(255) Neonatal outcomes of patients in cases of gestational hypertension with proteinuria

Objective: Hypertensive disorders of pregnancy are associated with increased rates of adverse neonatal outcomes. The severity of these outcomes is greatest in patients with pre-eclampsia with severe features (SPE). Proteinuria was once considered a diagnostic criterium for SPE, however as of the 2013 ACOG Task Force of Hypertension In Pregnancy, it is no longer considered a diagnostic marker. The objective of this study was to evaluate the effects of maternal proteinuria in the presence of gestational hypertension (gHTN) on subsequent neonatal outcomes.

Study Design: This was a retrospective cohort study to evaluate neonatal outcomes of infants delivered to mothers with gHTN, gHTN with proteinuria and SPE who delivered after 37 weeks gestation at a large public hospital between 2013 to 2022. Proteinuria was determined based on catheterized urine samples and defined as 2+ or greater. Patients with chronic hypertension were excluded. A multivariable logistic regression model was used to analyze rates of 5-minute Apgar < 3, pH < 7, birthweight less than the 3rd percentile, and neonatal intensive care unit (NICU) admission after adjusting for race, age, parity and body mass index.

Results: Of 94,115 live born infants 7,595 (8.1%) were delivered to mothers diagnosed with gHTN, 1,831 (1.9%) to mothers with gHTN with proteinuria, and 3,444 (3.7%) to mothers diagnosed with SPE. Infants from mothers with gHTN, when compared to gHTN with proteinuria, were significantly less likely to have birthweights less than the 3rd percentile (OR 0.53 95% CI 0.42,0.66) and less likely to be admitted to the NICU (OR 0.61, 95% CI 0.51,0.73). There were no significant differences between infants born to mothers with gHTN with proteinuria when compared to infants born to mothers with SPE (Table).

Conclusion: Although no longer considered a diagnostic criterium for SPE, maternal proteinuria in the setting gHTN is associated with significant adverse outcomes of neonatal growth restriction and NICU admission. The finding of proteinuria remains an important diagnostic marker when evaluating hypertensive disorders in pregnancy.