Search Results (150)

Background/Objectives: Preeclampsia is a heterogeneous hypertensive disorder of pregnancy, and accessible hematologic indices may reflect maternal physiologic differences before the clinical syndrome becomes evident. This study evaluated whether the first-trimester hemoglobin-to-red cell distribution width (Hb/RDW) ratio was associated with later documented preeclampsia and assessed its discrimination, relation to disease severity, and association with maternal–neonatal outcomes in a tertiary-care cohort. Methods: This retrospective cohort study included 224 singleton pregnancies managed at a tertiary referral center between January 2024 and December 2025. Data extraction, anonymization, and analysis were performed after ethics approval (Approval No. 72; 2 March 2026). Participants were categorized as preeclampsia-negative (n = 131) or preeclampsia-positive (n = 93). Preeclampsia and severe features were defined according to American College of Obstetricians and Gynecologists criteria. The Hb/RDW ratio was calculated from routine first-trimester complete blood count parameters obtained before clinical diagnosis or final outcome classification. ROC analysis, multivariable logistic regression, multicollinearity assessment, events-per-variable evaluation, calibration testing, and exploratory incremental discrimination analyses were performed. Results: The first-trimester Hb/RDW ratio was higher in pregnancies later complicated by preeclampsia. Single-marker ROC analysis showed moderate discrimination (AUC = 0.687; bootstrap 95% CI: 0.618–0.755). At the 0.63 cut-off, sensitivity was 89.2%, specificity 47.3%, positive predictive value 54.6%, and negative predictive value 86.1%. In the primary multivariable model, Hb/RDW remained associated with later preeclampsia (adjusted OR per 0.1-unit increase = 1.45; 95% CI: 1.22–1.72; p < 0.001). However, Hb/RDW was not independently associated with severe preeclampsia among affected patients, fetal growth restriction, or composite maternal morbidity. VIF values ranged from 1.00 to 1.07. Secondary models for fetal growth restriction and composite maternal morbidity had borderline events-per-variable values and were interpreted as exploratory. Conclusions: First-trimester Hb/RDW was associated with later documented preeclampsia in this retrospective tertiary-care cohort, but its single-marker performance was modest and specificity was limited. The ratio should be interpreted as an inexpensive research marker of hematologic phenotype rather than a stand-alone screening, diagnostic, or management tool. Prospective multicenter validation with standardized first-trimester sampling and adjustment for hematinic and nutritional variables is required before clinical implementation. Full article

Background: Preeclampsia and fetal growth restriction (FGR) are major obstetric complications originating from abnormal placental development during early pregnancy. Early identification of pregnancies at increased risk remains challenging despite the availability of several first-trimester biochemical and biophysical markers. Objective: This study aimed to evaluate the predictive value of first-trimester placental volume, bilateral uterine artery Doppler pulsatility indices (UtA-PI), pregnancy-associated plasma protein-A (PAPP-A), and free β-human chorionic gonadotropin (free β-hCG) for the subsequent development of preeclampsia and FGR. Methods: This retrospective cohort study included 251 singleton pregnancies that underwent routine first-trimester aneuploidy screening. Placental volume was estimated using a standardized two-dimensional ultrasonographic method; bilateral uterine artery Doppler examinations were performed according to Fetal Medicine Foundation recommendations, and maternal serum PAPP-A and free β-hCG values were recorded as multiples of the median. Receiver operating characteristic (ROC) analysis, multivariable logistic regression, and leave-one-out cross-validation were performed to evaluate predictive performance. Results: Preeclampsia and FGR developed in 8 (3.2%) and 29 (11.6%) pregnancies, respectively. None of the investigated biochemical or biophysical markers differed significantly between affected and unaffected pregnancies. Individual biomarkers demonstrated poor discriminatory performance, with AUC values ranging from 0.50 to 0.64. Following adjustment for maternal characteristics, only lower maternal free β-hCG remained independently associated with FGR (adjusted OR 0.49, 95% CI 0.25–0.96; p = 0.038). The apparent performance of the combined prediction model was not maintained following internal validation, indicating substantial model overfitting. Conclusions: First-trimester placental volume, uterine artery Doppler indices, PAPP-A, and free β-hCG demonstrated limited predictive performance for preeclampsia and FGR in this cohort. These findings suggest that currently available first-trimester biomarkers are insufficient as stand-alone screening tools and support the development of multimodal prediction strategies integrating biochemical, biophysical, angiogenic, and molecular biomarkers rather than relying on isolated first-trimester markers. Full article

Background: Several scenarios of abnormal fetal growth develop during pregnancy in women with pregestational diabetes. A trend towards a higher incidence of large-for-gestational-age (LGA) births among women with type 1 diabetes (T1D) is observed worldwide despite novel approaches to maternal glycaemic control. Fetal growth restriction (FGR) is commonly recognised as a severe condition. However, the risk of adverse outcomes in LGA fetuses generally remains underestimated. Methods: We conducted a comparative analysis of pregnancy outcomes across different birthweight categories in pregnancies with T1D based on published data (2001–2026). Results: Interactions between disorders of early placentation, impaired nutrient transfer, fetal overnutrition, and genetic background result in alterations in birthweight and disproportionate fetal adipose tissue deposition. Both FGR and macrosomia are associated with increased risks of adverse perinatal outcomes. Although stillbirth occurs at both extremes of fetal growth, term LGA fetuses may remain particularly vulnerable because routine surveillance methods, including arterial Doppler assessment, fail to identify compromised fetuses with excessive growth. Accelerated fetal growth in T1D pregnancies, when placentation is initially impaired, may cause growth-restricted fetuses to appear appropriate for gestational age (AGA). Routine assessment may classify these vulnerable fetuses as being at low risk of perinatal complications. Disproportionate growth, even among infants classified as AGA, is associated with shoulder dystocia, birth trauma, and operative delivery. Neonatal hypoglycaemia and respiratory disorders remain frequent complications across the spectrum of abnormal fetal growth. Conclusions: Increased glucose variability may explain differences in placental and fetal growth trajectories and the high rate of pregnancy complications in patients with target glycated haemoglobin levels and routine capillary glucose monitoring results. Fetal overgrowth reflects impaired intrauterine development and should be considered a high-risk condition requiring careful consideration of the timing and mode of delivery. Full article

Preeclampsia (PE) is a major pregnancy complication characterized by placental dysfunction and metabolic disturbances. Although mitochondrial abnormalities are frequently observed in PE, the upstream regulatory mechanisms remain incompletely understood. Here, we investigated the potential involvement of BACH1 in trophoblast dysfunction in PE and explored its association with mitochondrial metabolic alterations and protein succinylation. BACH1 expression was assessed in placental tissues and plasma samples from patients with PE, its functional effects were examined in trophoblast cell lines and BACH1 overexpression mouse models, and metabolic, bioenergetic, and succinylation-related alterations were evaluated using multi-omics and functional analyses. BACH1 expression was elevated in PE placentas and correlated with disease severity. In trophoblasts, BACH1 overexpression impaired proliferation, invasion, and trophoblast-mediated angiogenesis and was accompanied by mitochondrial and metabolic abnormalities, while quantitative succinylproteomic analysis revealed widespread alterations in mitochondrial protein succinylation. In vivo, BACH1 overexpression induced key PE-like features, including hypertension, fetal growth restriction, and placental abnormalities, and glycine supplementation partially rescued the trophoblast dysfunction associated with BACH1 overexpression. Together, evidence from clinical samples and experimental models suggests that BACH1 is associated with mitochondrial succinylation remodeling and trophoblast dysfunction in PE, supporting the hypothesis that BACH1-associated metabolic dysregulation and mitochondrial succinylation remodeling may contribute to PE pathogenesis. Further studies are required to establish the causal relevance and clinical significance of these mechanisms in human PE. Full article

Fetal growth restriction (FGR) is a leading cause of perinatal morbidity and mortality, yet reliable first-trimester biomarkers for early prediction remain lacking. Growing evidence suggests that placental dysfunction is a central pathological driver of FGR. Therefore, placenta-derived proteins in maternal circulation may serve as mechanistically informative biomarkers for early detection. Here, we aimed to evaluate several placenta-relevant molecules as biomarkers for predicting isolated FGR and its subtypes. In this prospective nested case–control study, we included singleton pregnancies that underwent Down screening in the first trimester and were subsequently diagnosed with FGR (n = 50, including early-onset FGR [EFGR] and late-onset FGR [LFGR]) and healthy pregnancies (n = 100). Pregnancies with maternal comorbidities or fetal anomalies were excluded. Maternal serum protein concentrations were measured using ELISA kits. There were no significant differences in placenta-specific protein 1 (PLAC1) or netrin-1 between the two groups. By contrast, maternal soluble programmed death-ligand 1 (sPD-L1) levels were significantly lower in overall FGR (p < 0.001) and FGR subtypes (p = 0.002) than in controls. Circulating sPD-L1 levels were positively correlated with gestational age at delivery and birth weight Z score. Each one-unit increase in sPD-L1 was associated with lower odds of overall FGR (Odd ratio, OR 0.33), EFGR (OR 0.17), LFGR (OR 0.43), birth weight Z score 3–10% (OR 0.30), and neonatal intensive care unit (NICU) admission (OR 0.38). Moreover, first-trimester sPD-L1 predicted overall FGR (area under the receiver operating characteristic curve, AUC 0.75), EFGR (AUC 0.84), LFGR (AUC 0.70), birth weight Z score 3–10% (AUC 0.75), and NICU admission (AUC 0.67). Collectively, decreased maternal circulating sPD-L1 in early pregnancy may serve as a potential biomarker for isolated FGR, warranting validation in larger multicenter mechanistic studies. Full article

Preeclampsia (PE) is a severe pregnancy-specific hypertensive disorder characterized by immune microenvironment dysregulation at the maternal–fetal interface, with decidual macrophage phenotypic imbalance being a key pathological feature. The Ghrelin/growth hormone secretagogue receptor-1a (GHSR-1a) axis exerts immunomodulatory and anti-inflammatory effects, but its role in regulating decidual macrophage infiltration and phenotypic marker expression in PE remains unclear. In this study, we first detected the expression of the Ghrelin/GHSR-1a axis in decidual tissues from 10 healthy pregnant women and 12 PE patients via immunohistochemistry (IHC). We then established a lipopolysaccharide (LPS)-induced PE-like rat model to investigate the axis’s functional role and underlying mechanisms. Intriguingly, clinical analysis revealed a severity-dependent compensatory escalation of the Ghrelin/GHSR-1a axis in PE decidual tissues, potentially representing an endogenous antagonistic response to pregnancy-associated pathological stress. In the animal model, exogenous Ghrelin supplementation reversed LPS-induced PE-like phenotypes, including hypertension, proteinuria, fetal growth restriction (FGR), and placental dysfunction, and alleviated pathological damage to the maternal liver, kidney, and placenta. Mechanistically, Ghrelin modulated decidual macrophage phenotypic marker expression by downregulating the M1 marker CD86 and upregulating the M2 marker CD163 and promoted trophoblast invasion and spiral artery remodeling by restoring laminin, α-cytokeratin 7 (α-CK7), and α-smooth muscle actin (α-SMA) expression in placental tissue. All protective effects of Ghrelin were abrogated by co-administration of D-lys-3-GHRP-6, a specific GHSR-1a antagonist, confirming the dependence on the Ghrelin/GHSR-1a axis. Collectively, our findings suggest that the Ghrelin/GHSR-1a axis is compensatorily upregulated in PE and may exert a protective role by regulating decidual macrophage phenotypic marker expression and improving placental function, providing preliminary evidence that this axis merits further investigation as a potential research target for PE. Full article

Nutrient restriction (NR) increases small-for-gestational-age (SGA) offspring; however, some NR ewes deliver Non-SGA lambs. We evaluated whether fetal biometry and Doppler indices could distinguish divergent fetal growth trajectories. Ninety-five single-pregnant Corriedale ewes were assigned to NR grazing (n = 72) or supplemented Controls (n = 23) from gestational day (GD) 70 to 140. Fetal biparietal diameter (BPD), femur length (FL), thoracic height (TH), umbilical cord diameter (UCD), and resistance (RI) and pulsatility (PI) indices in umbilical (UA), cotyledonary (CA), and uterine (UtA) arteries were assessed at several GDs. Offspring within NR group was stratified by birth weight (BW) quartiles as SGA (n = 18) or Non-SGA (n = 18). At birth, BW differed (p < 0.05) among Control (4.95 ± 0.10 kg), Non-SGA (5.33 ± 0.06 kg), and SGA (3.79 ± 0.11 kg), with reduced BPD and FL in SGA lambs. Prenatal biometry did not differ. UA-RI at GD125 was higher in SGA (p < 0.005) and associated with BW (R² = 0.15; p < 0.001). UtA indices were lower in SGA at GD110 and GD125 (p < 0.05) but weakly associated with BW (R² ≤ 0.08). Doppler differences were detected before measurable growth divergence but have modest predictive value. Full article

This prospective study evaluated first-trimester markers in pregnancies with isolated and combined forms of fetal growth disorders and gestational diabetes mellitus (GDM). Among 1869 screened women, the analysis included 83 controls, 55 GDM, 22 isolated intrauterine growth restriction (iIUGR), and 33 isolated large-for-gestational-age (iLGA) cases, with GDM subgroups stratified by fetal growth (GDM with normal fetal weight, GDM + IUGR, and GDM + LGA). First-trimester clinical and routine biochemical parameters were recorded, and serum concentrations of 80 proteins were measured using targeted LC-MRM-MS proteomics. Different trajectories emerged: IUGR phenotypes showed low PAPP-A/PlGF and high TSH (p < 0.01), indicating early placental insufficiency, while macrosomia showed opposite trends. GDM + IUGR represented the most severe “double hit” phenotype (lowest PlGF, earliest delivery), whereas GDM + LGA showed increased umbilical artery resistance despite excessive growth, suggesting endothelial dysfunction. Targeted proteomics revealed characteristic signatures: iIUGR featured low complement (C4A|C4B) and IGF proteins (IGFALS, IGFBP3) versus GDM and iLGA (p < 0.001); GDM + IUGR showed elevated PZP and CD5L versus iIUGR (p < 0.05); GDM + LGA was marked by high C4BPA and low RBP4, SERPINA7 versus iLGA (p < 0.05). Complement and IGF pathways were consistently implicated. Machine learning achieved 77% sensitivity for IUGR prediction using clinical parameters and 88% sensitivity for LGA prediction using proteomic data. These findings demonstrate that fetal growth disorders represent pathophysiologically unique entities detectable in the first trimester, enabling early risk stratification and personalized management. Full article

Background and Objectives: Placental vascular lesions are significant histopathological findings that indicate disruptions in uteroplacental and fetoplacental circulations and are associated with adverse pregnancy outcomes such as preeclampsia, intrauterine growth restriction (IUGR), and perinatal morbidity. This study aimed to re-examine the frequency and distribution of placental vascular lesions in placentas submitted for histopathological analysis at our center, based on criteria established by the Amsterdam Placental Workshop Group Consensus Statement. Materials and Methods: In this retrospective study, placental samples examined in the Department of Pathology at Akdeniz University Faculty of Medicine from 2016 to 2019 were analyzed. A total of 571 cases with at least one placental vascular lesion identified on histopathology were included. Hematoxylin–eosin-stained sections from all cases were re-evaluated, and maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and other placental vascular pathologies were assessed according to the Amsterdam consensus criteria. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were compared using the chi-square or Fisher’s exact test, while continuous variables were analyzed with the Mann–Whitney U test. Results: MVM and FVM were considered the primary outcomes of the study. MVM was identified in 95.1% of cases, whereas FVM was present in 1.9%. Among individual lesions, chorangiosis (97.2%) and villous/perivillous fibrinoid deposition (88.3%) were the most frequent findings, followed by mucinous cystic degeneration of the umbilical cord (61.5%) and dystrophic calcification (58.1%). Retroplacental hematoma was observed in 38.4% of cases. Although no significant association was found between MVM and placental weight or size, umbilical cord length was significantly shorter in MVM-positive cases (p = 0.032). In contrast, FVM showed significant associations with chorangiosis (p = 0.035) and placentomegaly (p = 0.003). The high frequency of chorangiosis may reflect a compensatory angiogenic response to chronic intrauterine hypoxia, potentially mediated by vascular growth factors, with variable effectiveness depending on the severity of the underlying condition. Conclusions: These findings suggest that placental vascular lesions are not only markers of obstetric complications but also serve as morphological indicators of fetoplacental adaptive responses. Full article

Objective: To evaluate clinical factors associated with termination of pregnancy (TOP) recommendations following prenatal diagnosis of congenital heart disease (CHD) within a multidisciplinary fetal council model. Methods: This retrospective cohort study included 146 fetuses with prenatally diagnosed CHD discussed in a tertiary referral center fetal council between October 2023 and December 2025. The primary outcome was council-issued recommendation for TOP (yes/no). Variables included gestational age (GA) at diagnosis, cardiac severity (Davey scale grouped as low, moderate, high), extracardiac anomalies, fetal growth restriction (FGR), and genetic evaluation/results. Group comparisons were performed using Mann–Whitney U and χ² tests. Independent associations were assessed using binary logistic regression. A subgroup analysis was conducted in isolated CHD cases (no extracardiac structural anomalies). Results: A total of 146 fetuses with prenatal CHD were included in the analysis. TOP was recommended in 71 cases (48.6%). GA at diagnosis did not differ between groups when analyzed continuously; however, categorical GA showed significant differences, with earlier diagnoses more frequent among TOP-recommended cases. Cardiac severity distribution differed significantly between groups. In multivariable analysis, GA at diagnosis and cardiac severity were independently associated with TOP recommendation. Compared with <20 weeks, diagnosis at 20–23+6 weeks (OR 17.96, 95% CI 3.50–92.22) and ≥24 weeks (OR 3.92, 95% CI 1.53–10.06) increased the odds of TOP recommendation. Relative to high severity, moderate (OR 0.23, 95% CI 0.07–0.72) and low severity (OR 0.20, 95% CI 0.08–0.50) were associated with lower odds of TOP recommendation. Extracardiac anomalies, genetic findings, and FGR were not independently associated after adjustment. Similar patterns were observed in isolated CHD cases. Conclusions: In a multidisciplinary prenatal counseling setting, TOP recommendations after prenatal CHD diagnosis were primarily driven by cardiac severity and GA at diagnosis, rather than extracardiac or genetic findings alone. Full article

Background: Despite well-established racial/ethnic disparities in cancer outcomes, little is known about the extent to which race/ethnicity influences adverse pregnancy outcomes (APOs) among women with early onset cancer. We evaluated racial/ethnic disparity in the occurrence of cancer during pregnancy and APOs among women with cancer in the United States. Methods: Data consisted of 17.6 million singleton deliveries among females aged 18–49 years from the National Inpatient Sample. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Results: From 2000 to 2022, the prevalence of births among women with cancer increased more than 225%, from 120.4 to 391.8 per 100,000. After accounting for sociodemographic and behavioral/lifestyle factors and comorbidity index among women with cancer (n = 49,824, mean age = 33.4 years), non-Hispanic Black women had the highest odds for hypertensive disorders of pregnancy (OR = 1.67, CI: 1.54–1.82), preterm birth (OR = 1.44, CI: 1.26–1.64) and fetal death (OR = 3.04, CI: 1.99–4.63). Asian or Pacific Islander and Native American women had the highest odds for gestational diabetes (OR = 2.48, CI: 2.17–2.85) and fetal growth restriction (OR = 1.92, CI: 1.00–3.69), respectively. Among racial/ethnic minority women, the odds for maternal mortality and several APOs were significantly higher among those with cancer than those without cancer, with the odds for APOs being highest for breast cancer (OR = 1.39, CI: 1.23–1.56). Conclusions: This large population-based study showed significant racial and ethnic disparities in APOs among women with a concurrent cancer diagnosis at delivery. Targeted management of APO risk factors during pregnancy among racial/ethnic minority populations with cancer may help reduce adverse maternal and neonatal outcomes. Full article

Fetal growth restriction (FGR), a condition in which the fetus fails to achieve its growth and developmental potential, affects 5% to 10% of pregnancies and is associated with high rates of perinatal morbidity and mortality. There is currently insufficient high-quality evidence to define the optimal approach for diagnosing fetal growth restriction. In 2016, with the aim of standardizing clinical practice and enabling comparability across scientific studies, an expert opinion-based consensus was published. This document proposed unified terminology and clear diagnostic criteria for early- and late-onset fetal growth restriction (FGR). Because no effective treatment is available, careful assessment of fetal well-being and appropriate timing of delivery are the main tools for managing these fetuses. This decision should be based on gestational age and the severity of abnormalities identified on fetal surveillance tests, balancing the risks of prematurity against the risks of severe permanent sequelae or fetal death. The objective of this update is to analyze the most recent evidence on when and how to deliver pregnancies complicated by fetal growth restriction, emphasizing that specific abnormalities on fetal surveillance examinations warrant delivery at different gestational ages. To this end, a literature search of the PubMed/Medline and Latin America and the Caribbean Literature on Health Sciences (LILACS) databases was conducted using the terms fetal growth restriction, management, and delivery over the past ten years. Results were grouped into gestational age at delivery, mode of delivery, and methods of labor induction. The main fetal surveillance abnormalities prompting delivery in each gestational-age range were discussed, leading to the development of management flowcharts. Despite the lack of consensus in the literature and the limited number of randomized clinical trials guiding clinical decisions in FGR, the available evidence was summarized to assist clinicians in managing pregnancies complicated by FGR. It should be emphasized that there are few randomized clinical trials to guide management decisions in FGR. Full article

Background/Objectives: Fetal growth restriction (FGR) describes the situation of a fetus that fails to reach its genetic growth potential. Postnatal catch-up growth represents a central adaptive process, yet its timing and magnitude vary widely and may influence one individual’s state of health and later metabolic risk. This study aimed to characterize longitudinal growth trajectories from birth to 10 years in children born at term, affected antenatally by growth restriction, with a particular focus on the influence of sex and FGR severity on catch-up growth. Methods: We conducted a retrospective observational study including 170 term-born children with documented FGR, admitted to a tertiary pediatric center between 2019 and 2023. Anthropometric data (weight, length/height, BMI) at birth, 1, 2, 5, and 10 years were converted to World Health Organization (WHO) age- and sex-adjusted z-scores. Catch-up growth was defined as an increase of >0.67 SD. Participants were stratified by sex and FGR severity (moderate: 10th–3rd percentile; severe: <3rd percentile). Results: Severe FGR infants exhibited significantly lower birth anthropometrics but demonstrated more pronounced early catch-up in weight and length at 1 and 2 years (p < 0.01). By 5 and 10 years, growth trajectories converged between severity groups, with no differences in BMI at any age. Sex influenced absolute anthropometric values but not the probability of achieving catch-up growth. Conclusions: Among term-born FGR infants, severity—but not sex—shapes early postnatal growth. Despite early deficits, most children achieved substantial catch-up, underscoring the need for careful monitoring to support healthy, proportionate growth and mitigate subsequent metabolic risk. Full article

Objective: To evaluate the diagnostic utility of antepartum amnioinfusion in cases of severe oligo- and anhydramnios and to descriptively report perinatal outcomes. Methods: This retrospective single-center study analyzed all antepartum amnioinfusions performed between 2009 and 2024 in pregnancies between 16 + 0 and 34 + 0 weeks of gestation. The primary endpoint was diagnostic impact following amnioinfusion. Secondary endpoints were descriptive perinatal outcomes. No inferential statistical analyses were performed. Results: A total of 37 amnioinfusions were performed in 31 patients. Median gestational age at first amnioinfusion was 22 ± 4.3 weeks, with a mean infusion volume of 259 ± 59.4 mL. The most frequent etiologies were preterm prelabor rupture of membranes (PROM, 29%), fetal growth restriction (FGR, 25.8%), and urogenital malformations (22.6%). Amnioinfusion improved sonographic visualization and diagnostic assessment in the majority of cases. Pregnancy prolongation was observed in selected subgroups; however, causal inference regarding therapeutic efficacy cannot be drawn. Conclusions: Antepartum amnioinfusion represents a valuable adjunct for prenatal diagnostic evaluation in severe oligo- and anhydramnios. Observed perinatal outcomes should be interpreted descriptively. Further prospective, controlled studies are required to define the role of amnioinfusion beyond diagnostic feasibility. Full article

Objective: To investigate the impact of proteinuria severity on obstetric and neonatal outcomes and to assess the predictive value of 24 h urinary protein excretion, both alone and within a multivariable model, for adverse pregnancy outcomes. Methods: This retrospective cohort study included 203 pregnant women with proteinuria who were classified into mild (≥0.3 g/day and <3.0 g/day, n = 50), severe (≥3.0 g/day and <5.0 g/day, n = 67), and massive (≥5.0 g/day; n = 86) groups based on 24 h urine protein levels. Maternal and neonatal outcomes were compared between these groups. Correlation analysis, receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression were used to evaluate the predictive value of proteinuria for obstetric complications and identification of increased risk of early delivery. The AUC values of the proteinuria-only model and the multivariable model were compared using the DeLong test, as both models were derived from the same dataset and therefore represented correlated ROC curves. Results: The incidence of obstetric complications was significantly higher in the severe (68.7%) and massive (81.4%) proteinuria groups compared with the mild group (32.0%; p < 0.001). Increasing proteinuria severity was associated with earlier gestational age at delivery, lower birth weight, and higher rates of fetal growth restriction (all p < 0.001). The 24 h proteinuria level demonstrated moderate predictive ability for obstetric complications (AUC 0.73; 95% CI 0.66–0.80). A multivariable model including nephrotic-range proteinuria (≥3 g/day) and gestational age at diagnosis showed improved discriminatory performance compared with proteinuria alone (AUC 0.81; 95% CI 0.75–0.88). The model based on continuous 24 h proteinuria yielded an AUC of 0.73 (95% CI, 0.66–0.80) for identifying pregnancies at increased risk of obstetric complications. The multivariable model showed a numerically higher AUC of 0.81 (95% CI, 0.73–0.86); however, the difference between the two AUCs was not statistically significant according to the DeLong test (z = 0.82, p = 0.41). Conclusions: The severity of maternal proteinuria is associated with a higher likelihood of adverse maternal and neonatal outcomes, and higher proteinuria levels appear to show a graded association with increasing risk. A multivariable model integrating proteinuria with key clinical parameters demonstrated moderate discriminatory ability for obstetric complications, may support a more holistic approach to risk stratification in clinical practice. Full article