Preeclampsia

Original article 295

Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension
Caroline S.E. Homera, Mark A. Brownb,c,d, George Mangosb,c,d and Gregory K. Davisb
Objective To determine whether outcomes differed for women with pre-eclampsia according to the presence of proteinuria and whether non-proteinuric pre-eclampsia is similar to gestationalhypertension. Design From 1987 to 2005, at three hospitals in Sydney, Australia, women referred to the obstetric medicine team were recruited. Outcomes for three groups were compared: proteinuric pre-eclampsia, non-proteinuric pre-eclampsia and gestational hypertension. Results Women with proteinuric pre-eclampsia were more likely to have severe hypertension (39 versus 30%, P U 0.003), deliver preterminfants (39 versus 30%, P U 0.007) and had a higher perinatal mortality rate (25.2 versus 5.7 per 1000, P U 0.02) than those with non-proteinuric pre-eclampsia, who were more likely to have thrombocytopenia and liver disease. Women with non-proteinuric pre-eclampsia were more likely to have multiple pregnancies (3.9 versus 9.9%, P < 0.001), experience severe hypertension (8.9 versus 29.7%, P < 0.001),and deliver preterm infants (11.3 versus 30.2%, P < 0.001) who were small for gestational age (12.7 versus 20.9%, P < 0.001) than those with gestational hypertension. Conclusion This study highlights differences between non-proteinuric pre-eclampsia and gestational hypertension. The subclassification of ‘non-proteinuric pre-eclampsia’ should be added to existing classification systems to alertclinicians to potential risks. J Hypertens 26:295–302 Q 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Journal of Hypertension 2008, 26:295–302 Keywords: gestational hypertension, hypertension in pregnancy, pre-eclampsia, proteinuria Abbreviations: ASSHP, Australasian Society for the Study of Hypertension in Pregnancy; CH, Chronic Hypertension; DBP, Diastolic blood pressure; GH,Gestational hypertension; ISSHP, International Society for the Study of Hypertension in Pregnancy; PE, Pre-eclampsia; PN, Perinatal; PNM, Perinatal Mortality Rate; RAP, Risk Associated Pregnancy Team; SBP, Systolic blood pressure; SGA, Small for gestational age; SOMANZ, Society of Obstetric Medicine of Australia and New Zealand; SPSS, Statistical Package for Social Science; UAC, Uric acid; WCH, White CoatHypertension
a Centre for Midwifery, Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, bDepartment of Women’s Health, c Department of Renal Medicine and dDepartment of Medicine, St George Hospital and University of New South Wales, Kogarah, Sydney, Australia

Correspondence to Mark A. Brown, MD, Department of Renal Medicine, St George Hospitaland University of NSW, Kogarah, Sydney NSW 2217, Australia E-mail: mbrown@unsw.edu.au This work was presented at the 27th Triennial Congress of the International Confederation of Midwives, Brisbane, Australia in July 2005. Reprints will not be available. Received 8 May 2007 Revised 12 August 2007 Accepted 31 August 2007

Introduction
Hypertensive disorders in pregnancy are common, affectingapproximately 10–12% of pregnant women. Approximately 3–4% have pre-eclampsia, a similar proportion has gestational hypertension and 1–2% has pre-existing chronic hypertension [1]. There is a lack of data on the outcomes of hypertensive pregnancies, particularly for women with a consistent diagnosis of gestational hypertension compared with pre-eclampsia. Population-based research in Australia [2–4]has relied on datasets that are known to suffer from under-reporting and the misclassification of gestational hypertension and pre-eclampsia [5,6]. Since 1987, we have maintained a prospective database of all women who were referred to two obstetric medicine physicians, either during pregnancy or in the immediate postpartum period. To date, women with a total of 3345
0263-6352 ß 2008 Wolters...