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Clinical significance of severe proteinuria in preeclampsia: a multicenter study of maternal and neonatal outcomes

Hypertension Research volume 48, pages 2991–3008 (2025)Cite this article

Abstract

This study aimed to determine the association between proteinuria severity and maternal/neonatal outcomes among preeclamptic women with hypertension with proteinuria. We retrospectively assessed 721 women at 11 institutions. All participants had singleton pregnancies and delivered at ≥22 gestational weeks. They were diagnosed with preeclampsia (excluding superimposed preeclampsia) after 20 gestational weeks and had results from a spot urine protein/creatinine ratio test at delivery. The severe proteinuria significantly increased the frequency of preterm delivery in the both women of severe and nonsevere hypertension (72.3% vs. 49.9%, 57.5% vs. 24.8%, p < 0.001, respectively). In the nonsevere hypertension and severe proteinuria group comparison with the severe hypertension and nonsevere proteinuria group, the frequency of women with pulmonary edema/pleural effusion onset was significantly higher (15.0% vs. 5.8%, p = 0.041) and the median serum albumin was significantly lower (2.6 g/dL vs. 2.8 g/dL, p < 0.001). Furthermore, the serum albumin was the laboratory findings with the highest relationship to u-P/C ratio at delivery. Women with preeclampsia with severe hypoalbuminemia had a significant high risk of developing severe proteinuria and pulmonary edema/pleural effusion at delivery than those without severe hypoalbuminemia, respectively. However, severe hypoalbuminemia was not the risk factor for severe hypertension in women with preeclampsia. Women with preeclampsia with severe proteinuria would have worse maternal outcome (pulmonary edema and/or pleural effusion induced by hypoalbuminemia) than those with severe hypertension. In conclusion, obstetricians should be aware of the risk of maternal pulmonary edema/pleural effusion in cases of preeclampsia with nonsevere hypertension with severe proteinuria.

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Acknowledgements

The authors thank the Japan Society for the Study of Hypertension in Pregnancy (JSSHP). In particular, we thank Dr. Manabu Ogoyama (Jichi Medical University) and Tomohito Okamoto (Aichi Medical University) for their support with data collection. The authors thank Enago (www.enago.jp) for the English language review.

Funding

MM received funding for this work from the Japan Society for the Study of Hypertension in Pregnancy (JSSHP).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Osaka, Japan

    Mamoru Morikawa

  2. Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan

    Akihide Ohkuchi & Hirotada Suzuki

  3. Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan

    Takayuki Iriyama & Yu Ariyoshi

  4. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Kazuya Mimura

  5. Department of Obstetrics and Gynecology, School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan

    Kazushi Watanabe

  6. Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    Takafumi Ushida

  7. Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan

    Tomoyoshi Nohira

  8. Department of Regional Pediatrics and Perinatology, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan

    Keiichi Matsubara

  9. Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan

    Ikuno Kawabata

  10. Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan

    Shintaro Maki

  11. Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Tochigi, Japan

    Katsuhiko Naruse

  12. Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan

    Hiroyuki Seki

  13. Department of Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan

    Ichihara Atsuhiro

  14. Department of Obstetrics and Gynecology, Toyama University, Toyama, Toyama, Japan

    Shigeru Saito

Authors
  1. Mamoru Morikawa
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  2. Akihide Ohkuchi
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  3. Takayuki Iriyama
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  4. Kazuya Mimura
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  5. Kazushi Watanabe
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  6. Takafumi Ushida
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  7. Tomoyoshi Nohira
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  8. Keiichi Matsubara
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  9. Ikuno Kawabata
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  10. Shintaro Maki
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  11. Katsuhiko Naruse
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  12. Hirotada Suzuki
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  13. Yu Ariyoshi
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  14. Hiroyuki Seki
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  15. Ichihara Atsuhiro
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  16. Shigeru Saito
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Correspondence to Mamoru Morikawa.

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Morikawa, M., Ohkuchi, A., Iriyama, T. et al. Clinical significance of severe proteinuria in preeclampsia: a multicenter study of maternal and neonatal outcomes. Hypertens Res 48, 2991–3008 (2025). https://doi.org/10.1038/s41440-025-02360-3

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