Evaluation of the clinical impact of the revised ISSHP and ACOG definitions on preeclampsia

Background: In 2018/2013 both ISSHP and ACOG revised their original statements and postulated new criteria for preeclampsia with and without severe features. Most importantly, preeclampsia can now also be established in the absence of proteinuria when other specific symptoms are present. Objective: What is the clinical impact of the use of three different new definitions for the diagnosis of preeclampsia? Study design: Retrospective cohort study of all pregnant women who gave birth in the Erasmus MC between 01 and 01-2014 and 01-01-2016. Hypertensive disorders of pregnancy (HDP) were defined when blood pressure was elevated at least during two occasions. All HDP cases were classified according to the ISSHP 2001, ISSHP 2018 and ACOG 2013 definitions. Results: In our cohort (N = 4395) 878 patients had HDP (20,0%). The ISSHP 2018/ACOG 2013 definition cause a significant increase in patients with (superimposed) preeclampsia versus the ISSHP 2001 definition, from 272 patients (6,2%) to respectively 360 (8,2%)/290 (6,6%) (p < 0,001/p < 0,001). This increase is due to non-proteinuric preeclampsia cases. According to the ACOG 2013 definition there were 154 (53,1%) cases of preeclampsia with severe features. Neonatal NICU admission rates were almost doubled in the proteinuric preeclampsia group compared to the non-proteinuric preeclampsia group. Discussion: Implementation of the ISSHP 2018/ACOG 2013 definitions cause a shift from gestational hypertension and chronic hypertension towards (superimposed) preeclampsia (relative increase 10%/2%). These increases are caused by inclusion of non-proteinuric cases. More research is necessary into the course and prognosis of especially non-proteinuric preeclampsia cases.