Incidence and pregnancy outcomes of superimposed preeclampsia with or without proteinuria among women with chronic hypertension

- Exclusion of proteinuria from the diagnostic criteria for preeclampsia is valid.
- Uncontrolled hypertension should be treated as PE superimposed on chronic hypertension.
- Uteroplacental dysfunction should not be treated as PE superimposed on chronic hypertension.

ObjectiveTo investigate the incidence and pregnancy outcomes of superimposed preeclampsia (PE) with or without proteinuria among women with chronic hypertension.MethodsThis retrospective study included 142 women with essential hypertension diagnosed at ⩽20 weeks of gestation, managed at a tertiary center. They were divided into three groups (non-PE, PE with proteinuria, and PE without proteinuria) to compare pregnancy outcomes. The non-PE group was further divided into two subgroups (controlled and uncontrolled hypertension).ResultsThere were 87 women in the non-PE group, 47 in the PE with proteinuria group, and 8 in the PE without proteinuria group. Median gestational age at delivery was 38.7 weeks in the non-PE group, 30.4 in the PE with proteinuria group, and 28.4 in the PE without proteinuria group. In three of the women in the PE without proteinuria group, the diagnostic criteria were fulfilled by liver involvement (complicated by thrombocytopenia in one woman). The remaining five women had uteroplacental dysfunction. The 87 women in the non-PE group were divided into a controlled hypertension subgroup of 75 women and uncontrolled hypertension subgroup of 12. The median gestational age at delivery was 39.1 weeks in the controlled HT subgroup and 34.1 weeks in the uncontrolled hypertension subgroup. The pregnancy outcomes were significantly poorer in the latter group.ConclusionPregnancy outcomes were unfavorable in both the PE without proteinuria and PE with proteinuria groups. Women with non-PE uncontrolled hypertension also had poor pregnancy outcomes, although their outcomes were better than those of women with PE.