Population-level data on antenatal screening for proteinuria; India, Mozambique, Nigeria, Pakistan.
Bull World Health Organ
; 98(10): 661-670, 2020 Oct 01.
Article
em En
| MEDLINE
| ID: mdl-33177756
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diagnóstico Pré-Natal
/
Cesárea
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Female
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Humans
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Pregnancy
País/Região como assunto:
Africa
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Asia
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article