Hyponatremia among preeclampsia patients – a potential sign of severity
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Chen Remer
Abstract
Objectives
Although hyponatremia in preeclamptic patients was previously described, its significance remains unknown. We aimed to describe the prevalence and clinical significance of hyponatremia among a cohort of preeclamptic patients.
Methods
An electronic medical record based retrospective cohort study included all singleton deliveries at Hadassah University Medical Center between 2003 and 2015. Preeclampsia, with and without severe features, was defined using the American College of Obstetrics and Gynecology (ACOG) Hypertension in Pregnancy Guidelines. Hyponatremia was defined as a sodium (Na) level ≤130 mEq/L, and severe hyponatremia as <125 mEq/L. A group of normotensive pregnant women, matched for gestational age, gravdity and parity, served as control.
Results
A total of 700 preeclamptic patients were identified during the study period. Hyponatremia was noted in 14.6% compared to 0 of 79 patients in the control group. Hyponatremia was strongly correlated with severe features of preeclampsia, adverse neonatal and obstetrical outcome. Severe hyponatremia was strongly correlated with preeclampsia with severe features. Furthermore, even among subgroup of preeclamptic patients without severe features, hyponatremia correlated with less favorable pregnancy outcomes.
Conclusions
Among relatively large cohort of preeclamptic patients, hyponatremia was not a rare finding. We found it more common in patients with preeclampsia and severe features. As women with preeclampsia are at risk for hyponatremia, serum sodium levels should be monitored, especially in those with severe features. In preeclamptic patients without severe features, hyponatremia may indicate a need for closer surveillance. However, larger studies are needed to establish hyponatremia as a marker of severity.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable
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Ethical approval: The study was received and approved by the Hadassah Medical Organization’s Ethics Committee (HMO-18-142).
References
1. Gestational hypertension and preeclampsia: ACOG practice bulletin summary, number 222. Obstet Gynecol 2020;135:1492–5. PMID:32443077.10.1097/AOG.0000000000003892Suche in Google Scholar PubMed
2. Tomimatsu, T, Mimura, K, Endo, M, Kumasawa, K, Kimura, T. Pathophysiology of preeclampsia: an angiogenic imbalance and long-lasting systemic vascular dysfunction. Hypertens Res 2017;40:305–10. https://doi.org/10.1038/hr.2016.152.Suche in Google Scholar PubMed
3. Brunton, PJ, Arunachalam, S, Russel, JA. Control of neurohypophysial hormone secretion, blood osmolality and volume in pregnancy. J Physiol Pharmacol 2008;59(8 Suppl):27–45.Suche in Google Scholar
4. Pazhayattil, GS, Rastegar, A, Brewster, UC. Approach to the diagnosis and treatment of hyponatremia in pregnancy. Am J Kidney Dis 2015;65:623–7. https://doi.org/10.1053/j.ajkd.2014.09.027.Suche in Google Scholar PubMed
5. Razavi, AS, Chasen, ST, Gyawali, R, Kalish, RB. Hyponatremia associated with preeclampsia. J Perinat Med 2017;45:467–70. https://doi.org/10.1515/jpm-2016-0062.Suche in Google Scholar PubMed
6. Thaker, S. Recognizing and avoiding significant maternal hyponatremia. J South Asian Feder Obstet Gynecol 2020;12:100–3. https://doi.org/10.5005/jp-journals-10006-1770.Suche in Google Scholar
7. Goodlin, R, Mostello, D. Maternal hyponatremia and the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Am J Obstet Gynecol 1987;156:910–1. https://doi.org/10.1016/0002-9378(87)90351-6.Suche in Google Scholar PubMed
8. Anglim, B, Levins, K, Bussmann, N, Imcha, M. Severe hyponatraemia associated with pre-eclampsia. BMJ Case Rep 2016;2016. https://doi.org/10.1136/bcr-2016-215036.Suche in Google Scholar PubMed PubMed Central
9. Hinkson, L, Armbrust, R, Moller, A, Henrich, W. Case report of severe maternal hyponatremia complicating preeclampsia. J Matern Fetal Neonatal Med 2018;31:1948–9. https://doi.org/10.1080/14767058.2017.1332032.Suche in Google Scholar PubMed
10. Camara-Lemarroy, CR, de Leon-Cruz, A, Rodriguez-Gutierrez, R, Galarza-Delgado, DA. Severe hyponatremia associated with pre-eclampsia. Gynecol Endocrinol 2013;29:801–3. https://doi.org/10.3109/09513590.2013.797401.Suche in Google Scholar PubMed
11. Xodo, S, Cecchini, F, Celante, L, Novak, A, Rossetti, E, Baccarini, G, et al.. Preeclampsia and low sodium: a retrospective cohort analysis and literature review. Pregnancy Hypertens 2021;23:169–73. https://doi.org/10.1016/j.preghy.2020.12.007.Suche in Google Scholar PubMed
12. Grimmett, W, Lee, J, Doherty, J, Cheung, B, Chinthamuneedi, M. A case report of preeclampsia causing severe hyponatremia: rare or rarely reported? In Pract 2019;12:261–3. https://doi.org/10.1213/xaa.0000000000000904.Suche in Google Scholar
13. Santillan, MK, Santillan, DA, Scroggins, SM, Min, JY, Sandgren, JA, Pearson, NA, et al.. Vasopressin in preeclampsia: a novel very early human pregnancy biomarker and clinically relevant mouse model. Hypertension 2014;64:852–9. https://doi.org/10.1161/hypertensionaha.114.03848.Suche in Google Scholar PubMed PubMed Central
14. Magee, LA, Pels, A, Helewa, M, Rey, E, von Dadelszen, P. Canadian Hypertensive Disorders of Pregnancy Working G. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014;36:416–41. https://doi.org/10.1016/s1701-2163(15)30588-0.Suche in Google Scholar PubMed
15. National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management. In: National Institute for Health and Care Excellence: guidelines. London: National Institute for Health and Care Excellence; 2019.Suche in Google Scholar
© 2022 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- WAPM Guideline
- Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
- Original Articles – Obstetrics
- Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
- Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
- Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
- Termination of pregnancy in the second trimester – the course of different therapy regimens
- Hyponatremia among preeclampsia patients – a potential sign of severity
- Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
- Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
- Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
- The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
- Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
- Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
- Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
- Research progress on N6-methyladenosine in the human placenta
- Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
- Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
- Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
- Original Articles – Fetus
- Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
Artikel in diesem Heft
- Frontmatter
- WAPM Guideline
- Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
- Original Articles – Obstetrics
- Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
- Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
- Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
- Termination of pregnancy in the second trimester – the course of different therapy regimens
- Hyponatremia among preeclampsia patients – a potential sign of severity
- Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
- Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
- Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
- The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
- Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
- Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
- Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
- Research progress on N6-methyladenosine in the human placenta
- Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
- Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
- Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
- Original Articles – Fetus
- Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
