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Poster Session 3

Category: Hypertension

Poster Session 3

(698) Clinical Factors Associated with Hyponatremia in Preeclampsia with Severe Features: A Matched Case-control Study

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

A. U. Amanda Nwaba, MD, MPH (she/her/hers)

Resident Physician
NYU Grossman School of Medicine
New York, New York, United States

Coauthor(s)

Meralis V. Lantigua-Martinez, MD

MFM Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York, New York, United States
NK

Nikita A. Kakkad, BA, BS

NYU Grossman School of Medicine
New York, New York, United States
XZ

Xiaoying Zheng, BS

Medical Student
NYU Grossman School of Medicine
New York, New York, United States
Kate Tolleson, BS, MS (she/her/hers)

Medical Student
New York University Grossman School of Medicine
NYU Grossman School of Medicine, New York, United States
Cody Goldberger, MD (she/her/hers)

Resident
Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York, New York, United States
LZ

Linda Zambrano, MD

NYU Grossman School of Medicine
NYU Grossman School of Medicine, New York, United States
SF

Steven Friedman, MS

Associate Research Scientist
Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine
New York, New York, United States
EH

Erinn M. Hade, PhD

Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine
New York, New York, United States
AR

Ashley S. Roman, MD, MPH

MFM Division Director
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York, New York, United States
Christina A. Penfield, MD, MPH

Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York City, New York, United States

Objective:
Hyponatremia is a rare but potentially life-threatening condition associated with preeclampsia. We sought to characterize clinical factors associated with hyponatremia among patients with preeclampsia with severe features (PEC-SF).

Study Design:
We performed a multisite matched case-control study of patients with PEC-SF who delivered > 34 weeks gestation and received magnesium sulfate between 1/2020-6/2024. Cases were defined as new-onset moderate or severe hyponatremia (serum sodium < 130 mEq/L) during the delivery admission. Controls were matched on a 1:1 basis by delivery date, delivery mode, and completed weeks gestation at delivery. We excluded patients with conditions or medications associated with hyponatremia. We evaluated demographics and clinical factors associated with hyponatremia. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals (CI) for categorical covariates, and the Welch method was used to estimate mean difference (MD) and 95% CI assuming unequal variance for continuous characteristics.

Results:
Of 3,293 patients with PEC-SF, 361 patients (11%) developed hyponatremia, and 292 patients met inclusion criteria. Compared to matched controls, cases more often had pregestational diabetes (6.2% vs 2%), lower BMI (32.0 kg/m2 vs. 34.4 kg/m2, 95% CI -3.5, -0.89), and higher maximum creatinine (0.94 mg/dL vs. 0.78 mg/dL, 95% CI 0.08, 0.24). Cases had longer magnesium exposure than controls (30.4 (14.5) vs. 33.5 (14.4) hours, 95% CI 0.69, 5.4). Hyponatremia was more common among those exposed to labor plus cesarean delivery (CD) compared to CD only (OR 1.44, 95% CI 0.92, 2.26) and less common among those diagnosed with PEC-SF postpartum compared to antepartum (OR 0.42, 95% CI 0.26, 0.65). Magnesium diluent was not associated with risk of hyponatremia (Table 2).

Conclusion:
Pregestational diabetes, antepartum PEC-SF, longer magnesium exposure, and exposure to labor plus CD were associated with higher odds of hyponatremia. Thus, there may be a role for monitoring sodium levels during prolonged magnesium exposure, especially after an unsuccessful trial of labor.