(566) Association of Proteinuria with Latency in Expectantly Managed Early-Onset Preeclampsia with Severe Features

Although the role of proteinuria in the classification and stratification of preeclampsia has declined over time, it is still a marker of kidney dysfunction in those with serum creatinine of < 1.1 mg/dl. This study aimed to evaluate if presence of proteinuria (urine protein-creatinine ratio [UPCr] ≥0.3 or 24-hour urine protein ≥300mg) in expectantly managed preeclampsia with severe features before 33 weeks was associated with latency from diagnosis to delivery.

Study Design:

A single center retrospective cohort study from 2018 to 2025 including singletons diagnosed with preeclampsia with severe features between 23 weeks 0 days and 32 weeks 6 days gestation for whom urine protein was available. Exclusion criteria were chronic hypertension or contraindications to expectant management (placental abruption, intrauterine fetal demise, acute kidney injury, pulmonary edema, HELLP syndrome, eclampsia). The primary outcome was latency (days) between those patients with and without proteinuria. Following adjustment, multivariable linear regression was used to calculate the effect size (B) with 95% confidence intervals (CI).

Results:

160 patients were identified; 128 (80%) had proteinuria, and 32 (20%) did not. Those with proteinuria had higher rates of pregestational diabetes (12.5% vs. 0%, p= 0.04). Median latency in patients without proteinuria was longer (9.5, IQR 3-20) than in patients with proteinuria (4, IQR 2-9) (p= 0.02). Following adjustment for pregestational diabetes, the presence of proteinuria was associated with shorter latency (OR 5.59, 95% CI 1.34-9.83). Additionally, higher UPCr levels were associated with shorter latency in a dose-dependent manner (p=0.01; Figure). The rate of composite maternal adverse outcomes did not differ between groups (Table).

Conclusion:

Among expectantly managed patients, the presence of proteinuria was associated with a more than 5-day shorter latency period. These findings suggest that proteinuria may be a useful predictor of latency and could be considered in the design of clinical trials focused on prolonging pregnancy in this population.