Clinical Significance of Isolated Gestational Proteinuria: A Prospective Analysis of Maternal and Neonatal Outcomes
Received: 25 Dec 2023 | Received in revised form: 30 Sep 2024
Accepted: 30 Oct 2024 | Available online: 22 Nov 2024Tayfun VURALa , Suna YILDIRIM KARACAa , Burak BAYRAKTARa,b, Ceren GÖLBAŞIc , Atalay EKİNd , Mehmet ÖZERENd
aUniversity of Health Sciences Tepecik Training and Research Hospital, Department of Gynecology and Obstetrics, İzmir, Türkiye
bAnkara Etlik City Hospital, Clinic of Perinatology, Ankara, Türkiye
cİzmir Tınaztepe University Faculty of Medicine, Department of Gynecology and Obstetrics, İzmir, Türkiye
dUniversity of Health Sciences Tepecik Training and Research Hospital, Division of Perinatology, İzmir, Türkiye
JCOG. 2024;34(4):132-40
DOI: 10.5336/jcog.2023-100976
Article Language: EN
Copyright Ⓒ 2025 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (
http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: This study aimed to investigate maternal and fetal outcomes in patients with isolated gestational proteinuria (IGP) and identified risk factors for developing preeclampsia (PE). Material and Methods: This prospective case-control study was conducted between April 2018 and January 2020 at a tertiary center. In this research, total protein levels were measured in 24-hour urine samples from second-trimester normotensive patients who exhibited proteinuria of ≥+1 on a dipstick test. Three groups were defined at the outset: Group 1 (IGP group, n=41): Pregnant women with proteinuria ≥300 mg/24-hour without hypertension. Group 2 (IGP onset PE group, n=10): Pregnant women with proteinuria ≥300 mg/24-hour who later developed hypertension. Group 3 (Control group, n=84): Pregnant women without proteinuria (<300 mg/24-hour) and hypertension during antenatal follow-up formed the control group. Maternal and neonatal outcomes of each group were compared. Results: Maternal and neonatal outcomes, including gestational age at delivery, preterm birth, delivery mode, and neonatal intensive care admissions, were similar between the IGP and control groups. The progression rate of IGP to PE was 19.6% (10/51). The overall prevalence of PE was 2.04% (195/9,520). Based on these findings, IGP was associated with a 12-fold increased risk of developing PE (OR 11.6, 95% CI 5.7-23.6; p<0.001). Additionally, younger maternal age and previous PE history were found as risk factors in the progression of IGP to PE. Conclusion: Unless hypertension develops in IGP, there is no difference between maternal and neonatal outcomes in pregnant women with IGP and healthy pregnant women.
REFERENCES:- Morikawa M, Yamada T, Minakami H. Outcome of pregnancy in patients with isolated proteinuria. Curr Opin Obstet Gynecol. 2009;21(6):491-5. [Crossref] [PubMed]
- Kattah A, Milic N, White W, Garovic V. Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia. Am J Physiol Regul Integr Comp Physiol. 2017;313(4):R418-R424. [Crossref] [PubMed] [PMC]
- Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376(9741):631-44. [Crossref] [PubMed]
- Högberg U. The World Health Report 2005: "make every mother and child count" - including Africans. Scand J Public Health. 2005;33(6):409-11. [Crossref] [PubMed]
- Marasciulo F, Orabona R, Fratelli N, Fichera A, Valcamonico A, Ferrari F, et al. Preeclampsia and late fetal growth restriction. Minerva Obstet Gynecol. 2021;73(4):435-41. [Crossref] [PubMed]
- Monari F, Menichini D, Pignatti L, Basile L, Facchinetti F, Neri I. Effect of L-arginine supplementation in pregnant women with chronic hypertension and previous placenta vascular disorders receiving Aspirin prophylaxis: a randomized control trial. Minerva Obstet Gynecol. 2021;73(6):782-9. [Crossref] [PubMed]
- ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77(1):67-75. [Crossref] [PubMed]
- Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-31. [PubMed]
- Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ. 2008;336(7637):211-5. [Crossref] [PubMed] [PMC]
- Homer CS, Brown MA, Mangos G, Davis GK. Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension. J Hypertens. 2008;26(2):295-302. [Crossref] [PubMed]
- Macdonald-Wallis C, Lawlor DA, Heron J, Fraser A, Nelson SM, Tilling K. Relationships of risk factors for pre-eclampsia with patterns of occurrence of isolated gestational proteinuria during normal term pregnancy. PLoS One. 2011;6(7):e22115. [Crossref] [PubMed] [PMC]
- 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(5):419-24. [Crossref] [PubMed]
- Watanabe K, Naruse K, Tanaka K, Metoki H, Suzuki Y. Outline of definition and classification of "pregnancy induced hypertension (PIH)." Hypertens Res Pregnancy. 2013;1(1):3-4. [Crossref]
- Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):1-7. [Crossref] [PubMed]
- Côté AM, Firoz T, Mattman A, Lam EM, von Dadelszen P, Magee LA. The 24-hour urine collection: gold standard or historical practice? Am J Obstet Gynecol. 2008;199(6):625.e1-6. [Crossref] [PubMed]
- ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):e49-e64. [Crossref] [PubMed]
- American College of Obstetrics and Gynecology. ACOG practice bulletin. Perinatal care at the threshold of viability. Number 38, September 2002. American College of Obstetrics and Gynecology. Int J Gynaecol Obstet. 2002;79(2):181-8. [Crossref] [PubMed]
- Pritchard NL, Hiscock RJ, Lockie E, Permezel M, McGauren MFG, Kennedy AL, et al. Identification of the optimal growth charts for use in a preterm population: an Australian state-wide retrospective cohort study. PLoS Med. 2019;16(10):e1002923. [Crossref] [PubMed] [PMC]
- Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75-84. [Crossref] [PubMed] [PMC]
- Holston AM, Qian C, Yu KF, Epstein FH, Karumanchi SA, Levine RJ. Circulating angiogenic factors in gestational proteinuria without hypertension. Am J Obstet Gynecol. 2009;200(4):392.e1-10. [Crossref] [PubMed] [PMC]
- Ekiz A, Kaya B, Polat I, Avci ME, Ozkose B, Kicik Caliskan R, et al. The outcome of pregnancy with new onset proteinuria without hypertension: retrospective observational study. J Matern Fetal Neonatal Med. 2016;29(11):1765-9. [PubMed]
- Shinar S, Asher-Landsberg J, Schwartz A, Ram-Weiner M, Kupferminc MJ, Many A. 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. 2016;36(1):25-9. [Crossref] [PubMed]
- Yamada T, Obata-Yasuoka M, Hamada H, Baba Y, Ohkuchi A, Yasuda S, et al. Isolated gestational proteinuria preceding the diagnosis of preeclampsia - an observational study. Acta Obstet Gynecol Scand. 2016;95(9):1048-54. [Crossref] [PubMed]
- Erkenekli K, Iskender C, Oztas E, Özgü-Erdinç AS, Yucel A, Uygur D. Clinical, but not laboratory features are predictive of risk of subsequent development of preeclampsia in patients with isolated proteinuria after midgestation. Hypertens Pregnancy. 2015;34(4):495-505. [Crossref] [PubMed]
- Masuyama H, Suwaki N, Nakatsukasa H, Masumoto A, Tateishi Y, Hiramatrsu Y. Circulating angiogenic factors in preeclampsia, gestational proteinuria, and preeclampsia superimposed on chronic glomerulonephritis. Am J Obstet Gynecol. 2006;194(2):551-6. [Crossref] [PubMed]
- Yildirim G, Gungorduk K, Gul A, Asıcıoglu O, Sudolmus S, Gungorduk OC, et al. HELLP syndrome: 8 years of experience from a tertiary referral center in western Turkey. Hypertens Pregnancy. 2012;31(3):316-26. [Crossref] [PubMed]
- Villalaín C, Herraiz I, Valle L, Mendoza M, Delgado JL, Vázquez-Fernández M, et al. Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio. J Am Heart Assoc. 2020;9(7):e015548. [Crossref] [PubMed] [PMC]
- Stepan H, Hund M, Andraczek T. Combining biomarkers to predict pregnancy complications and redefine preeclampsia: the angiogenic-placental syndrome. Hypertension. 2020;75(4):918-26. [Crossref] [PubMed] [PMC]
- Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med. 2016;374(1):13-22. [Crossref] [PubMed]
- Waugh JJ, Clark TJ, Divakaran TG, Khan KS, Kilby MD. Accuracy of urinalysis dipstick techniques in predicting significant proteinuria in pregnancy. Obstet Gynecol. 2004;103(4):769-77. [Crossref] [PubMed]
- Sarno L, Maruotti GM, Saccone G, Sirico A, Mazzarelli LL, Martinelli P. Pregnancy outcome in proteinuria-onset and hypertension-onset preeclampsia. Hypertens Pregnancy. 2015;34(3):284-90. [Crossref] [PubMed]