İUGR Tanısı Anında Saptanan Proteinürinin Preeklampsi veya Gestasyonel Hipertansiyon Gelişimini Öngörmedeki Değeri İUGR Olgularında Preeklampsinin Erken Belirteci Olarak Proteinüri

Öz

İntrauterin büyüme kısıtlılığı (İUGR), esas olarak uteroplasental yetersizlik ve maternal vasküler disfonksiyon sonucu gelişen, perinatal morbidite ve mortalitenin önemli nedenlerinden biridir. Proteinüri klasik olarak preeklampsi tanı kriterlerinden biri olarak kabul edilse de, İUGR ile komplike olmuş normotansif gebeliklerde de öngörü değeri taşıyabilir. Bu çalışmanın amacı, İUGR tanısı anında saptanan proteinürinin sonraki dönemde preeklampsi veya gestasyonel hipertansiyon (PE/GHT) gelişimini öngörüp öngörmediğini değerlendirmektir. Bu retrospektif kohort çalışmaya, 24–32. gebelik haftaları arasında İUGR tanısı alan 180 kadın dahil edilmiştir. Kronik hipertansiyon, böbrek hastalığı, diyabet veya çoğul gebeliği olan olgular dışlanmıştır. Proteinüri, 24 saatlik idrar toplama (n = 106) veya spot idrar protein/kreatinin (Pr/Cr) oranı (n = 74) ile değerlendirilmiş; ≥300 mg/gün veya Pr/Cr ≥0,30 proteinüri olarak kabul edilmiştir. Birincil sonuç değişkeni, preeklampsi veya gestasyonel hipertansiyon gelişimi olup, alıcı işletim karakteristiği (ROC) eğrisi analizi ile öngörü gücü değerlendirilmiştir. Proteinürisi olan olguların %68,8’i (24 saatlik test) ve %75,0’ı (spot test) PE/GHT geliştirmiştir; buna karşın proteinürisi olmayanlarda bu oran sırasıyla %16,2 ve %17,6’dır (her ikisi için p < 0,001). AUC değerleri sırasıyla 0,82 ve 0,89 bulunmuştur. Proteinürisi pozitif kadınlarda PE/GHT gelişme olasılığı yaklaşık 4–5 kat daha yüksektir. İUGR tanısı anında saptanan proteinüri, sonraki hipertansif hastalıklar için güçlü bir öngördürücüdür. Spot Pr/Cr oranı, 24 saatlik testle benzer doğruluk göstermiş olup, normotansif İUGR gebeliklerinde erken risk değerlendirmesi için pratik ve hızlı bir yöntemdir.

Anahtar Kelimeler

• İntrauterin büyüme kısıtlılığı
• Proteinüri
• Preeklampsi
• Gestasyonel hipertansiyon
• Protein/kreatinin oranı
• Öngörü
• Plasental yetersizlik

Predictive Value of Proteinuria at the Time of IUGR Diagnosis for the Development of Preeclampsia or Gestational Hypertension

Öz

Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality, primarily resulting from uteroplacental insufficiency and maternal vascular dysfunction. Although proteinuria is traditionally a diagnostic criterion for preeclampsia, it may also have predictive value in normotensive pregnancies complicated by IUGR. This study aimed to evaluate whether proteinuria detected at the time of IUGR diagnosis in normotensive pregnancies predicts subsequent development of preeclampsia or gestational hypertension (PE/GHT). This retrospective cohort study included 180 women diagnosed with IUGR between 24–32 weeks of gestation at a tertiary perinatal center. Women with chronic hypertension, renal disease, diabetes, or multiple gestation were excluded. Proteinuria was assessed by either 24-hour urine collection (n = 106) or spot urine protein/creatinine (Pr/Cr) ratio (n = 74). Proteinuria was defined as ≥300 mg/day or Pr/Cr ≥0.30. The primary outcome was development of PE/GHT, analyzed using receiver operating characteristic (ROC) curves. In the 24-hour urine group, 68.8% of proteinuria-positive women and 16.2% without proteinuria developed PE/GHT (p < 0.001; AUC = 0.82, optimal cut-off 319.6 mg/day). In the spot Pr/Cr group, 75.0% of proteinuria-positive and 17.6% of proteinuria-negative women developed PE/GHT (p < 0.001; AUC = 0.89, cut-off 0.30). Proteinuria-positive women were approximately 4–5 times more likely to develop PE/GHT. Proteinuria detected at IUGR diagnosis—whether measured by 24-hour urine or spot Pr/Cr ratio—is a strong predictor of later hypertensive disorders. The spot Pr/Cr ratio provides comparable predictive accuracy and represents a practical, rapid screening method for early risk assessment in normotensive IUGR pregnancies.

Anahtar Kelimeler

• Intrauterine growth restriction
• Proteinuria
• Preeclampsia
• Gestational hypertension
• Protein/creatinine ratio
• Prediction
• Placental insufficiency

Kaynakça

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