Maternal and Fetal Outcomes in Pre-eclamptic Patients – Differentiation Based on the Level of Proteinuria in tertiary care centre

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Although recent guidelines have de-emphasized proteinuria as essential for diagnosis, the degree of proteinuria may still reflect disease severity [ 1 ]. The objective of this study is to evaluate maternal and fetal outcomes in pre-eclamptic women stratified by levels of proteinuria. Methods A cross-sectional observational study included 320 pregnant women diagnosed with pre-eclampsia. Based on spot urinary protein /urinary creatinine ratio (p/c), participants were classified into Group A (< 0.3 g), Group B (0.3–2 g), and Group C (≥ 2 g). Maternal and fetal outcomes were compared across these groups using appropriate statistical tests. Results A significantly higher proportion of women in the high-proteinuria group had elevated systolic and diastolic blood pressures. Emergency caesarean section and severe pre-eclampsia were most frequent in the high-proteinuria group. On subgroup analysis, birthweight < 2.5kg was clinically significant in patients with proteinuria of more than 2 grams. However, no statistically significant differences were found among the groups regarding age, BMI, gestational age at booking/delivery, laboratory parameters, or most fetal outcomes. Conclusion Higher levels of proteinuria are associated with increased maternal complications, particularly severe hypertension and preeclampsia, but not necessarily with worse fetal outcomes. Proteinuria pre-eclampsia fetal outcomes maternal outcomes morbidity mortality NICU preterm birth 1. Background Pre-eclampsia (PE) is a hypertensive disorder that develops after 20 weeks of gestation, often accompanied by proteinuria or systemic organ involvement. It affects 2–8% of pregnancies globally and contributes substantially to maternal and fetal morbidity and mortality [ 1 ]. Pregnant women with pre-eclampsia are at increased risk of multi-organ dysfunction, which can lead to adverse pregnancy outcomes such as hypertensive retinopathy, renal impairment, fetal growth restriction (FGR), and preterm delivery. However, the specific risk factors contributing to these outcomes require further investigation. [ 2 ] During pregnancy, increased renal blood flow and glomerular filtration rate (GFR) lead to a state of high perfusion and filtration in the glomeruli. Concurrently, the expanding uterus compresses the renal veins, raising venous pressure. This physiological adaptation results in higher urinary protein excretion compared to non-pregnant women.Proteinuria in pregnancy is not only a common finding but also a key marker of chronic kidney disease (CKD) and glomerular injury. It serves as an important indicator for predicting kidney damage during gestation.[ 9 ] While proteinuria was once central to diagnosis, current guidelines such as those from the American College of Obstetricians and Gynecologists (ACOG) now allow for diagnosis based on hypertension and other features, regardless of proteinuria [ 1 ]. Women who develop gestational hypertension and subsequently present with new-onset proteinuria are considered to have pre-eclampsia. [ 8 ] The 24-hour urine collection is traditionally used as the benchmark for assessing proteinuria in pregnancy, with significant proteinuria defined as an excretion of 0.3 grams or more per day. [ 8 ] Both the Australasian Society for the Study of Hypertension in Pregnancy and the International Society for the Study of Hypertension in Pregnancy (ISSHP) advocate for the use of the urinary spot protein-to-creatinine ratio as a practical alternative to the traditional 24-hour urine collection for quantifying proteinuria in pregnancy.[ 8 ] Furthermore, several studies have indicated that the amount of proteinuria is not reflective of the severity of preeclampsia and does not consistently predict pregnancy outcomes. [ 5 , 6 ] Nonetheless, the quantitative level of proteinuria may reflect endothelial dysfunction and placental pathology, offering potential insight into prognosis [ 3 ]. Extensive research indicates that severe proteinuria in preeclamptic patients is linked to a heightened likelihood of unfavourable pregnancy outcomes.[ 2 ] The significance of proteinuria in diagnosing and evaluating preeclampsia remains uncertain. In this study, we retrospectively examined the association between spot urinary protein and creatinine levels and adverse pregnancy outcomes in women with preeclampsia. This study aimed to examine outcomes among pre-eclamptic patients stratified by proteinuria levels to determine whether higher proteinuria correlates with poorer outcomes. 2. Methods 2.1 Ethical Exemption and Consent to Participate Formal ethical exemption for this research study was obtained from the Ethics Review Committee of Aga Khan University Hospital, Karachi, Pakistan (AKU ERC Number: 2023-8790-25581). As this was a retrospective study, the requirement for informed consent was waived by the Ethics Review Committee. The study was conducted in accordance with the principles of the Declaration of Helsinki. 2.2 Study Design and Population This observational cross-sectional study was conducted in Aga Khan University Hospital, Karachi, between June 2023 to June 2024. This study was conducted retrospectively from data obtained for clinical purposes, after approval from the ethical review committee of Aga Khan University Hospital. A total of 320 pre-eclamptic pregnant women at ≥ 20 weeks of gestation were enrolled. Based on spot urinary protein /urinary creatinine ratio (p/c), participants were classified into Group A (< 0.3 g), Group B (0.3–2 g), and Group C (≥ 2 g). 2.3 Group Classification Group Proteinuria Level (Spot P/c ratio) n A < 0.3 g 223 B 0.3–2 g 34 C ≥ 2 g 63 The Inclusion Criteria included all patients diagnosed with pre-eclampsia based on ACOG criteria [ 1 ] and available Spot urinary protein/creatinine ratio (p/c). The Exclusion Criteria include patients already diagnosed with chronic diseases that affect renal function and lead to proteinuria, even outside pregnancy, such as Chronic hypertension, renal disease, and diabetes mellitus. Multiple pregnancy patients were also excluded, as they are more likely to have proteinuria during the development of pre-eclampsia because of the pressure of the gravid uterus. 2.4 Data Collection Patient data were collected from hospital records. The demographic and clinical characteristics of the patients were collected, including age, gestational week at booking, gravidity, gestational age at delivery, body mass index (BMI), and mean systolic and diastolic blood pressure. Values of biochemical results were included: serum creatinine (Cr), serum uric acid (UA), alanine transaminase (ALT) levels, platelet counts, and spot urinary protein /spot urinary creatinine ratio (p/c). Based on spot urinary protein /urinary creatinine ratio (p/c), participants were classified into Group A (< 0.3 g), Group B (0.3–2 g), and Group C (≥ 2 g). Maternal outcomes were noted, which included preeclampsia severity, eclampsia, mode of delivery, including rate of caesarean delivery, preeclampsia, abruption, and disseminated intravascular coagulation (DIC). Fetal outcomes, which were also noted, included Gestational weeks at delivery, perinatal outcomes (including liveborn and perinatal deaths), birth weight, and Neonatal intensive care unit (NICU) admission. 2.5 Statistical Analysis SPSS v25.0 was used for statistical analysis. Chi-square or Fisher’s exact test was used to analyze categorical variables. ANOVA and t-tests were used for continuous variables. A p-value < 0.05 was considered statistically significant 3. Results Table 1 presents the association between demographics and antenatal characteristics of the participants and the level of proteinuria. A significantly higher proportion of very early preterm deliveries (less than 32 weeks) was observed in high proteinuria (≥2 g, Group C) (43%). Additionally, the mean systolic blood pressure was significantly higher among females in the high proteinuria group C (145.4 ± 23.9 mmHg; p < 0.001) compared to those in the moderate and low proteinuria groups. A similar trend was observed for mean diastolic blood pressure, which was significantly elevated in the high proteinuria group (87.3 ± 13.2 mmHg; p < 0.01) relative to the other two groups. However, no significant differences were found among the three groups with respect to age, BMI, gravidity, gestational age at booking and delivery, as well as biochemical markers including SGPT, platelet count, uric acid, and creatinine levels. Interpretation: Proteinuria ≥2 g is associated with significantly higher blood pressure but not with differences in baseline demographic or biochemical characteristics. Table 1 Comparison of demographic and antenatal characteristics of the participants with the level of proteinuria Variables Group A (35 30 (14) 82 (37) 68 (30) 43 (19) 4 (12) 12 (35) 22 (32) 7 (21) 14 (22) 20 (32) 21 (33) 8 (13) 0.59 BMI (in kg/m2) Normal weight (18-23) Over weight (23-27) Obese (≥ 27) 13 (6) 62 (28) 148 (66) 4 (12) 4 (12) 26 (76) 6 (10) 19 (30) 38 (60) >0.99 Gestational week at booking (in weeks) 26 97 (43) 104 (47) 22 (10) 10 (29) 16 (47) 8 (24) 21 (33) 25 (40) 17 (27) >0.99 Gestational week at delivery (in weeks) 0.99 Gravidity Primipara (%) Multipara (%) 57 (26) 166 (74) 6 (18) 28 (82) 14 (22) 49 (78) 0.56 SBP (mmHg) 132 ± 17.8 135.5 ± 16.9 145.4 ± 23.9 <0.001** DBP (mmHg) 81.2 ± 11.2 80.9 ± 14.4 87.3 ± 13.2 25 High 125 (57) 95 (43) 22 (67) 11 (33) 39 (62) 24 (38) 0.48 Platelets count 247.4 ± 85.4 87.4 ± 15 98.1 ± 12.3 0.48 Uric acid ≤ 5.4 Normal >5.4 High 125 (57) 96 (43) 6 (19) 25 (81) 16 (25) 47 (75) 0.48 Creatinine ≤ 1 Normal >1 High 167 (98) 3 (2) 22 (92) 2 (8) 53 (93) 4 (7) >0.99 * Significant at p value < 0.05 by using fisher exact test **Significant at p value < 0.05 by using independent t test Table 2 presents the association between maternal complications and the level of proteinuria. A significantly higher proportion of females in the high proteinuria group (≥2 g, Group C) had emergency Caesarean section (76%) compared to those in the moderate (0.3-2g, Group B) (65%) and low proteinuria (<0.3 g, Group A) (55%) groups. A significantly higher proportion of females in the low proteinuria group (<0.3 g, Group A) had spontaneous deliveries (28%) compared to those in the moderate (0.3-2g, Group B) (21%) and high proteinuria (≥2 g, Group C) (16%) groups. Whereas, a significantly higher proportion of females in the low proteinuria group (<0.3 g, Group A) had spontaneous deliveries (28%). Moreover, a significantly higher proportion of females in the high proteinuria group (≥2 g, Group C) had preeclampsia (60 %) compared to those in the moderate (0.3-2g, Group 2) and low proteinuria (<0.3 g, Group A) groups. However, no significant differences were found among the three groups with respect to other maternal complications. Interpretation: Higher proteinuria levels were associated with more severe preeclampsia and emergency caesarean delivery. The percentages of complications are demonstrated in Table 3. Table 2 Comparison of maternal complications with the level of proteinuria Variables Group A (< 0.3 g) n=223 Group B (0.3 -2 g) n= 34 Group C ( ≧ 2 g) n=63 P-Value Mode of Delivery SVD 52 (23) 7 (21) 1 (16) 0.03* Elective Caesarean section 48 (22) 5 (14) 5 (8) Emergency Caesarean section 123 (55) 22 (65) 4 (76) Maternal Outcomes Alive and Healthy 165 (74) 17 (50) 48 (76) >0.99 HDU Admissions 57 (26) 17 (50) 15 (24) ICU Admission 1 (0.4) 0 (0) 0 (0) Placental abruption (%)-Yes 11 (5.0) 2 (6.0) 6 (10) >0.99 Preeclampsia (%) Mild 110 (49) 9 (27) 8 (13) 0.99 Postpartum hemorrhage (%)-Yes 24 (11) 4 (12) 17 (27) >0.99 DIC (%)-Yes 7 (3) 0 (0) 8 (13) >0.99 *Significant at p value < 0.05 by using chi-square/Fisher's exact test SVD: Spontaneous vaginal delivery; DIC: Disseminated Intravascular Coagulation 3.2 Maternal Complications in percentages among the three groups of proteinuria(Table 3) Complication Group A Group B Group C p-value Severe PE (%) 31% 53% 60% <0.001 Emergency C-section 55% 65% 76% 0.03 Eclampsia (%) 3% 3% 10% NS Postpartum Hemorrhage 11% 12% 27% NS Table 4 shows the association of adverse fetal outcomes with the levels of maternal proteinuria. No statistically significant differences were observed in gestational age at delivery, perinatal outcomes (alive, IUD, neonatal death), NICU admission, or birth weight among the three groups. However, Group C had more very early preterm deliveries (<32 weeks). Higher proportion of babies with birth weight <2.5 kg (78% in Group C vs. 39% in Group A). Despite trends toward worse fetal outcomes in high proteinuria, differences were not statistically significant [3]. Table 4 Comparison of adverse fetal outcomes with levels of maternal proteinuria Variables Group A ( < 0.3 g) n=223 Group B ( 0.3 -2 g) n= 34 Group C ( ≧ 2 g) n=63 P-Value Gestational week at delivery (in weeks) 0.99 Perinatal Outcome Alive IUD NND 213 (95) 6 (3) 4 (2) 32 (94) 2 (6) 0 (0) 48 (76) 5 (8) 10 (16) >0.99 Transfer of the baby NICU WBN Dead 170 (76) 47 (21) 6 (3) 16 (47) 16 (47) 2 (6) 37 (59) 21 (33) 5(8) >0.99 Birth weight (g) 3.5 87 (39) 133 (60) 3 (1) 20 (59) 14 (41) 0 (0) 49 (78) 14 (22) 0 (0) >0.99 NICU: Neonatal Intensive Care Unit; WBN: Well-Baby Nursery Outcome Group A Group B Group C p-value Birth weight <2.5 kg 39% 59% 78% NS NICU Admission 21% 47% 59% NS Perinatal Death 4% 6% 24% NS 4. Discussion This study explored how the severity of proteinuria correlates with maternal and perinatal outcomes in pregnant women diagnosed with hypertension. The central hypothesis proposed that more severe proteinuria would correlate with significant maternal complications, particularly systolic/diastolic BP elevation, emergency caesarean delivery, severity of preeclampsia, higher risk of complications such as preterm birth, low birth weight babies, and NICU stay. Proteinuria in pregnancy arises from physiological increases in glomerular filtration and altered tubular reabsorption, with normal excretion around 30–130 mg/24 h and up to 0.25–0.30 g/24 h in late pregnancy without adverse effects. [ 10 – 13 ] Levels > 0.3 g/24 h indicate renal injury, while ≥ 2 g/24 h suggest significant pathology, potentially leading to hypoalbuminemia, retinal vascular changes, and maternal or perinatal complications. [ 14 – 16 ] In preeclampsia, placental dysfunction and systemic vasospasm damage the glomerular barrier, increasing protein leakage, reducing placental blood flow, and predisposing to maternal renal failure, fetal growth restriction, preterm birth, and higher perinatal mortality. [ 17 , 18 ] In this study, a total of 320 patients were included, with the mean maternal age being between 25–35 years. The demographic data was in comparison previous studies done by Minjie et. al and Guida et. Al.[ 9 , 19 ] Majority of the patients in our study were having BMI > 27 making about 66% of the study population, which was inconsistent with the previous study done Minjie et. al [ 9 ] but was like the results published in 2022 by Xiao et. al [ 20 ] The majority of our patients who developed proteinuria and complications were multigravida, which is inconsistent with previous studies, as pre-eclampsia is commonly seen in primigravida [ 9 , 19 , 20 ] The Mean systolic and diastolic blood pressures were high in Group C, showing a strong association of severe proteinuria with raised blood pressures, which is similar to all the previous literature. [ 9 , 19 , 20 ] The biochemical derangements of platelet count were associated with Group C, while deranged creatinine level of > 1 was associated with a very small number of patients in each category -highly suggestive of pre-eclampsia, causing mild kidney dysfunction, then permanent damage. Among the maternal outcomes, the majority of patients delivered with emergency Caesarean section in all three groups, but this was seen highest in Group C patients, making about 76% of the group population, which is consistent with previous data records by Xu X et al. and Guida et al. [ 17 , 19 ]. All maternal complications, eclampsia, postpartum haemorrhage, placenta abruptions, and HDU admissions were significantly higher in Group C, justifying our hypothesis that more significant the proteinuria during pregnancy, the more guarded the prognosis and maternal complications, which is consistent with previous study results by Guida et.al. [ 19 ] The gestational age at delivery of fetus were at term that is thirty-seven completed week was seen around 46% of patients in Group A, 24% in Group B and 11% in Group C, which is comparable to previous study done by Guida et al. [ 19 ] The percentage of very early preterm birth (less then thirty weeks gestation) in group C is 43% being highest among all the groups, is similar to the results seen in previous study done by Guida et.al [ 19 ] signifying that severe proteinuria at early gestation necessitates preterm birth to improve perinatal mortality and maternal morbidity. Among the perinatal outcomes, significant adverse outcomes, including birth weight less than 2.5 kg, NICU admissions, and perinatal deaths were seen in group C, with percentages being 78%, 59% and 24% respectively, comparable to previous studies done by Xu X et al. and Guida et al. [ 17 – 19 ]. These findings are in line with previous research, which has highlighted proteinuria as an important prognostic indicator in cases of hypertensive disorders during pregnancy. While fetal outcomes like low birth weight and NICU admission were more common in the higher proteinuria group, these differences did not reach statistical significance. Overall, this supports the growing consensus that proteinuria is more predictive of maternal complications than of fetal outcomes [ 3 , 4 , 7 ]. Consistent with prior evidence, Brown et al. demonstrated that higher proteinuria strongly predicts maternal complications but does not reliably indicate adverse perinatal outcomes [ 3 ], while Thangaratinam et al. [ 4 ] emphasized the limited role of proteinuria as a marker for fetal morbidity. In contrast, our results suggest that proteinuria may hold greater prognostic significance, highlighting its potential contribution to both maternal and perinatal risk stratification. Limitations The present study is limited by its retrospective design, which restricts causal interpretation, and by its single-center setting, which may affect the generalizability of the findings. 5. Conclusion Higher levels of proteinuria in pre-eclamptic patients are significantly associated with higher blood pressure, greater severity of preeclampsia, and increased likelihood of emergency cesarean section. Nonetheless, quantifying proteinuria can help in maternal risk assessment and management planning. Abbreviations Pre-eclampsia (PE) fetal growth restriction (FGR) spot urinary protein /urinary creatinine ratio (p/c) glomerular filtration rate (GFR) chronic kidney disease (CKD) American College of Obstetricians and Gynecologists (ACOG) The International Society for the Study of Hypertension in Pregnancy (ISSHP), body mass index (BMI) serum creatinine (Cr) serum uric acid (UA) alanine transaminase (ALT) disseminated intravascular coagulation (DIC) Neonatal intensive care unit (NICU) SVD Spontaneous vaginal delivery WBN: Well-Baby Nursery intrauterine death (IUD) Declarations Ethical Exemption and Consent to Participate Formal ethical exemption for this research study was obtained from the Ethics Review Committee of Aga Khan University Hospital, Karachi, Pakistan (AKU ERC Number: 2023-8790-25581). As this was a retrospective study, the requirement for informed consent was waived by the Ethics Review Committee. Consent to Publication: Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding No funding was required or obtained for this study. Authors’ contributions: * Dr Hiba Arshad Shaikh contributed to manuscript preparation. * Dr Durr-e-Shawar contributed to the conception and design of the study. * Amir Raza performed the statistical analysis. * Dr Ayesha Ali contributed to data collection. * Dr Hafsa Tehseen contributed to data collection. All authors read and approved the final manuscript. Acknowledgements: None. References American College of Obstetricians and Gynecologists. Practice Bulletin 222: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2020;135(6):e237–60. 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The renal circulation in normal pregnancy and preeclampsia: is there a place for relaxin? Am J physiology-Renal Physiol. 2014;306(10):F1121–35. Hladunewich MA. Chronic kidney disease and pregnancy. InSeminars in Nephrology 2017 Jul 1 (Vol. 37, No. 4, pp. 337–46). WB Saunders. Krane NK, Hamrahian M. Pregnancy: kidney diseases and hypertension. Am J Kidney Dis. 2007;49(2):336–45. Maynard SE, Thadhani R. Pregnancy and the kidney. J Am Soc Nephrol. 2009;20(1):14–22. Li B, Lin L, Yang H, Zhu Y, Wei Y, Li X, Chen D, Zhao X, Cui S, Ding H, Ding G. The value of the 24-h proteinuria in evaluating the severity of preeclampsia and predicting its adverse maternal outcomes. Hypertens Pregnancy. 2018;37(3):118–25. Lei T, Qiu T, Liao W, Li K, Lai X, Huang H, Yuan R, Chen L. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reproductive Biology Endocrinol. 2021;19(1):71. Xu X, Wang Y, Xu H, Kang Y, Zhu Q. Association between proteinuria and maternal and neonatal outcomes in pre-eclampsia pregnancy: a retrospective observational study. J Int Med Res. 2020;48(4):0300060520908114. Tomimatsu T, Mimura K, Matsuzaki S, Endo M, Kumasawa K, Kimura T. Preeclampsia: maternal systemic vascular disorder caused by generalized endothelial dysfunction due to placental antiangiogenic factors. Int J Mol Sci. 2019;20(17):4246. Guida JP, Parpinelli MA, Surita FG, Costa ML. The impact of proteinuria on maternal and perinatal outcomes among women with pre-eclampsia. Int J Gynecol Obstet. 2018;143(1):101–7. Xiao J, Fan W, Zhu Q, Shi Z. Diagnosis of proteinuria using a random urine protein-creatinine ratio and its correlation with adverse outcomes in pregnancy with preeclampsia characterized by renal damage. J Clin Hypertens. 2022;24(5):652–9. Additional Declarations No competing interests reported. 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14:11:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1346291,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8416119/v1/0bc86c21-8042-4c72-9033-70b8fa3527b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Maternal and Fetal Outcomes in Pre-eclamptic Patients – Differentiation Based on the Level of Proteinuria in tertiary care centre","fulltext":[{"header":"1. Background","content":"\u003cp\u003ePre-eclampsia (PE) is a hypertensive disorder that develops after 20 weeks of gestation, often accompanied by proteinuria or systemic organ involvement. It affects 2\u0026ndash;8% of pregnancies globally and contributes substantially to maternal and fetal morbidity and mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Pregnant women with pre-eclampsia are at increased risk of multi-organ dysfunction, which can lead to adverse pregnancy outcomes such as hypertensive retinopathy, renal impairment, fetal growth restriction (FGR), and preterm delivery. However, the specific risk factors contributing to these outcomes require further investigation. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDuring pregnancy, increased renal blood flow and glomerular filtration rate (GFR) lead to a state of high perfusion and filtration in the glomeruli. Concurrently, the expanding uterus compresses the renal veins, raising venous pressure. This physiological adaptation results in higher urinary protein excretion compared to non-pregnant women.Proteinuria in pregnancy is not only a common finding but also a key marker of chronic kidney disease (CKD) and glomerular injury. It serves as an important indicator for predicting kidney damage during gestation.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eWhile proteinuria was once central to diagnosis, current guidelines such as those from the American College of Obstetricians and Gynecologists (ACOG) now allow for diagnosis based on hypertension and other features, regardless of proteinuria [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Women who develop gestational hypertension and subsequently present with new-onset proteinuria are considered to have pre-eclampsia. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe 24-hour urine collection is traditionally used as the benchmark for assessing proteinuria in pregnancy, with significant proteinuria defined as an excretion of 0.3 grams or more per day. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Both the Australasian Society for the Study of Hypertension in Pregnancy and the International Society for the Study of Hypertension in Pregnancy (ISSHP) advocate for the use of the urinary spot protein-to-creatinine ratio as a practical alternative to the traditional 24-hour urine collection for quantifying proteinuria in pregnancy.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFurthermore, several studies have indicated that the amount of proteinuria is not reflective of the severity of preeclampsia and does not consistently predict pregnancy outcomes. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Nonetheless, the quantitative level of proteinuria may reflect endothelial dysfunction and placental pathology, offering potential insight into prognosis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Extensive research indicates that severe proteinuria in preeclamptic patients is linked to a heightened likelihood of unfavourable pregnancy outcomes.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe significance of proteinuria in diagnosing and evaluating preeclampsia remains uncertain. In this study, we retrospectively examined the association between spot urinary protein and creatinine levels and adverse pregnancy outcomes in women with preeclampsia. This study aimed to examine outcomes among pre-eclamptic patients stratified by proteinuria levels to determine whether higher proteinuria correlates with poorer outcomes.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Ethical Exemption and Consent to Participate\u003c/h2\u003e \u003cp\u003e Formal ethical exemption for this research study was obtained from the Ethics Review Committee of Aga Khan University Hospital, Karachi, Pakistan (AKU ERC Number: 2023-8790-25581). As this was a retrospective study, the requirement for informed consent was waived by the Ethics Review Committee. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Design and Population\u003c/h2\u003e \u003cp\u003eThis observational cross-sectional study was conducted in Aga Khan University Hospital, Karachi, between June 2023 to June 2024. This study was conducted retrospectively from data obtained for clinical purposes, after approval from the ethical review committee of Aga Khan University Hospital. A total of 320 pre-eclamptic pregnant women at \u0026ge;\u0026thinsp;20 weeks of gestation were enrolled. Based on spot urinary protein /urinary creatinine ratio (p/c), participants were classified into Group A (\u0026lt;\u0026thinsp;0.3 g), Group B (0.3\u0026ndash;2 g), and Group C (\u0026ge;\u0026thinsp;2 g).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Group Classification\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProteinuria Level (Spot P/c ratio)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.3 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3\u0026ndash;2 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Inclusion Criteria included all patients diagnosed with pre-eclampsia based on ACOG criteria [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and available Spot urinary protein/creatinine ratio (p/c). The Exclusion Criteria include patients already diagnosed with chronic diseases that affect renal function and lead to proteinuria, even outside pregnancy, such as Chronic hypertension, renal disease, and diabetes mellitus. Multiple pregnancy patients were also excluded, as they are more likely to have proteinuria during the development of pre-eclampsia because of the pressure of the gravid uterus.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Collection\u003c/h2\u003e \u003cp\u003ePatient data were collected from hospital records. The demographic and clinical characteristics of the patients were collected, including age, gestational week at booking, gravidity, gestational age at delivery, body mass index (BMI), and mean systolic and diastolic blood pressure. Values of biochemical results were included: serum creatinine (Cr), serum uric acid (UA), alanine transaminase (ALT) levels, platelet counts, and spot urinary protein /spot urinary creatinine ratio (p/c). Based on spot urinary protein /urinary creatinine ratio (p/c), participants were classified into Group A (\u0026lt;\u0026thinsp;0.3 g), Group B (0.3\u0026ndash;2 g), and Group C (\u0026ge;\u0026thinsp;2 g). Maternal outcomes were noted, which included preeclampsia severity, eclampsia, mode of delivery, including rate of caesarean delivery, preeclampsia, abruption, and disseminated intravascular coagulation (DIC). Fetal outcomes, which were also noted, included Gestational weeks at delivery, perinatal outcomes (including liveborn and perinatal deaths), birth weight, and Neonatal intensive care unit (NICU) admission.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS v25.0 was used for statistical analysis. Chi-square or Fisher\u0026rsquo;s exact test was used to analyze categorical variables. ANOVA and t-tests were used for continuous variables. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable 1 presents the association between demographics and antenatal characteristics of the participants and the level of proteinuria. A significantly higher proportion of very early preterm deliveries (less than 32 weeks) was observed in high proteinuria (\u0026ge;2 g, Group C) (43%). Additionally, the mean systolic blood pressure was significantly higher among females in the high proteinuria group C (145.4 \u0026plusmn; 23.9 mmHg; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) compared to those in the moderate and low proteinuria groups. A similar trend was observed for mean diastolic blood pressure, which was significantly elevated in the high proteinuria group (87.3 \u0026plusmn; 13.2 mmHg; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01) relative to the other two groups. However, no significant differences were found among the three groups with respect to age, BMI, gravidity, gestational age at booking and delivery, as well as biochemical markers including SGPT, platelet count, uric acid, and creatinine levels.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInterpretation: Proteinuria \u0026ge;2 g is associated with significantly higher blood pressure but not with differences in baseline demographic or biochemical characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Comparison of demographic and antenatal characteristics of the participants with the level of proteinuria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A (\u0026lt;\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;0.3\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=223\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B (0.3\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;-2\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en= 34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C (\u003c/strong\u003e\u003cstrong\u003e≧ 2\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=63\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le;25\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e26-30\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e31-35\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 (14)\u003c/p\u003e\n \u003cp\u003e82 (37)\u003c/p\u003e\n \u003cp\u003e68 (30)\u003c/p\u003e\n \u003cp\u003e43 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (12)\u003c/p\u003e\n \u003cp\u003e12 (35)\u003c/p\u003e\n \u003cp\u003e22 (32)\u003c/p\u003e\n \u003cp\u003e7 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (22)\u003c/p\u003e\n \u003cp\u003e20 (32)\u003c/p\u003e\n \u003cp\u003e21 (33)\u003c/p\u003e\n \u003cp\u003e8 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (in kg/m2)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNormal weight (18-23)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOver weight (23-27)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eObese (\u0026ge; 27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (6)\u003c/p\u003e\n \u003cp\u003e62 (28)\u003c/p\u003e\n \u003cp\u003e148 (66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (12)\u003c/p\u003e\n \u003cp\u003e4 (12)\u003c/p\u003e\n \u003cp\u003e26 (76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (10)\u003c/p\u003e\n \u003cp\u003e19 (30)\u003c/p\u003e\n \u003cp\u003e38 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational week at booking (in weeks)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;12\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e12-16\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e97 (43)\u003c/p\u003e\n \u003cp\u003e104 (47)\u003c/p\u003e\n \u003cp\u003e22 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (29)\u003c/p\u003e\n \u003cp\u003e16 (47)\u003c/p\u003e\n \u003cp\u003e8 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (33)\u003c/p\u003e\n \u003cp\u003e25 (40)\u003c/p\u003e\n \u003cp\u003e17 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational week at delivery (in weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026lt; 32 ( very early preterm )\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e32-34 (early preterm )\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e34-36+6 (Late preterm)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 37 (term)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (8)\u003c/p\u003e\n \u003cp\u003e21 (9)\u003c/p\u003e\n \u003cp\u003e83 (37)\u003c/p\u003e\n \u003cp\u003e103 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (24)\u003c/p\u003e\n \u003cp\u003e6 (17)\u003c/p\u003e\n \u003cp\u003e12 (35)\u003c/p\u003e\n \u003cp\u003e8 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (43)\u003c/p\u003e\n \u003cp\u003e9 (14)\u003c/p\u003e\n \u003cp\u003e16 (25)\u003c/p\u003e\n \u003cp\u003e11 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003eGravidity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePrimipara (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMultipara (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57 (26)\u003c/p\u003e\n \u003cp\u003e166 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (18)\u003c/p\u003e\n \u003cp\u003e28 (82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (22)\u003c/p\u003e\n \u003cp\u003e49 (78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp; \u0026nbsp; \u003cstrong\u003eSBP (mmHg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e132 \u0026plusmn; 17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e135.5 \u0026plusmn; 16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e145.4 \u0026plusmn; \u0026nbsp; 23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026emsp;DBP (mmHg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e81.2 \u0026plusmn; 11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e80.9 \u0026plusmn; 14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e87.3 \u0026plusmn; 13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;0.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026emsp;SGPT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 25 Normal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;25 High\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e125 (57)\u003c/p\u003e\n \u003cp\u003e95 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (67)\u003c/p\u003e\n \u003cp\u003e11 (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (62)\u003c/p\u003e\n \u003cp\u003e24 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlatelets count\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e247.4 \u0026plusmn; 85.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e87.4 \u0026plusmn; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e98.1 \u0026plusmn; 12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026emsp;Uric acid\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 5.4 Normal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;5.4 High\u003c/strong\u003e\u003c/p\u003e\u0026nbsp;\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e125 (57)\u003c/p\u003e\n \u003cp\u003e96 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (19)\u003c/p\u003e\n \u003cp\u003e25 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (25)\u003c/p\u003e\n \u003cp\u003e47 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026emsp;Creatinine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 1 Normal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;1 High\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e167 (98)\u003c/p\u003e\n \u003cp\u003e3 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (92)\u003c/p\u003e\n \u003cp\u003e2 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53 (93)\u003c/p\u003e\n \u003cp\u003e4 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 614px;\"\u003e\n \u003cp\u003e* Significant at p value \u0026lt; 0.05 by using fisher exact test\u003c/p\u003e\n \u003cp\u003e**Significant at p value \u0026lt; 0.05 by using independent t test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 presents the association between maternal complications and the level of proteinuria. A significantly higher proportion of females in the high proteinuria group (\u0026ge;2 g, Group C) had emergency Caesarean section (76%) compared to those in the moderate (0.3-2g, Group B) (65%) and low proteinuria (\u0026lt;0.3 g, Group A) (55%) groups. A significantly higher proportion of females in the low proteinuria group (\u0026lt;0.3 g, Group A) had spontaneous deliveries (28%) compared to those in the moderate (0.3-2g, Group B) (21%) and high proteinuria (\u0026ge;2 g, Group C) (16%) groups. \u0026nbsp;Whereas, a significantly higher proportion of females in the low proteinuria group (\u0026lt;0.3 g, Group A) had spontaneous deliveries (28%). Moreover, a significantly higher proportion of females in the high proteinuria group (\u0026ge;2 g, Group C) had preeclampsia (60 %) compared to those in the moderate (0.3-2g, Group 2) and low proteinuria (\u0026lt;0.3 g, Group A) groups. However, no significant differences were found among the three groups with respect to other maternal complications.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInterpretation: Higher proteinuria levels were associated with more severe preeclampsia and emergency caesarean delivery. The percentages of complications are demonstrated in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Comparison of maternal complications with the level of proteinuria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A (\u0026lt;\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;0.3\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=223\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B (0.3\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;-2\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en= 34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C (\u003c/strong\u003e\u003cstrong\u003e≧ 2\u003c/strong\u003e\u003cstrong\u003e\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=63\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of Delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026emsp;SVD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e52 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026emsp;Elective Caesarean section\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e48 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e5 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Emergency Caesarean section\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e123 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e22 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e4 (76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003eMaternal Outcomes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlive and Healthy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e165 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e17 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e48 (76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDU Admissions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e57 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e17 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e15 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU Admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlacental abruption (%)-Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e11 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e6 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Preeclampsia (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e110 (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e8 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e43 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e17 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e70 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e18 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e38 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEclampsia (%)-Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e7 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e6 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostpartum hemorrhage (%)-Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e24 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e17 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDIC (%)-Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e7 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e8 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\u0026nbsp;\u003cp\u003e*Significant at p value \u0026lt; 0.05 by using chi-square/Fisher\u0026apos;s exact test\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSVD: Spontaneous vaginal delivery; DIC: Disseminated Intravascular Coagulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Maternal Complications in percentages among the three groups of proteinuria(Table 3)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eSevere PE (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e53%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eEmergency C-section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eEclampsia (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003ePostpartum Hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 shows the association of adverse fetal outcomes with the levels of maternal proteinuria. No statistically significant differences were observed in gestational age at delivery, perinatal outcomes (alive, IUD, neonatal death), NICU admission, or birth weight among the three groups. However, Group C had more very early preterm deliveries (\u0026lt;32 weeks). Higher proportion of babies with birth weight \u0026lt;2.5 kg (78% in Group C vs. 39% in Group A). Despite trends toward worse fetal outcomes in high proteinuria, differences were not statistically significant [3].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Comparison of adverse fetal outcomes with levels of maternal proteinuria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A (\u003c/strong\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.3\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=223\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B (\u003c/strong\u003e\u003cstrong\u003e0.3\u0026thinsp;-2\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en= 34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C (\u003c/strong\u003e\u003cstrong\u003e≧\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;2\u0026thinsp;g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=63\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational week at delivery\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(in weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026lt; 32 ( very early preterm )\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e32-34 (early preterm )\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e34-36+6 (Late preterm)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 37 (term)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (8)\u003c/p\u003e\n \u003cp\u003e21 (9)\u003c/p\u003e\n \u003cp\u003e83 (37)\u003c/p\u003e\n \u003cp\u003e103 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (24)\u003c/p\u003e\n \u003cp\u003e6 (17)\u003c/p\u003e\n \u003cp\u003e12 (35)\u003c/p\u003e\n \u003cp\u003e8 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (43)\u003c/p\u003e\n \u003cp\u003e9 (14)\u003c/p\u003e\n \u003cp\u003e16 (25)\u003c/p\u003e\n \u003cp\u003e11 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerinatal Outcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAlive\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIUD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNND\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e213 (95)\u003c/p\u003e\n \u003cp\u003e6 (3)\u003c/p\u003e\n \u003cp\u003e4 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (94)\u003c/p\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (76)\u003c/p\u003e\n \u003cp\u003e5 (8)\u003c/p\u003e\n \u003cp\u003e10 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfer of the baby\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNICU\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWBN\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDead\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e170 (76)\u003c/p\u003e\n \u003cp\u003e47 (21)\u003c/p\u003e\n \u003cp\u003e6 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (47)\u003c/p\u003e\n \u003cp\u003e16 (47)\u003c/p\u003e\n \u003cp\u003e2 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (59)\u003c/p\u003e\n \u003cp\u003e21 (33)\u003c/p\u003e\n \u003cp\u003e5(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight (g)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;2.5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.5-3.5\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;3.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87 (39)\u003c/p\u003e\n \u003cp\u003e133 (60)\u003c/p\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (59)\u003c/p\u003e\n \u003cp\u003e14 (41)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49 (78)\u003c/p\u003e\n \u003cp\u003e14 (22)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eNICU: Neonatal Intensive Care Unit; WBN: Well-Baby Nursery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eBirth weight \u0026lt;2.5 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eNICU Admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e47%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003ePerinatal Death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study explored how the severity of proteinuria correlates with maternal and perinatal outcomes in pregnant women diagnosed with hypertension. The central hypothesis proposed that more severe proteinuria would correlate with significant maternal complications, particularly systolic/diastolic BP elevation, emergency caesarean delivery, severity of preeclampsia, higher risk of complications such as preterm birth, low birth weight babies, and NICU stay.\u003c/p\u003e \u003cp\u003eProteinuria in pregnancy arises from physiological increases in glomerular filtration and altered tubular reabsorption, with normal excretion around 30\u0026ndash;130 mg/24 h and up to 0.25\u0026ndash;0.30 g/24 h in late pregnancy without adverse effects. [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Levels\u0026thinsp;\u0026gt;\u0026thinsp;0.3 g/24 h indicate renal injury, while\u0026thinsp;\u0026ge;\u0026thinsp;2 g/24 h suggest significant pathology, potentially leading to hypoalbuminemia, retinal vascular changes, and maternal or perinatal complications. [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] In preeclampsia, placental dysfunction and systemic vasospasm damage the glomerular barrier, increasing protein leakage, reducing placental blood flow, and predisposing to maternal renal failure, fetal growth restriction, preterm birth, and higher perinatal mortality. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn this study, a total of 320 patients were included, with the mean maternal age being between 25\u0026ndash;35 years. The demographic data was in comparison previous studies done by Minjie et. al and Guida et. Al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Majority of the patients in our study were having BMI\u0026thinsp;\u0026gt;\u0026thinsp;27 making about 66% of the study population, which was inconsistent with the previous study done Minjie et. al [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] but was like the results published in 2022 by Xiao et. al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The majority of our patients who developed proteinuria and complications were multigravida, which is inconsistent with previous studies, as pre-eclampsia is commonly seen in primigravida [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe Mean systolic and diastolic blood pressures were high in Group C, showing a strong association of severe proteinuria with raised blood pressures, which is similar to all the previous literature. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The biochemical derangements of platelet count were associated with Group C, while deranged creatinine level of \u0026gt;\u0026thinsp;1 was associated with a very small number of patients in each category -highly suggestive of pre-eclampsia, causing mild kidney dysfunction, then permanent damage.\u003c/p\u003e \u003cp\u003eAmong the maternal outcomes, the majority of patients delivered with emergency Caesarean section in all three groups, but this was seen highest in Group C patients, making about 76% of the group population, which is consistent with previous data records by Xu X et al. and Guida et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. All maternal complications, eclampsia, postpartum haemorrhage, placenta abruptions, and HDU admissions were significantly higher in Group C, justifying our hypothesis that more significant the proteinuria during pregnancy, the more guarded the prognosis and maternal complications, which is consistent with previous study results by Guida et.al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe gestational age at delivery of fetus were at term that is thirty-seven completed week was seen around 46% of patients in Group A, 24% in Group B and 11% in Group C, which is comparable to previous study done by Guida et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] The percentage of very early preterm birth (less then thirty weeks gestation) in group C is 43% being highest among all the groups, is similar to the results seen in previous study done by Guida et.al [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] signifying that severe proteinuria at early gestation necessitates preterm birth to improve perinatal mortality and maternal morbidity.\u003c/p\u003e \u003cp\u003eAmong the perinatal outcomes, significant adverse outcomes, including birth weight less than 2.5 kg, NICU admissions, and perinatal deaths were seen in group C, with percentages being 78%, 59% and 24% respectively, comparable to previous studies done by Xu X et al. and Guida et al. [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings are in line with previous research, which has highlighted proteinuria as an important prognostic indicator in cases of hypertensive disorders during pregnancy. While fetal outcomes like low birth weight and NICU admission were more common in the higher proteinuria group, these differences did not reach statistical significance. Overall, this supports the growing consensus that proteinuria is more predictive of maternal complications than of fetal outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsistent with prior evidence, Brown et al. demonstrated that higher proteinuria strongly predicts maternal complications but does not reliably indicate adverse perinatal outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], while Thangaratinam et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] emphasized the limited role of proteinuria as a marker for fetal morbidity. In contrast, our results suggest that proteinuria may hold greater prognostic significance, highlighting its potential contribution to both maternal and perinatal risk stratification.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe present study is limited by its retrospective design, which restricts causal interpretation, and by its single-center setting, which may affect the generalizability of the findings.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eHigher levels of proteinuria in pre-eclamptic patients are significantly associated with higher blood pressure, greater severity of preeclampsia, and increased likelihood of emergency cesarean section. Nonetheless, quantifying proteinuria can help in maternal risk assessment and management planning.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePre-eclampsia (PE)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;fetal growth restriction (FGR)\u003c/p\u003e\n\u003cp\u003espot urinary protein /urinary creatinine ratio (p/c)\u003c/p\u003e\n\u003cp\u003eglomerular filtration rate (GFR)\u003c/p\u003e\n\u003cp\u003echronic kidney disease (CKD)\u003c/p\u003e\n\u003cp\u003eAmerican College of Obstetricians and Gynecologists (ACOG)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The International Society for the Study of Hypertension in Pregnancy (ISSHP),\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ebody mass index (BMI)\u003c/p\u003e\n\u003cp\u003eserum creatinine (Cr)\u003c/p\u003e\n\u003cp\u003eserum uric acid (UA)\u003c/p\u003e\n\u003cp\u003ealanine transaminase (ALT)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;disseminated intravascular coagulation (DIC)\u003c/p\u003e\n\u003cp\u003eNeonatal intensive care unit (NICU)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;SVD Spontaneous vaginal delivery\u003c/p\u003e\n\u003cp\u003eWBN: Well-Baby Nursery\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eintrauterine death (IUD)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Exemption and Consent to Participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Formal ethical exemption for this research study was obtained from the Ethics Review Committee of Aga Khan University Hospital, Karachi, Pakistan (AKU ERC Number: 2023-8790-25581). As this was a retrospective study, the requirement for informed consent was waived by the Ethics Review Committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publication:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003cbr\u003e\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was required or obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp;* \u0026nbsp; Dr Hiba Arshad Shaikh contributed to manuscript preparation.\u003cbr\u003e\u0026nbsp; \u0026nbsp;* \u0026nbsp; Dr Durr-e-Shawar contributed to the conception and design of the study.\u003cbr\u003e\u0026nbsp; \u0026nbsp;* \u0026nbsp; Amir Raza performed the statistical analysis.\u003cbr\u003e\u0026nbsp; \u0026nbsp;* \u0026nbsp; Dr Ayesha Ali contributed to data collection.\u003cbr\u003e\u0026nbsp; \u0026nbsp;* \u0026nbsp; Dr Hafsa Tehseen contributed to data collection.\u003cbr\u003e\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican College of Obstetricians and Gynecologists. Practice Bulletin 222: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2020;135(6):e237\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProteinuria may be. an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study.Tingting Lei1, Ting Qiu1, Wanyu Liao1, Kangjie Li2, Xinyue Lai1,Hongbo Huang3Rui Yuan4 and Ling Chen5*.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy. 2001;20(1):IX\u0026ndash;XIV.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThangaratinam S, Coomarasamy A, O'Mahony F, Sharp S, et al. Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review. BMJ. 2006;333(7569):546.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShinar 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\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/jp.2015.138\u003c/span\u003e\u003cspan address=\"10.1038/jp.2015.138\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouzari Z, Javadiankutenai M, Darzi A, Barat S. Does proteinura in preeclampsia have enough value to predict pregnancy outcome? Clin Exp Obstet Gynecol. 2014;41(2):163\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLei T, Qiu T, Liao W, et al. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reprod Biol Endocrinol. 2021;19(1):71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12958-021-00751-y\u003c/span\u003e\u003cspan address=\"10.1186/s12958-021-00751-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eC\u0026ocirc;t\u0026eacute; AM, Brown MA, Lam E, von Dadelszen P, Firoz T, Liston RM, Magee LA. Diagnostic accuracy of urinary spot protein: creatinine ratio for proteinuria in hypertensive pregnant women: systematic review. BMJ. 2008;336(7651):1003\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu M, Shi J, Lu W. Association between proteinuria and adverse pregnancy outcomes: a retrospective cohort study. J Obstet Gynaecol. 2023;43(1):2126299.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis. 2013;20(3):209\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConrad KP, Davison JM. The renal circulation in normal pregnancy and preeclampsia: is there a place for relaxin? Am J physiology-Renal Physiol. 2014;306(10):F1121\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHladunewich MA. Chronic kidney disease and pregnancy. InSeminars in Nephrology 2017 Jul 1 (Vol. 37, No. 4, pp. 337\u0026ndash;46). WB Saunders.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrane NK, Hamrahian M. Pregnancy: kidney diseases and hypertension. Am J Kidney Dis. 2007;49(2):336\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaynard SE, Thadhani R. Pregnancy and the kidney. J Am Soc Nephrol. 2009;20(1):14\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi B, Lin L, Yang H, Zhu Y, Wei Y, Li X, Chen D, Zhao X, Cui S, Ding H, Ding G. The value of the 24-h proteinuria in evaluating the severity of preeclampsia and predicting its adverse maternal outcomes. Hypertens Pregnancy. 2018;37(3):118\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLei T, Qiu T, Liao W, Li K, Lai X, Huang H, Yuan R, Chen L. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reproductive Biology Endocrinol. 2021;19(1):71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu X, Wang Y, Xu H, Kang Y, Zhu Q. Association between proteinuria and maternal and neonatal outcomes in pre-eclampsia pregnancy: a retrospective observational study. J Int Med Res. 2020;48(4):0300060520908114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomimatsu T, Mimura K, Matsuzaki S, Endo M, Kumasawa K, Kimura T. Preeclampsia: maternal systemic vascular disorder caused by generalized endothelial dysfunction due to placental antiangiogenic factors. Int J Mol Sci. 2019;20(17):4246.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuida JP, Parpinelli MA, Surita FG, Costa ML. The impact of proteinuria on maternal and perinatal outcomes among women with pre-eclampsia. Int J Gynecol Obstet. 2018;143(1):101\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiao J, Fan W, Zhu Q, Shi Z. Diagnosis of proteinuria using a random urine protein-creatinine ratio and its correlation with adverse outcomes in pregnancy with preeclampsia characterized by renal damage. J Clin Hypertens. 2022;24(5):652\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Proteinuria, pre-eclampsia, fetal outcomes, maternal outcomes, morbidity, mortality, NICU, preterm birth","lastPublishedDoi":"10.21203/rs.3.rs-8416119/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8416119/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePre-eclampsia is a significant contributor to maternal and fetal morbidity and mortality. Although recent guidelines have de-emphasized proteinuria as essential for diagnosis, the degree of proteinuria may still reflect disease severity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The objective of this study is to evaluate maternal and fetal outcomes in pre-eclamptic women stratified by levels of proteinuria.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional observational study included 320 pregnant women diagnosed with pre-eclampsia. Based on spot urinary protein /urinary creatinine ratio (p/c), participants were classified into Group A (\u0026lt;\u0026thinsp;0.3 g), Group B (0.3\u0026ndash;2 g), and Group C (\u0026ge;\u0026thinsp;2 g). Maternal and fetal outcomes were compared across these groups using appropriate statistical tests.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA significantly higher proportion of women in the high-proteinuria group had elevated systolic and diastolic blood pressures. Emergency caesarean section and severe pre-eclampsia were most frequent in the high-proteinuria group. On subgroup analysis, birthweight\u0026thinsp;\u0026lt;\u0026thinsp;2.5kg was clinically significant in patients with proteinuria of more than 2 grams. However, no statistically significant differences were found among the groups regarding age, BMI, gestational age at booking/delivery, laboratory parameters, or most fetal outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHigher levels of proteinuria are associated with increased maternal complications, particularly severe hypertension and preeclampsia, but not necessarily with worse fetal outcomes.\u003c/p\u003e","manuscriptTitle":"Maternal and Fetal Outcomes in Pre-eclamptic Patients – Differentiation Based on the Level of Proteinuria in tertiary care centre","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 14:11:25","doi":"10.21203/rs.3.rs-8416119/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T22:34:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215166954143468228267783957614948487334","date":"2026-05-17T00:25:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-16T22:05:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5386403431118713144464312812639362514","date":"2026-05-16T19:36:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T13:01:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44750967831770363160377986982388196391","date":"2026-05-15T12:53:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14168237842945413984580110949041841479","date":"2026-05-14T18:51:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67332165350049970198816173825058466625","date":"2026-05-08T01:28:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211988127024241288667874647564225791849","date":"2026-02-11T07:00:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T06:36:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T06:26:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-21T17:48:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-18T16:12:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-01-18T16:06:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7018b89c-abed-4f06-8728-4638d9751e7b","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T22:34:13+00:00","index":98,"fulltext":""},{"type":"reviewerAgreed","content":"215166954143468228267783957614948487334","date":"2026-05-17T00:25:39+00:00","index":97,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-16T22:05:55+00:00","index":96,"fulltext":""},{"type":"reviewerAgreed","content":"5386403431118713144464312812639362514","date":"2026-05-16T19:36:48+00:00","index":95,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T13:01:44+00:00","index":94,"fulltext":""},{"type":"reviewerAgreed","content":"44750967831770363160377986982388196391","date":"2026-05-15T12:53:24+00:00","index":93,"fulltext":""},{"type":"reviewerAgreed","content":"14168237842945413984580110949041841479","date":"2026-05-14T18:51:54+00:00","index":92,"fulltext":""},{"type":"reviewerAgreed","content":"67332165350049970198816173825058466625","date":"2026-05-08T01:28:25+00:00","index":83,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T14:11:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 14:11:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8416119","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8416119","identity":"rs-8416119","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}