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Hypertension in pregnancy: maternal and fetal outcomes according to laboratory and clinical features

Mark A Brown and Megan L Buddle
Med J Aust 1996; 165 (7): 360-365.
Published online: 9 September 1999
Research

Hypertension in pregnancy: maternal and fetal outcomes according to laboratory and clinical features

Mark A Brown and Megan L Buddle

MJA 1996; 165: 360-365

Abstract - Introduction - Methods - Results - Discussion - Acknowledgements - References - Authors' details
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Abstract Objectives: To determine the predictive value of clinical and laboratory parameters for maternal and fetal complications in pregnant women with hypertension.
Design: Prospective data collection.
Setting: Two primary referral hospitals in the southern suburbs of Sydney between March 1987 and July 1994.
Subjects: 1183 pregnant women with hypertension managed conjointly by a physician and obstetrician.
Intervention: Uniform management protocol, plus antihypertensive medications if systolic blood pressure was persistently ≥ 160 mmHg and/or diastolic blood pressure ≥ 90 mmHg.
Main outcome measures: Maternal and fetal complications, as defined by the Australasian Society for the Study of Hypertension in Pregnancy Consensus Statement.
Results: Of 825 women with pre-eclampsia (502 mild; 323 severe), univariate analysis showed that hyperuricaemia, proteinuria and severe hypertension were significantly associated with a higher rate of maternal and fetal complications. In multivariate analyses without confounders, only primiparity, low serum albumin levels and absence of diabetes were significantly associated with severe pre-eclampsia. Severe pre-eclampsia, high haemoglobin levels and low platelet count were associated with higher rates of small-for-gestational-age babies, but only low serum albumin levels were associated with increased perinatal mortality rates. Low birthweight was associated with severe hypertension and severe pre-eclampsia.
Conclusions: Simple clinical and laboratory parameters are useful predictors for maternal and fetal outcomes in pregnancies complicated by hypertension.


Introduction Hypertensive disorders in pregnancy are common and their incidence appears to be increasing.1 These disorders comprise hypertension de novo in pregnancy (variably called pre-eclampsia, gestational or transient hypertension), and chronic forms of hypertension (essential and secondary hypertension), and have multiple modes of clinical presentations.

With the current emphasis on outpatient management of pregnant women with non-proteinuric hypertension,2 clinicians require readily available clinical and laboratory parameters as indicators of the likely outcome of pregnancies complicated by hypertension. Such information is often difficult to obtain because of the selective nature of cases and complications reported by high-risk tertiary-care obstetric units, and is confounded by the varying treatments given to pregnant women before referral.3,4

Our study examined prospectively the maternal and fetal outcomes in women with hypertension in pregnancy, and the associated clinical and laboratory features. In particular, we sought to determine whether complications were greater if the woman had hyperuricaemia, severe hypertension and/or proteinuria, was nulliparous, or presented with hypertension early in the pregnancy. We also sought to determine which clinical and laboratory features were associated with severe pre-eclampsia.


Methods The study group consisted of all pregnant women with hypertension who were referred by their obstetrician to one physician (M A B) at primary referral hospitals (St George or Hurstville community hospitals) in Sydney between March 1987 and July 1994.

Indications for referral were:

  • Hypertension failing to settle after overnight rest in hospital, or repeated measurement in a day-only unit;

  • The presence of proteinuria or other abnormal urinalysis, abnormal biochemistry (serum electrolytes and creatinine levels, liver function tests) or thrombocytopenia;

  • Recurrent admissions for hypertension; or

  • A suspected secondary cause for hypertension.

The definitions, classifications and complications of hypertension in pregnancy used in our study were those of the Australasian Society for the Study of Hypertension in Pregnancy (ASSHP) (Boxes 1 and 2).5

The maternal biochemical and haematological data used in our analysis were those recorded immediately before delivery. Complications were those having occurred by the time of discharge from hospital or by the postpartum check-up (after three months).

Each patient's management was overseen by one physician (M A B) in conjunction with the patient's obstetrician. A standardised management protocol was followed by all staff during the course of this study (Box 3).

Statistical analysis
All data were stored in a database program (iBANK) and analysed using Minitab statistical package6 and BMDP statistical software.7

For initial bivariate analyses, the frequency of adverse events within groups was tested by χ2 analysis and, where significant, by 2 x 2 contingency tables. Biochemical and haematological indices and birthweights were compared using Student's t tests, and significance assessed using Hochberg's method for interpreting multiple comparisons.

The maternal-outcome variable was severity of pre-eclampsia. Logistic regression analysis was used to analyse the following variables as predictors of severe pre-eclampsia: parity; gestation at presentation; age; plasma uric acid level; serum albumin, haemoglobin and haematocrit levels; and diabetes. Proteinuria, platelet count and serum creatinine levels were not analysed because abnormalities of these form part of the diagnosis of severe pre-eclampsia.

Fetal-outcome variables were birthweight, small-for-gestational-age (SGA) and perinatal mortality (PNM). Each of the following variables was analysed as a predictor of poor fetal outcome: maternal complications, age, parity, diabetes, gestation at presentation and laboratory data. Multiple regression analysis was used for birthweight and logistic regression analysis for SGA and PNM.

For regressions, backward elimination was used until all remaining predictors were statistically significant (P < 0.05).


Results
Clinical details From March 1987 to July 1994, 1183 pregnant women with hypertension fulfilled the criteria for referral to a physician (M A B) and were entered into the study, representing 6.7% of all confinements at the two hospitals. During this period, 2121 women were documented in hospital records as having hypertension in pregnancy, representing 12% of all confinements.

There were 825 women (70%) with pre-eclampsia (mild, 502; severe, 323), 82 (7%) with superimposed pre-eclampsia, 223 (19%) with essential hypertension, and 53 (4%) with secondary hypertension (predominantly renal disease).

Oral antihypertensive medications were given to 563 women (48%), additional parenteral antihypertensives were required by 281 (24%), and 339 (29%) received no antihypertensive medications. Thirteen women (1%) received "prophylactic" low-dose aspirin.

Five women (0.4%) required dialysis during or after pregnancy and four women (0.3%) had convulsions. Seventy-three women (6%) had pre-existing or gestational diabetes mellitus.

Of the 1242 babies born to the women in the study, there were 15 perinatal deaths (12 per 1000 hypertensive pregnancies). There was one maternal death (0.08%) in a 29-year-old woman who presented at 29 weeks' gestation with severe pre-eclampsia and who delivered immediately and died unexpectedly the next day. Despite autopsy, the cause of death was not established.

Predictors of outcomes in women with pre-eclampsia
Univariate analysis
Hyperuricaemia was significantly associated with higher rates of all maternal complications and SGA babies and babies with lower average birthweights than normal plasma uric acid levels (Box 4).

Severe hypertension was significantly associated with higher maternal complication rates and earlier gestation at delivery than mild hypertension (Box 4). This group of women had babies of a lower average birthweight, a higher proportion of SGA babies and a higher perinatal mortality rate.

Proteinuria was significantly associated with similar maternal and fetal complication rates as severe hypertension, and the proportion of SGA babies was similar to non-proteinuric hypertension (Box 4).

Parity did not affect maternal complication rates, except for a higher prevalence of severe hypertension and liver disease in nulliparae (Box 5).

Early gestation at presentation with hypertension (at or before 32 weeks' gestation) was significantly associated with a higher prevalence of proteinuria than later presentation (Box 5).

Multivariate analysis
Severe pre-eclampsia was associated with low serum albumin (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.90-0.97; P = 0.0001), primiparity (OR, 0.51; 95% CI, 0.33-0.79; P = 0.002) and the absence of diabetes (OR, 0.21; 95% CI, 0.05-0.93; P = 0.04).

SGA was associated with severe pre-eclampsia (OR, 2.5; 95% CI, 1.6-3.9; P = 0.0001), high maternal haemoglobin levels (OR, 3.7; 95% CI, 1.1-12.8; P = 0.04) and low platelet counts (OR, 1.4; 95% CI, 1.1-1.8; P = 0.02).

Birthweight was positively associated with gestation at presentation (regression coefficient [β], 41; standard error [SE], 5; P < 0.0001) and serum albumin levels (β, 28; SE, 5; P < 0.0001) and inversely associated with severe hypertension (β, 2193; SE, 69; P < 0.005) and severe pre-eclampsia (β, 2311; SE, 60; P < 0.0001).

Perinatal mortality was associated only with low serum albumin levels (OR, 0.88; 95% CI, 0.82-0.95; P < 0.0003), but there were too few perinatal deaths to support a useful formal analysis.

Outcomes in women with all forms of hypertension in pregnancy
Box 6 shows the maternal and fetal outcomes in women with the different forms of hypertension in pregnancy.

Maternal and fetal outcomes were better for women with essential hypertension than for the other groups. Twenty-seven per cent (or 10% if proteinuria was included in the diagnosis) of women with essential hypertension developed superimposed pre-eclampsia.

Women with superimposed pre-eclampsia delivered their babies earlier, had babies with lower average birthweights, significantly more SGA babies and significantly higher rates of all maternal complications than women with essential hypertension alone.

Women with secondary (predominantly renal) hypertension had similar maternal and fetal outcomes to women with superimposed pre-eclampsia (data available from author).


Discussion In our prospective study, there was uniform management of all women with hypertensive disorders in pregnancy. As the database excluded very mild cases of hypertension in pregnancy, an inherent bias exists, but our study provides a general estimate of fetal and maternal outcomes for women with hypertension managed in primary referral hospitals.

During the study period, 12% of all confinements were complicated by hypertension, which is either similar to or higher than previous reports.8-11 Hjertberg et al. noted a 5% incidence of hypertension in pregnancy, of whom 83% had hypertension de novo in pregnancy.12 In our study, 70% of women had pre-eclampsia (hypertension de novo in pregnancy), 19% had essential hypertension alone, 7% had superimposed pre-eclampsia, and 4% had a renal or other secondary cause. These results are similar to those from a smaller study in a tertiary referral unit.13

When analysed separately, hyperuricaemia, proteinuria and severe hypertension were associated with higher rates of all maternal and fetal complications, while parity was associated with severe hypertension and liver disease. Presentation before 32 weeks' gestation impacted negatively on fetal outcome. We have reported previously on the adverse impact of proteinuria on maternal and fetal outcomes.14

Hyperuricaemia is an established marker of severe pre-eclampsia, correlating histologically with the severity of renal lesions,15 and clinically with adverse fetal outcomes.16 We found that hyperuricaemia, when considered alone, was associated with higher maternal complication rates and fetal growth retardation, but, with multivariate analysis, was not a significant predictor of adverse maternal or fetal outcomes. Hyperuricaemia remains a useful marker of pre-eclampsia, but women with normal serum uric acid levels and pre-eclampsia may still develop complications.

Severe hypertension was confirmed by multivariate analysis to be associated with low birthweight babies, and, in univariate analysis, with a higher incidence of all fetal complications and a higher incidence of SGA babies. Therefore, the more severe the hypertension, the more the likelihood of fetal as well as maternal complications.

Pre-eclampsia has long been considered a disorder of primigravidae.17 However, it is clear that pre-eclampsia does occur in second or subsequent pregnancies (particularly following a change of partner); in our study, approximately two-fifths of the women with pre-eclampsia were parous women. Parous women had a lower incidence of severe hypertension and liver disease when compared with nulliparae, but there were no other differences in outcomes between these groups. Therefore, equal risk to the fetus should be assumed in both groups of women once hypertension has developed in the second half of pregnancy.

The gestation at presentation in pre-eclampsia influences fetal outcome because of the likelihood of early delivery, but we are unaware of any prospective studies that relate gestation at presentation to maternal complication rates. Apart from proteinuria, maternal complication rates for women presenting before 33 weeks' gestation in our study were similar to those who presented later. Two retrospective studies have reported a higher incidence of maternal complications in women with pre-eclampsia of early onset.18,19 Our patients presenting early with pre-eclampsia had milder disease than that reported by Sibai et al.20 As expected, the earlier the gestation with pre-eclampsia the lower the birthweight (because gestation did not proceed as far as those presenting later), but the likelihood of having an SGA baby was not increased.

Although maternal diabetes was associated with a lower risk of severe pre-eclampsia, only 6% of our study population had diabetes. Therefore, it should not be assumed that diabetes protects pregnant women against severe pre-eclampsia.

The consistent relationship between low serum albumin levels and adverse maternal and fetal outcomes was independent of proteinuria and implies that hepatic albumin synthesis is altered in severe pre-eclampsia. The association between high maternal haemoglobin levels and SGA babies presumably reflects a reduced plasma volume and haemoconcentration, which is associated with poor fetal growth.21

In conclusion, for women with pre-eclampsia, the traditional clinical markers of proteinuria, parity and severe hypertension remain useful clinical indices of maternal risk, while severe pre-eclampsia, severe hypertension, elevated haemoglobin and low serum albumin levels portend increased fetal risk.



Acknowledgements
We wish to thank the obstetricians of St George and Hurstville community hospitals, Professor J A Whitworth, Ms Jodie Wilkinson and Dr M Jones (Intstat Australia Pty Ltd).


References
  1. Crawford JS. Epidemic pre-eclampsia. Lancet 1987; 1: 329-330.
  2. Tuffnell DJ, Lilford RJ, Buchan PC, et al. Randomised controlled trial of day care for hypertension in pregnancy. Lancet 1992; 339: 224-227.
  3. Horvath JS, Korda A, Child A, et al. Hypertension in pregnancy. A study of 142 women presenting before 32 weeks' gestation. Med J Aust 1985; 143: 19-21.
  4. Clarke M, Mason ES, Macvicar J, Clayton DG. Evaluating perinatal mortality rates: effects of referral and case mix. BMJ 1993; 306: 824-827.
  5. Australasian Society for the Study of Hypertension in Pregnancy. Consensus Statement on Management of Hypertension in Pregnancy: Executive Summary. Med J Aust 1993; 158: 700-702.
  6. Minitab [computer program], version 9.1. Pennsylvania State College: Minitab Inc, 1993.
  7. BMDP [computer program]. Berkeley, Calif: University of California, 1990.
  8. Martikainen AM, Heinonen KM, Saarikoski SV. The effect of hypertension in pregnancy on fetal and neonatal condition. Int J Gynaecol Obstet 1989; 30: 213-220.
  9. Andrews WW, Cox SM, Sherman ML, Leveno KJ. Maternal and perinatal effects of hypertension at term. J Reprod Med 1992; 37: 73-76.
  10. Safflas AF, Oldson DR, Franks AL, et al. Epidemiology of pre-eclampsia and eclampsia in the United States, 1979-1986. Am J Obstet Gynecol 1990; 163: 460-465.
  11. Pietrantoni M, O'Brien WF. The current impact of the hypertensive disorders of pregnancy. Clin Exp Hypertens 1994; 16: 479-492.
  12. Hjertberg R, Bellrage P, Hanson U. Conservative treatment of mild and moderate hypertension in pregnancy. Acta Obstet Gynecol Scand 1992; 71: 439-446.
  13. Horvath JS, Phippard A, Henderson-Smart D, et al. High risk hypertensive pregnancies: maternal and foetal outcome. Clin Exp Hypertens Pregnancy 1983; B2: 21-28.
  14. Brown MA, Buddle ML. The importance of non proteinuric hypertension in pregnancy. Hypertens Pregnancy 1995; 14: 57-65.
  15. Pollak VE, Nettles JB. The kidney in toxemia of pregnancy: a clinical and pathologic study based on renal biopsies. Medicine (Baltimore) 1960; 39: 469-526.
  16. Redman CWG, Beilin LJ, Bonnar J, Wilkinson PH. Plasma urate measurements in predicting fetal death in hypertensive pregnancy. Lancet 1976; 2: 1370-1373.
  17. Chesley LC. Diagnosis of pre-eclampsia. Obstet Gynecol 1985; 65: 423-425.
  18. Sibai BM, Taslimi M, Abdella TN, et al. Maternal and perinatal outcome of conservative management of severe pre-eclampsia in midtrimester. Am J Obstet Gynecol 1985; 152: 32-37.
  19. Railton A, Allen DG. Management and outcome of pregnancy complicated by severe pre-eclampsia of early onset. S Afr Med J 1987; 72: 608-610.
  20. Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe pre-eclampsia at 28 to 32 weeks' gestation: a randomized controlled trial. Am J Obstet Gynecol 1994; 171: 818-822.
  21. Brown MA, Zammit VC, Mitar DM. Extracellular fluid volumes in pregnancy-induced hypertension. J Hypertens 1992; 10: 821-829.

(Received 9 Oct 1995, accepted 13 May 1996)


Authors' details Departments of Medicine, Renal Medicine and Obstetrics, St George and Hurstville community hospitals, University of NSW.
Mark A Brown, MB BS, FRACP, MD, Associate Professor of Medicine;
Megan L Buddle, SRN, Hypertension Unit Registered Nurse.

No reprints will be available.
Correspondence: Associate Professor M A Brown, Department of Renal Medicine, St George Hospital, Kogarah, NSW 2217.
E-mail: "nest::brown"ATdodo.ssahs.unsw.edu.au






1: ASSHP classifications and definitions of hypertension in pregnancy

Hypertension: A sitting systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP (phase IV Korotkoff sound) ≥ 90 mmHg, or a rise in systolic BP of ≥ 25 mmHg and/or diastolic BP ≥ 15 mmHg from first-trimester BP (two readings taken six hours apart).

Proteinuria: ≥ 300 mg/day (24-hour urine collection) or persistently (over two or more days) ≥ 2+ protein (1 g/L) on urinalysis (dipstick testing). As urinalysis was performed daily, non-proteinuric hypertension that progressed to proteinuric hypertension was always detected.

Hyperuricaemia: Plasma uric acid level > 0.35 mmol/L.

Pre-eclampsia: The development of hypertension after 20 weeks' gestation in a woman with no known history of hypertension or renal disease and whose blood pressure (BP) was normal in the first half of the pregnancy and returned to normal after delivery: (i) mild pre-eclampsia: hypertension only; (ii) severe pre-eclampsia: hypertension and evidence of maternal organ dysfunction (see Maternal complications, Box 2).

Essential hypertension: Hypertension in the first half of pregnancy (often occurring before pregnancy) without a demonstrable secondary cause, or the appearance of hypertension in the second half of pregnancy in a woman whose BP failed to return to normal within three months after delivery.

Superimposed pre-eclampsia: The development of proteinuria and/or hyperuricaemia in the second half of pregnancy in a woman with essential hypertension. Secondary hypertension: To exclude a secondary cause of hypertension, all women had serum potassium levels measured and had urinalysis, microscopy and a clinical examination; urinary catecholamines and renal ultrasound were performed in selected cases. Within this group, superimposed pre-eclampsia was not diagnosed as a separate entity as it was too difficult to ascertain whether changes (e.g., increasing proteinuria) reflected superimposed pre-eclampsia or progression of the underlying (usually renal) disease.


ASSHP = Australasian Society for the Study of Hypertension in Pregnancy.5
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2: ASSHP complications of hypertension in pregnancy

Maternal complications:
(i)Severe hypertension: Blood pressure (BP) ≥ 170 mmHg systolic and/or ≥ 110 mmHg diastolic;
(ii)Proteinuria (Box 1);
(iii)Haematological abnormalities: haemolysis (haemoglobin < 110g/L, with reticulocytosis, fragments) or thrombocytopenia (< 150 x 109/L platelets);
(iv)Renal impairment: serum creatinine level ≥ 0.10 mmol/L;
(v)Liver disease: elevated serum aspartate aminotransferase level > 40 IU/L, with or without severe epigastric pain;
(vi)Neurological disturbances: visual scotoma; severe headaches with hyperreflexia; hyperreflexia with sustained clonus (> 3 beats).
Fetal complications:
(i)Small-for-gestational-age (SGA): birthweight below the 10th centile for gestation, corrected for sex;
(ii)Perinatal mortality (PNM): stillbirths and neonatal deaths per 1000 hypertensive pregnancies.

ASSHP = Australasian Society for the Study of Hypertension in Pregnancy.5
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3: Management protocol during pregnancy

Maternal complications:

  • Blood pressure (BP) measurements six times per day;
  • Fetal cardiotocograph recordings on alternate days (or more often if clinically indicated);
  • Daily urinalysis;
  • Biochemistry and haematological testing at least twice weekly;
  • Bedrest if there is evidence of intrauterine fetal growth retardation, or maternal neurological features or severe hypertension.

Antihypertensive therapy:

  • Oral antihypertensive therapy (single agent or combinations) of oxprenolol, hydralazine, methyldopa, prazosin or nifedipine was instituted if the systolic BP was persistently > 160 mmHg or diastolic BP persistently > 90 mmHg after overnight bedrest in hospital.
  • Parenteral antihypertensive therapy (sublingual nifedipine or intravenous hydralazine) was given for severe hypertension (Box 2).
  • Convulsion prophylaxis (intravenous phenytoin followed by oral phenytoin) was used for women with neurological disturbances (Box 2).

Indications for delivery.
Delivery (by induction) was scheduled after 38 weeks' gestation if the BP remained stable and the cervix was favourable.
Indications for delivery before 38 weeks' gestation were:5

  • Fetal compromise: premorbid (cardiotocographic) tracing of fetal heart rate or failure of fetal growth (assessed by doppler ultrasound).
  • Inability to control maternal BP;
  • Persistent neurological disturbances (see Box 2);
  • Progressively rising liver enzyme or serum creatinine levels, or worsening thrombocytopenia.

Women whose pregnancies could not be prolonged beyond 30 weeks' (and occasionally 32 weeks') gestation were sometimes transferred before delivery to a tertiary referral unit with neonatal intensive care facilities. Outcomes of this group were included in our analysis.

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For box 4 click here

5: Maternal and fetal outcomes in women with pre-eclampsia (mild and severe) according to parity and gestation at presentation (see text for definitions). Data are percentages or means (standard deviation).

Gestation at presentation
Nulliparae ParousP ≤ 32 wks> 32 wks P

n508317129696
Age (years)27 (5)30 (5) < 0.0001*29 (5)28 (5)0.30
Nulliparae (%)10000.0001*57630.20
Gestation at presentation (weeks)36 (4)35 (6)0.00927 (7)37 (2)< 0.0001*
Gestation at delivery (weeks)38 (3)38 (2) 0.8935 (4)38 (2)< 0.0001*
Hyperuricaemia (%)61540.0456590.53
Maternal complications
Severe hypertension24%15%0.001*29%19%0.008
Thrombocytopenia11%8%0.1011%10%0.75
Proteinuria21%16%0.0931%17%0.003*
Renal insufficiency8%5%0.089%7%0.27
Liver disease12%6%0.005*15%9%0.04
Neurological13%10%0.4116%11%0.09
Laboratory data
Plasma creatinine (mmol/L).07 (.04).07 (.02).18.08 (.08)0.07 (.02) 0.51
Plasma uric acid (mmol/L).40 (.20).37 (.04) .01.38 (.09)0.39 (0.17)0.66
Plasma albumin (g/L)33 (5)34 (5) .3431 (8)34 (4)0.002*
Haemoglobin (g/L)119 (23)122 (16) .03117 (37)121 (15)0.20
Haematocrit (%)35.1 (5.5)35.9 (5.6) .1033.7 (8.7)35.7 (4.7)0.02
Platelets (x 109/L)223 (82)232 (82) .11206 (95)230 (79)0.009*
Fetal complications
SGA (%)17210.1724180.10
PNM (per 1000)1730.06544< 0.0001*
Birthweight (g)2984 (701)2985 (694) 0.982312 (960)3105 (561)< 0.0001*

* Statistically significant . SGA = small-for-gestational-age. PNM = perinatal mortality.
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6: Maternal and fetal outcomes in women with different forms of hypertension in pregnancy (ASSHP classifications). Data are percentages or means (standard deviation).

Pre-eclampsiaEssential hypertension Superimposed pre-eclampsiaP*

n82523382
Age (years)28 (5)30 (530 (5)> 0.0001
Nulliparae (%)6237560.290.002
Gestation at presentation (weeks)35 (5)26 (10)28 (10) < 0.00010.17
Gestation at delivery (weeks)38 (3)38 (2)36 (1)0.0007< 0.0001
Hyperuricaemia (%)581683< 0.00010.0001
Maternal complications
Severe hypertension21%13%38%0.0005< 0.0001
Thrombocytopenia10%1%16%0.11< 0.0001
Proteinuria19%035%0.0005< 0.0001
Renal insufficiency7%09%0.62< 0.0001
Liver disease10%1%11%0.79< 0.0001
Neurological12%3%20%0.06< 0.0001
Laboratory data
Plasma creatinine (mmol/L)0.07 (0.04)0.06 (0.02)0.07 (0.02)0.78< 0.0001
Plasma uric acid (mmol/L)0.39 (0.16)0.32 (0.25)0.46 (0.35)0.090.002
Plasma albumin (g/L)33 (5)35 (6)33 (5)0.810.04
Haemoglobin (g/L)120 (20)119 (14) 117 (17)0.140.52
Haematocrit (%)35.4 (5.5)35.1 (4.0) 34.7 (5.4)0.290.64
Platelets (x 109/L)226 (82)256 (68) 235 (78)0.360.03
Fetal complications
SGA (%)199280.20< 0.0001
PNM (per 1000)129120.930.80
Birthweight (g)2984 (701)3260 (652) 2795 (935)0.080.0001

* Significance of difference between outcomes for women with pre-eclampsia and superimposed pre-eclampsia (and for women with essential hypertension and superimposed pre-eclampsia). Statistically significant. SGA = small-for-gestational-age. PNM = perinatal mortality. ASSHP = Australasian Society for the Study of Hypertension in Pregnancy.5
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Received 20 September 2018, accepted 20 September 2018

  • Mark A Brown
  • Megan L Buddle


Correspondence: 

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