Proteinuria is a widely used biomarker for risk stratification in hypertensive pregnancies, with potential predictive value for adverse maternal and perinatal outcomes. This study evaluated the predictive value of 24-hour urine protein levels for adverse maternal and perinatal outcomes in hypertensive pregnancies. A retrospective cohort of 213 pregnant women with hypertension was categorized into four groups based on proteinuria severity: 2000 mg (n = 19). Higher proteinuria levels were significantly associated with increased rates of oligohydramnios (p = 0.001) and fetal growth restriction (FGR; p = 0.005), particularly in the > 2000 mg group (44.0% and 68.4%, respectively). Gestational age at delivery decreased with worsening proteinuria (p < 0.001), with the lowest mean age (32.84 ± 3.82 weeks) in the > 2000 mg group. Postpartum hospital stays were prolonged in chronic hypertension (p = 0.002) and severe proteinuria groups (p = 0.007). ROC analysis identified a 24-hour urine protein cutoff of 135 mg (AUC: 0.635, p = 0.001) for predicting fetal distress. The > 2000 mg group had universal magnesium sulfate use, earlier deliveries, and higher FGR rates. Chronic hypertension correlated with longer postpartum stays (p = 0.002) and higher postpartum renal disease (p = 0.040). These findings underscore proteinuria as a prognostic marker for adverse outcomes, supporting its role in risk stratification for hypertensive pregnancies. Future research should validate thresholds and explore targeted interventions.

Preeclampsia (PE) is characterized by systemic inflammation and endothelial dysfunction, contributing to adverse maternal and neonatal outcomes. Antenatal corticosteroids (ACS) therapy is widely used to enhance fetal lung maturity in women at risk of preterm birth. However, little is known about the dynamic changes in maternal inflammatory markers after ACS administration in PE and their potential predictive value for perinatal outcomes. This retrospective cohort study included 206 pregnant women with PE who received ACS therapy due to preterm birth risk. Complete blood count (CBC) parameters and systemic inflammatory indices were recorded before and after ACS. Delta (Δ) values were calculated to reflect the percentage change between pre- and post-ACS measurements. Correlations between Δ inflammatory markers and perinatal outcomes were analyzed, and predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. Following ACS administration, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and aspartate aminotransferase-to-platelet ratio (APRI) increased significantly, while lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) decreased. Δ mean platelet volume (MPV), Δ aspartate aminotransferase (AST), Δ Lactate Dehydrogenase (LDH), ΔNLR, and ΔAPRI showed low-level positive correlations with umbilical cord blood pH. ROC analysis indicated that ΔMPV ≤ 1.81 (area under the curve (AUC) = 0.664) and ΔAPRI ≤ 1.81 (AUC = 0.605) moderately predicted neonatal intensive care unit (NICU) admission. Dynamic changes in maternal inflammatory markers occur after ACS therapy in preeclamptic pregnancies. ΔMPV and ΔAPRI demonstrated potential predictive value for NICU admission, highlighting their possible clinical utility in risk stratification. These findings provide novel insight into the maternal inflammatory response to ACS in PE and its implications for perinatal outcomes.