King's College London

Research portal

Population-level data on antenatal screening for proteinuria; india, mozambique, nigeria, pakistan

Research output: Contribution to journalArticlepeer-review

Laura A. Magee, Sumedha Sharma, Esperança Sevene, Rahat N. Qureshi, Ashalata Mallapur, Salésio E. Macuácua, Shivaprasad Goudar, Mrutunjaya B. Bellad, Olalekan O. Adetoro, Beth A. Payne, John Sotunsa, Anifa Valá, Jeffrey Bone, Andrew H. Shennan, Marianne Vidler, Zulfiqar A. Bhutta, Peter von Dadelszen

Original languageEnglish
Pages (from-to)661-670
Number of pages10
JournalBulletin of the World Health Organization
Volume98
Issue number10
DOIs
Published1 Oct 2020

King's Authors

Abstract

Objective To estimate the prevalence and prognosis of proteinuria at enrolment in the 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia cluster randomized trials. Methods We identified pregnant women eligible for inclusion in the trials in their communities in four countries (2013–2017). We included women who delivered by trial end and received an intervention antenatal care visit. The intervention was a community health worker providing supplementary hypertension-oriented care, including proteinuria assessment by visual assessment of urinary dipstick at the first visit and all subsequent visits when hypertension was detected. In a multilevel regression model, we compared baseline prevalence of proteinuria (≥ 1+ or ≥ 2+) across countries. We compared the incidence of subsequent complications by baseline proteinuria. Findings Baseline proteinuria was detected in less than 5% of eligible pregnancies in each country (India: 234/6120; Mozambique: 94/4234; Nigeria: 286/7004; Pakistan: 315/10 885), almost always with normotension (India: 225/234; Mozambique: 93/94; Nigeria: 241/286; Pakistan: 264/315). There was no consistent relationship between baseline proteinuria (either ≥ 1+ or ≥ 2+) and progression to hypertension, maternal mortality or morbidity, birth at <37 weeks, caesarean section delivery or perinatal mortality or morbidity. If proteinuria testing were restricted to women with hypertension, we projected annual cost savings of 153 223 981 United States dollars (US$) in India, US$ 9 055 286 in Mozambique, US$ 53 181 933 in Nigeria and US$ 38 828 746 in Pakistan. Conclusion Our findings question the recommendations to routinely evaluate proteinuria at first assessment in pregnancy. Restricting proteinuria testing to pregnant women with hypertension has the potential to save resources.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454