To explore the impact of blood pressure control strategies on fetal growth restriction (FGR) in preeclampsia (PE) patients with different proteinuria levels.

The data of 199 PE patients admitted to Shanxi Provincial Nuclear Industry 215 Hospital from March 2023 to February 2025 were retrospectively analyzed. According to the level of proteinuria, they were divided into a mild proteinuria group (n=112) and a massive proteinuria group (n=87). Among them, 103 patients had an average blood pressure controlled at 130-139/80-89 mmHg (strict control subgroup) (1 mmHg=0.133 kPa), while 96 cases had an average blood pressure controlled at 140-155/90-105 mmHg (conventional control subgroup). The study aimed to compare the baseline data of patients with different proteinuria levels, compare the incidence of FGR as the primary outcome in each group, analyze influencing factors related to FGR, investigate the interaction between proteinuria and blood pressure control target on FGR, and compare the maternal safety and fetal/neonatal outcomes among groups.

The systolic blood pressure (151.32±5.08)mmHg, diastolic blood pressure (99.65±4.21)mmHg and 24 h urine protein quantification (5.43±1.10)g in the massive proteinuria group were significantly higher than those in the mild proteinuria group [(145.89±4.67)mmHg, (94.56±3.89)mmHg, (1.12±0.26)g] (t=7.829, 8.832, 40.077, all P<0.05). The incidence of FGR in the massive proteinuria group[27.59(24/87)], was significantly higher than that in the mild proteinuria group[12.50%(14/112)] (χ²=7.213, P<0.01). Within the massive proteinuria group, the incidence of FGR in the strictly controlled subgroup [39.02%(16/41)] was higher than that in the conventionally controlled subgroup [17.39%(8/46)] (χ²=5.079, P<0.05). There were statistically significant differences in 24 h urinary protein quantification, systolic blood pressure, diastolic blood pressure and proteinuria stratification between the non-FGR group and the FGR group (t=6.926, 5.804, 6.076, χ²=7.213, all P<0.05). In all PE patients, after adjusting for systolic blood pressure and diastolic blood pressure, 24 h urinary protein quantification (OR=1.603, 95%CI: 1.214-2.117) was a significant influencing factor of FGR (P<0.01). Within the massive proteinuria group, the blood pressure control target (OR=2.079, 95%CI: 1.522-2.839) was a influencing factor of FGR (P<0.01). The interaction analysis showed for proteinuria and blood pressure control target in PE patients, RERI=1.882 (95%CI: 1.054-2.710), S=6.937 (95%CI: 3.258-7.004), AP=0.588 (95%CI: 0.396-0.712). Among FGR cases in patients with both massive proteinuria and strict blood pressure control, 58.8% of the risk was caused by the synergistic effect of these 2 factors. Severe hypertension was observed in 16 patients (18.39%) in the high proteinuria group, significantly higher than the 10 cases (8.93%) in the mild proteinuria group (P<0.05). The birth weight of newborns in the massive proteinuria group [(2 195.03±495.65)g] was lower than that in the mild proteinuria group [(2 569.23±483.26)g] (P<0.01).

The proteinuria level and blood pressure control target of PE patients affect the risk of FGR together. Massive proteinuria is an independent risk factor for FGR, and the use of strict blood pressure control targets in related patients will increase the incidence of FGR.