo Japan
| | - Mana Obata-Yasuoka
- Department of Obstetrics and Gynecology; University of Tsukuba Hospital; Tsukuba Japan
| | - Hiromi Hamada
- Department of Obstetrics and Gynecology; University of Tsukuba Hospital; Tsukuba Japan
| | - Yosuke Baba
- Department of Obstetrics and Gynecology; Jichi Medical University Hospital; Shimotsuke Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology; Jichi Medical University Hospital; Shimotsuke Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology; Fukushima Medical University Hospital; Fukushima Japan
| | - Kosuke Kawabata
- Department of Obstetrics and Gynecology; Hakodate Central General Hospital; Hakodate Japan
| | - Shiori Minakawa
- Department of Obstetrics and Gynecology; Hiroshima University Hospital; Hiroshima Japan
| | - Chihiro Hirai
- Department of Obstetrics and Gynecology; Juntendo University Hospital; Tokyo Japan
| | - Hideto Kusaka
- Department of Obstetrics and Gynecology; Mie Chuo Medical Center; Tsu Japan
| | - Nao Murabayashi
- Department of Obstetrics and Gynecology; Mie University Hospital; Tsu Japan
| | - Yusuke Inde
- Department of Obstetrics and Gynecology; Medical School Tama Nagayama Hospital; Tama Japan
| | - Michikazu Nagura
- Department of Obstetrics and Gynecology; Rakuwakai Otowa Hospital; Kyoto Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology; Hokkaido University Hospital; Sapporo Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology; Juntendo University Hospital; Tokyo Japan
| | - Makoto Maeda
- Department of Obstetrics and Gynecology; Mie Chuo Medical Center; Tsu Japan
| | - Norimasa Sagawa
- Department of Obstetrics and Gynecology; Rakuwakai Otowa Hospital; Kyoto Japan
| | - Yasumasa Ohno
- Department of Obstetrics and Gynecology; Ohno Ladies Clinic; Iwakura Japan
| | - Soromon Kataoka
- Department of Obstetrics and Gynecology; Hakodate Central General Hospital; Hakodate Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology; Fukushima Medical University Hospital; Fukushima Japan
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology; Hiroshima University Hospital; Hiroshima Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology; Mie University Hospital; Tsu Japan
| | - Akihito Nakai
- Department of Obstetrics and Gynecology; Medical School Tama Nagayama Hospital; Tama Japan
| | - Hisanori Minakami
- Department of Obstetrics and Gynecology; Hokkaido University Hospital; Sapporo Japan
| |
Collapse
|
5
|
Baba Y, Yamada T, Obata-Yasuoka M, Yasuda S, Ohno Y, Kawabata K, Minakawa S, Hirai C, Kusaka H, Murabayashi N, Inde Y, Nagura M, Hamada H, Itakura A, Ohkuchi A, Maeda M, Sagawa N, Nakai A, Kataoka S, Fujimori K, Kudo Y, Ikeda T, Minakami H. Urinary protein-to-creatinine ratio in pregnant women after dipstick testing: prospective observational study. BMC Pregnancy Childbirth 2015; 15:331. [PMID: 26667089 PMCID: PMC4678658 DOI: 10.1186/s12884-015-0776-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 12/05/2015] [Indexed: 11/19/2022] Open
Abstract
Background The dipstick test is widely used as a primary screening test for detection of significant proteinuria in pregnancy (SPIP). However, it often shows a false positive test result. This study was performed to determine which pregnant women should be recommended to undergo determination of urinary protein-to-creatinine ratio (mg/mg, P/Cr test) after dipstick test for confirmation of SPIP. Methods This was a multicenter, prospective, and observational study of 2212 urine specimens from 1033 pregnant women who underwent simultaneous dipstick and P/Cr tests in the same spot urine samples at least once. SPIP was defined as P/Cr > 0.27. Preeclampsia was diagnosed in women with both hypertension and SPIP. Results Preeclampsia, hypertension alone, and SPIP alone developed in 202 (20 %), 73 (7.1 %), and 120 (12 %) women, respectively. Creatinine concentration [Cr] varied greatly, ranging from 8.1 to 831 mg/dL in the 2212 urine samples. Rate of positive dipstick test results increased with increasing [Cr], while SPIP prevalence rate was lower in urine samples with higher [Cr], yielding higher false positive rates in samples with higher [Cr]. Postpartum urine samples had significantly lower [Cr] compared to those obtained antepartum (60 [8.7–297] vs. 100 [10–401] mg/dL, respectively). At the first P/Cr test among women with similar dipstick test results, the risk of having SPIP was consistently and significantly higher for hypertensive women than for normotensive women at any dipstick test result: 18 % (14/77) vs. 3.2 % (8/251), 47 % (26/55) vs. 8.7 % (37/425), 91 % (82/90) vs. 59 % (44/75) for negative/equivocal, 1+, and ≥ 2+ test results, respectively. The risk of SPIP was 16 % (9/55) for normotensive women when two successive antenatal urine samples showed a dipstick test result of 1 + . Conclusions For prediction of SPIP, the dipstick test was more likely to show a false positive result in concentrated urine samples with higher [Cr]. Hypertensive women with ≥ 1+ as well as normotensive women with ≥ 2+ on dipstick test should be advised to undergo the P/Cr test.
Collapse
Affiliation(s)
- Yosuke Baba
- Departments of Obstetrics and Gynecology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Kita-ku N15 W7, Sapporo, 060-8638, Japan.
| | - Mana Obata-Yasuoka
- Departments of Obstetrics and Gynecology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shun Yasuda
- Departments of Obstetrics and Gynecology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yasumasa Ohno
- Departments of Obstetrics and Gynecology, Ohno Ladies Clinic, Iwakura, Japan
| | - Kosuke Kawabata
- Departments of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan
| | - Shiori Minakawa
- Departments of Obstetrics and Gynecology, Hiroshima University Hospital, Hiroshima, Japan
| | - Chihiro Hirai
- Departments of Obstetrics and Gynecology, Juntendo University Hospital, Tokyo, Japan
| | - Hideto Kusaka
- Departments of Obstetrics and Gynecology, Mie Chuo Medical Center, Tsu, Japan
| | - Nao Murabayashi
- Departments of Obstetrics and Gynecology, Mie University Hospital, Tsu, Japan
| | - Yusuke Inde
- Departments of Obstetrics and Gynecology, Nippon Medical School Tama Nagayama Hospital, Tama, Japan
| | - Michikazu Nagura
- Departments of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Hiromi Hamada
- Departments of Obstetrics and Gynecology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Atsuo Itakura
- Departments of Obstetrics and Gynecology, Juntendo University Hospital, Tokyo, Japan
| | - Akihide Ohkuchi
- Departments of Obstetrics and Gynecology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Makoto Maeda
- Departments of Obstetrics and Gynecology, Mie Chuo Medical Center, Tsu, Japan
| | - Norimasa Sagawa
- Departments of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Akihito Nakai
- Departments of Obstetrics and Gynecology, Nippon Medical School Tama Nagayama Hospital, Tama, Japan
| | - Soromon Kataoka
- Departments of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan
| | - Keiya Fujimori
- Departments of Obstetrics and Gynecology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yoshiki Kudo
- Departments of Obstetrics and Gynecology, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoaki Ikeda
- Departments of Obstetrics and Gynecology, Mie University Hospital, Tsu, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Kita-ku N15 W7, Sapporo, 060-8638, Japan
| |
Collapse
|
6
|
Umazume T, Yamada T, Ishikawa S, Yamada T, Koyama T, Furuta I, Morikawa M, Yamada S, Minakami H. Prospective study on changes in blood variables in pregnant women at higher risk of peripartum cardiomyopathy. ESC Heart Fail 2015; 2:208-215. [PMID: 28834676 PMCID: PMC6410548 DOI: 10.1002/ehf2.12050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/16/2015] [Accepted: 06/17/2015] [Indexed: 01/01/2023] Open
Abstract
Aims Echocardiography is necessary for the diagnosis of peripartum cardiomyopathy (PPCM). Multifetal pregnancies (MFP) and hypertensive disorders (HD) are prominent risk factors for PPCM. To determine which blood variables exhibit greater change in a late stage of pregnancy in women with MFP and/or HD compared with women with normotensive singleton pregnancies. Methods and results Serum levels of six variables—high‐sensitive troponin I (hs‐TnI), N‐terminal fragment of precursor protein brain‐type natriuretic peptide (NT‐proBNP), myoglobin, creatine kinase‐myocardial band, ferritin, and prolactin—were compared between 29 women with MFP (n = 13) and/or HD (n = 18) and 100 women with normotensive singleton pregnancies (control group). None of 129 women developed PPCM. All variables increased significantly peripartum in both groups. In 29 women with MFP and/or HD, the elevated hs‐TnI and NT‐proBNP levels (median) were significantly higher compared with the control group (5.4 vs. 3.7 pg/mL for hs‐TnI with P = 0.002, 185 vs. 68 pg/mL for NT‐proBNP with P = 0.007), and the prevalence rate of more than 90th percentile value specific for the 129 women was significantly more frequent for hs‐TnI (>12.2 pg/mL; 31% [9/29] vs. 4.0% [4/100], P < 0.001) and tended to be more frequent for NT‐proBNP (>342 pg/mL; 21% [6/29] vs. 7.0%, P = 0.072). Conclusions Both hs‐TnI and NT‐proBNP were likely to increase markedly in women with MFP and/or HD. The combination of hs‐TnI and NT‐proBNP may contribute to better selection of candidates for echocardiography.
Collapse
Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Ishikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashi Yamada
- Department of Obstetrics and Gynecology, Hokkaido JCHO Hospital, Sapporo, Japan
| | - Takahiro Koyama
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Itsuko Furuta
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
7
|
Abstract
Preeclamptic twin pregnancy with larger gestational weight gain (GWG) is suggested to have a higher risk of peripartum cardiomyopathy (PPCM). This was true in a 5-year experience at a single center. A primiparous woman with twins and prepregnancy weight of 51.0 kg exhibited hypertension at gestational week (GW) 32−6/7 and GWG of 18.3 kg (6.0 kg and 2.9 kg during the last four weeks and one week of gestation, resp.) concomitant with generalized edema, gave birth at GW 34−4/7, developed proteinuria, cough, and dyspnea postpartum, and was diagnosed with preeclampsia and PPCM showing left ventricular ejection fraction of 34% and plasma BNP level of 1530 pg/mL. This was the only case of PPCM among 101 (12 with preeclampsia) and 3266 women with twin and singleton pregnancies, respectively. Thus, PPCM occurred significantly more often in women with preeclamptic twin pregnancies than in women with singleton pregnancies (8.3% [1/12] versus 0.0% [0/3266], P = 0.0355). This patient showed the greatest weight gain of 6.0 kg during the last four weeks of gestation and the greatest weight loss of 19.2 kg during one month postpartum among 90 women with twin deliveries at GW ≥ 32.
Collapse
|
8
|
Umazume T, Yamada T, Yamada S, Minakami H. Peripartum cardiomyopathy in a woman with preeclampsia with twin pregnancy. BMJ Case Rep 2014; 2014:bcr-2014-208186. [PMID: 25414233 DOI: 10.1136/bcr-2014-208186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 27-year-old nulliparous Japanese woman with twin pregnancy developed preeclampsia at gestational week (GW) 26. Cardiac function was checked regularly as women carrying twins with preeclampsia are expected to have increased risk of peripartum cardiomyopathy (PPCM). Although conventional parameters including blood pressure, proteinuria, platelet count and liver function did not indicate early delivery, gradual worsening of left ventricular ejection fraction (LVEF) to 44% and plasma brain-type natriuretic peptide level of 254 pg/mL suggested impending PPCM and a need for early delivery at GW 32. A nadir LVEF value of 35% on postpartum day (PPD) 3 followed by a value of 49% on PPD 32 was seen in this patient with PPCM. This case highlights the risk of PPCM among women with preeclampsia carrying twins and the role of pregnancy termination in the clinical course of PPCM.
Collapse
Affiliation(s)
- Takeshi Umazume
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Yamada
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Yamada
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | |
Collapse
|
9
|
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:e004870. [PMID: 24747797 PMCID: PMC3996810 DOI: 10.1136/bmjopen-2014-004870] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Some women with isolated gestational proteinuria (IGP) later develop hypertension and are diagnosed with pre-eclampsia (PE). This study was performed to determine whether clinical features of such proteinuria preceding PE (P-PE) differ from those of other PE (O-PE). DESIGN Retrospective observational study after approval of the institutional review board of ethics. SETTING A single university hospital. Proteinuria was defined as a protein-to-creatinine ratio (mg/mg; P/Cr) of ≥0.27 in the spot urine specimen. IGP was defined as proteinuria in the absence of hypertension. P-PE was defined as PE in which proteinuria preceded hypertension by more than 2 days. PARTICIPANTS All of 10 and 18 consecutive women with P-PE and O-PE, respectively, who gave birth between January 2008 and August 2013. RESULTS Proteinuria appeared earlier (at 30.2±3.0 vs 35.3±4.3 weeks, p=0.001), the P/Cr level was greater at birth (7.28±2.14 vs 3.19±2.49, p<0.001), net maternal weight gain during the last antenatal 1 week was greater (3.1±1.8 vs 1.3±1.7 kg, p=0.023) and length of pregnancy was shorter (32.5±1.9 vs 36.1±3.6 weeks, p=0.001) in women with P-PE than in O-PE. The duration of IGP was 10.0±5.9 days (range 3-20), and the time interval until delivery after diagnosis of PE was 6.1±8.2 days (range 0-23) in 10 women with P-PE. The P/Cr levels at birth were significantly inversely correlated with the antenatal lowest antithrombin activity and fibrinogen levels among the 28 women with PE. CONCLUSIONS Women with P-PE were likely to exhibit greater proteinuria in the urine, greater water retention in the interstitial space and more enhanced coagulation-fibrinolysis, thus suggesting that they may constitute a more severe form of PE than women with O-PE do.
Collapse
Affiliation(s)
- Rina Akaishi
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | | | | | | | | |
Collapse
|