Maternal Serum Uric Acid Levels Research Articles

Relationship between maternal serum uric acid in the first trimester and congenital heart diseases in offspring: A prospective cohort study

ObjectiveThis study aimed to investigate the relationship between maternal serum uric acid levels in the first trimester and the incidence of congenital heart diseases (CHDs) in offspring. MethodsThis prospective cohort study was conducted in the southeast of China and involved 21,425 pregnant women and their offspring in the final analysis between 2019 and 2022. Fasting blood samples from pregnant women participating in the Fujian birth cohort study (11.3 ± 1.40 weeks of gestation) were analyzed for serum uric acid levels. The perinatal outcome was the incidence of CHDs. All fetuses with CHDs were confirmed by echocardiography doctors and pediatric cardiologists. Logistic regression analysis and restricted cubic spline (RCS) modeling were employed to investigate the relationship between serum uric acid level and the incidence of CHDs. ResultsWe observed that maternal log2-transformed values of serum uric acid were strongly associated with odds of CHDs in offspring (adjusted odds ratio [AOR] 1.589, 95 % CI [1.149, 2.198]). Compared to the lowest quartile, the AORs for maternal uric acid levels in the other quartiles and the corresponding risk of CHDs in offspring were 1.363 (95 % CI [1.036, 1.793]), 1.213 (95 % CI [0.914, 1.610]), and 1.472 (95 % CI [1.112, 1.949]), respectively. Hyperuricemia in the first trimester significantly increased the risk of CHDs in offspring 1.837 (95 % CI [1.073, 3.145]). Furthermore, RCS showed a linear relationship between maternal serum uric acid levels in the first trimester and the incidence of CHDs (P for nonlinearity = 0.71). ConclusionsThe results of this study indicated that elevated maternal serum uric acid levels in the first trimester were associated with an increased incidence of CHDs in offspring.

Serum Uric Acid Levels as a Risk Stratification Tool in Hypertensive Disorders of Pregnancy: A Retrospective Study.

Worldwide, hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality. Serum uric acid is a test that can evaluate the severity of HDP and the associated maternal and fetal morbidity and mortality. To examine the relationship between maternal serum uric acid levels and the severity of HDP and overall pregnancy outcomes. A retrospective study was conducted on women with a gestational age > 20 weeks and BP >140/90 mmHg over three years. A total of 134 patients were included in the study. Patients with chronic hypertension, hyperuricemia without hypertension, and other major illnesses were excluded. Data were collected from medical records, including age, gravida, parity, weight, height, gestational age, blood pressure at admission, urine albumin, and serum uric acid levels. Of the 134 enrolled women with HDP, 76 had gestational hypertension, 41 had preeclampsia, and 17 had eclampsia. Mean uric acid levels in mg/dL were 6.06±1.651, 6.20±0.824, and 7.38±1.26 in gestational hypertension, preeclampsia, and eclampsia, respectively, which was a significant association (p=0.002). Mean uric acid in mg/dL was 5.86±1.27 in intensive care unit (ICU) patients compared to 6.45±1.39 in ward patients (p=0.015). There was a significantly increased risk of ICU admission and preterm delivery (r=-0.401, p<0.001) in patients with elevated uric acid levels. There was a significantly increased risk of low-birth-weight babies with elevated uric acid levels (r=-0.278, p=0.001). However, there was no statistically significant increased risk of newborn intensive care unit admissions (p=0.264) with elevated uric acid levels. Serum uric acid levels vary significantly in HDP and were found to be elevated in severe preeclampsia and eclampsia. It can be considered for risk stratification in HDP based on disease severity; however, its role in determining outcomes is debatable. Using serum uric acid levels in predictive models along with known biomarkers may determine its possible additional value in disease prediction and severity.

Association of maternal serum uric acid levels with LBW/SGA: a large retrospective cohort study

BackgroundElevated maternal serum uric acid (UA) levels were associated with adverse perinatal outcomes. This study aimed to examine the association between UA and the risk of low birth weight (LBW) / small for gestational age (SGA).MethodsA cohort study of women delivered in Shanghai maternity hospital was included between 2017 and 2021. Electronic medical records were utilized to extract information and antenatal care records. The cut-off value of UA was 360 μmol/L. The outcome was LBW/SGA, with LBW defined as birth weight below 2500 g and SGA indicating birth weight below the 10th percentile of average weight for gestational age. The assessment of SGA was based on the Chinese standard curve for birth weight at various gestational ages. Univariate, multivariate logistic regression models, restricted cubic spline were used in this study, with adjustments made for confounding factors.ResultsSixty-nine thousand six hundred seventy-four live births and singleton pregnancies were included. The ratio of LBW/SGA was 3.3%/9%. Maternal UA levels were significantly negatively correlated with birth weight. High UA levels were associated with high risk of LBW/SGA, especially in third trimester. In BMI < 25 group, the risk of LBW increased to 2.35-fold (95%CI, 1.66–3.31) in hyperuricemic group (UA > 360 μmol/L). The SGA risk was 1.66-fold (95%CI, 1.37–2.00). Gestational hypertension (GH) with hyperuricemica increased the risk of LBW (aOR = 4.00, 95%CI, 2.01–7.93) and SGA (aOR = 2.63, 95%CI, 1.83–3.78). Preeclampsia (PE) with hyperuricemia increased the risk of LBW (aOR = 1.38, 95%CI, 0.63–3.03) and SGA (aOR = 1.81, 95%CI, 1.18–2.78). In delivery gestational week (DGW) ≥ 37 group, if UA > 360 μmol/L, the incidence of LBW increased to 2.46-fold (95%CI, 1.62, 3.73) and the incidence of SGA increased to 1.52-fold (95%CI, 1.24, 1.87). In DGW < 37 group, if UA > 360 μmol/L, the incidence of LBW increased to 2.70-fold (95%CI, 1.92, 3.80) and the incidence of SGA increased to 2.13-fold(95%CI, 1.50, 3.02).ConclusionsThe study found an inverse correlation between UA levels and birth weight. High UA levels were associated with increased risk of LBW/SGA, particularly in third trimester. GH or PE complicated by hyperuricemia were found to have significantly higher risk of developing LBW/SGA. This relationship also existed in pregnant women with BMI < 25.

Alteration in maternal serum uric acid levels in pre-eclampsia and associated perinatal outcomes: a cross-sectional study in Ghana.

pre-eclampsia (PE) is a multisystemic pregnancy-specific hypertensive disorder associated with significant adverse maternal and perinatal outcomes. Maternal serum uric acid level is hypothesized as a reliable marker for predicting the severity and adverse outcomes of pre-eclampsia and facilitating clinical decisions. This study explored the association between maternal serum uric acid and adverse pregnancy outcomes in pre-eclampsia. a cross-sectional study involving women diagnosed with pre-eclampsia was conducted at Korle-Bu Teaching Hospital (KBTH), a tertiary hospital in Ghana. Descriptive analyses were performed and multivariable logistic regression model was used to explore the association between maternal serum uric acid levels and pregnancy outcomes using R software. we included 100 women with pre-eclampsia comprising 79% and 21% preterm and term pre-eclampsia respectively and with mean gestational age (GA) at diagnosis of 32.35±2.66 weeks and 35.96±1.94 weeks respectively. The mean maternal age of preterm and term pre-eclampsia groups was 29.81±5.29 years and 29.46±5.78 years respectively. Hyperuricemia (serum uric acid >375 µmol/L) occurred in 61% of the pre-eclamptic women. The mean gestational age (in weeks) at diagnosis was significantly lower in the pre-eclamptic women with hyperuricemia compared with those with normal levels of uric acid (33.51±3.03 versus 34.80±2.71). There was a significant negative association (moderate correlation) between maternal serum uric acid levels and birth weight (R= -0.34, p < 0.001) in pre-eclampsia; the statistical significance was limited to preterm only (Pearson R= -0.39, p-value <0.001) but not term pre-eclampsia. Hyperuricemia was significantly associated with low birth weight [aOR: 3.222 (95% CI: 1.098, 10.393)], caesarean section [aOR: 2.281 (95% CI: 1.084, 7.568)] and severe diastolic pressure at birth [aOR: 3.517 (95% CI: 1.123, 11.939)]. hyperuricemia in pre-eclampsia was significantly associated with both maternal (caesarean section and severe hypertension) and neonatal (low birth weight) adverse outcomes. Hyperuricemia seems clinically useful in predicting pregnancy outcomes, especially in preterm pre-eclampsia. Further longitudinal study is recommended in exploring the clinical significance of maternal uric acid levels and pregnancy outcomes in pre-eclampsia.

The role of haptoglobin in the diagnosis of preeclampsia and HELLP syndrome and in predicting neonatal outcomes.

The study aimed to determine whether maternal serum haptoglobin values could have an effect on predicting diagnosis and neonatal outcomes in preeclampsia and HELLP syndrome. Hundred sixteen pregnant women who met the inclusion criteria were included in the study. To evaluate whether serum haptoglobin level in maternal blood could be used in early diagnosis of preeclampsia and HELLP syndrome, 49 pregnant women diagnosed with preeclampsia and 13 pregnant women diagnosed with HELLP syndrome were included in the study group, and 54 healthy pregnant women in the control group. The groups were compared regarding maternal serum haptoglobin level, platelet count, ALT, AST, LDH, and uric acid levels. Moreover, the age, obstetric histories, and newborn outcomes of all pregnant women were recorded and compared between groups. The mean haptoglobin values were 0.29 ± 0.23 g/L in the HELLP syndrome group, 1.01 ± 0.52 g/L in the preeclampsia group, and 1.16 ± 0.37 g/L in the control group. The mean haptoglobin result was lower in the HELLP syndrome group compared to the preeclampsia and control groups (p < 0.001). While the differences between HELLP syndrome and the control and preeclampsia groups were statistically significant, no significant difference was determined between the preeclampsia and control groups. There was a significant positive correlation between haptoglobin value with the week of delivery, umbilical cord pH value, and the first and fifth-minute Apgar scores (p < 0.05). It was concluded that haptoglobin values could be used together with other biochemical parameters to diagnose HELLP syndrome and predict newborn outcomes.

The Inter-Trimester Variation and Prognostic Value of Creatinine, Cystatin C and Uric Acid in Preeclamptic Patients: A Retrospective Study

Background: This study aimed to evaluate the clinical significance of maternal serum creatinine, cystatin C, and uric acid levels in relation to fetal death in pregnant women with preeclampsia. Methods: This retrospective study evaluated 708 women with preeclampsia, and 738 healthy pregnant women were selected as control. Medical records were reviewed to collect obstetric, neonatal, and biochemical data, including creatinine, cystatin C, and uric acid concentrations. Results: Maternal serum creatinine, cystatin C, and uric acid concentrations were significantly higher in the preeclamptic group than in the control (p &lt; 0.05). Preeclamptic women in the fetal death group had significantly higher creatinine levels during their second and third trimesters, and higher uric acid concentrations throughout the pregnancy compared to the fetal survival group. Preeclamptic patients were divided into four groups based on quartiles of uric acid levels. The overall fetal survival rate in patients with upper-quartile uric acid concentrations was significantly lower than those with low uric acid levels during pregnancy. Multivariate logistic regression analysis revealed that uric acid concentration was a significant risk factor for fetal death in the first and second trimesters in the preeclamptic group (p &lt; 0.05). Conclusions: In pregnant women with preeclampsia, fetal death was associated with upper-quartile uric acid concentrations in the first and second trimesters. Uric acid levels can be an indicator of fetal death in the early and middle stage of pregnancy.

Study on the correlation between maternal serum uric acid and foetal birth weight in Naqu, Tibet

In high-altitude regions, low birth weight is mainly caused by hypoxia. We aimed to determine whether maternal serum uric acid (SUC) level was associated with decreased foetal birth weight. The relevant data of individual pregnant women who delivered between 37 and 40 weeks in the People’s Hospital of Naqu City, Tibet were retrospectively collected. The correlation between maternal SUC and birth weight was examined using multivariate linear regression analysis and subgroup analysis. The results showed that there was a significant negative correlation between SUC and birth weight in pregnant women with proteinuria, female foetuses, and primiparas. Fitting smoothing curve analysis showed that there was a negative linear correlation between SUC and birth weight in primiparas and female foetuses. Maternal SUC is negatively associated with foetal birth weight in a single pregnancy with proteinuria, primipara, or female foetuses in the Naqu region of Tibet, China. IMPACT STATEMENT What is already known on this subject? Preeclampsia associated with hyperuricaemia can affect foetal birth weight, foetal birth weight in plains area is negatively correlated with maternal hyperuricaemia. What do the results of this study add? Maternal SUC was negatively correlated with foetal birth weight, especially in primipara, mothers with proteinuria, and pregnant girls. What are the implications of these findings for clinical practice and/or further research? The results suggest that attention should be paid to SUC in pregnant women, especially in primipara, mothers with proteinuria, and pregnant girls, in the prevention of low birth weight infants in Naqu Plateau area of Tibet.

Maternal serum uric acid, creatinine and blood urea levels in the prediction of pre-eclampsia among pregnant women attending ANC and delivery services at Bahir Dar city public hospitals, northwest Ethiopia: A case-control study

BackgroundPre-eclampsia (PE) is a metabolic disorder that adversely affects the lives of mother and their infants. Even though, several studies have been conducted on PE, no effective diagnostic and therapeutic agents were developed so far. Hence, this study was designed to evaluate serum uric acid, blood urea and creatinine levels in the prediction of PE. MethodsA hospital-based case-control study was conducted among pregnant women. A simple random sampling technique was applied to select study participants. The socio-demographic and clinical data were collected using an interview-administered questionnaire. Serum samples were used to determine the maternal uric acid, urea and creatinine levels via an automated chemistry analyzer. Independent sample t-test, Pearson correlation test and receiver operating characteristic (ROC) curve analysis were performed to check the association and diagnostic accuracy of variables to PE. ResultsThe mean ages (in years) of the case and control groups were 27.98 ± 5.64 and 27.33 ± 4.45, respectively. The mean serum uric acid and blood urea levels were significantly higher in pre-eclamptic women than in normotensive pregnant women (6.27 ± 0.20 vs 4.43 ± 0.15, and 8.50 ± 3.99 vs 5.67 ± 2.19), respectively but the serum creatinine level is non-significantly increased in cases as compared to controls (0.70 ± 0.05 vs 0.50 ± 0.01). The areas under the ROC curve of serum uric acid, creatinine and blood urea levels were 0.785, 0.735 and 0.764 (sensitivity: 69%, 60.7%, 67.9%; specificity: 73.8%, 75%, 71.4%) with the cutoff points of ≥5.25 mg/dL, ≥0.565 mg/dL and ≥6.5 mg/dL, respectively. ConclusionIn this study, we observed a significantly higher concentration of serum uric acid and blood urea values in pre-eclampsia as compared with normotensive pregnant women. Therefore, this suggested that serum uric acid; blood urea and creatinine values can be associated with PE. Moreover, serum uric acid, blood urea and creatinine levels could be carefully utilized as a diagnostic marker for PE, but their inclusion in routine diagnostic test to PE requires large-scale multi-center prospective studies that corroborate our findings.

Correlation of Maternal Serum Uric Acid Level and Feto-maternal Outcome in Hypertensive Disorder of Pregnancy: A Prospective Study

Introduction: Hypertensive disorder of pregnancy complicates around 5-10% of all pregnancies. Hyperuricemia is one of the common findings in pre-eclampsia. The uric acid level in pre-eclamptic women is increased before the onset of hypertension and proteinuria. The increase in serum uric acid is associated with an increased risk of adverse fetal outcomes like IUGR, prematurity, IUFD and increased severity of maternal hypertensive disorders like pre-eclampsia, severe pre-eclampsia, and eclampsia and HELLP syndrome.&#x0D; Methods: This was an observational, prospective cross-sectional study. One hundred and twenty women fulfilling the inclusion criteria were included in the study. Maternal uric acid was grouped into two groups i) &lt;5.5mg/dl and ii) ≥ 5.5 mg/dl. A Pearson’s Chi-Squared test was carried out to assess whether maternal serum uric acid level and maternal and fetal complications were related.&#x0D; Results: A total of 120 women fulfilling the inclusion criteria were included in the study. Seventy-six women (63.3%) had serum uric acid levels &lt;5.5mg/dl and forty-four (36.7%) women had serum uric acid levels≥ 5.5 mg/dl. In women with serum uric acid levels of 5.5 mg/dl and more, 21 fetuses with complications like IUFD, IUGR, prematurity and those whose serum uric acid level was less than 5.5 mg/dl, 16 fetuses had complications. There was a significant association between maternal serum uric acid levels and maternal complications like pre-eclampsia, severe pre-eclampsia, eclampsia and HELLP syndrome (p=0.004).&#x0D; Conclusion: Raised serum uric acid is associated with an increased risk of the feto-maternal outcome.

Relationship between maternal serum uric acid level and preeclampsia with or without severe features

Hyperuricaemia is common in preeclampsia. Its relationship and the utility in predicting of preeclampsia must be evaluated. The objective was to determine the association between maternal serum uric acid level and preeclampsia with or without severe features, including maternal and neonatal outcomes. A retrospective study was conducted at Rajavithi Hospital between June 2015 and May 2019. Inferential analysis comparison using binary logistic regression analysis and correlation using Chi-Square test/Fisher’s exact test were used for analysis. Among the 400 participants, 331 (82.7%) women were preeclampsia with severe features. The mean uric acid level was significantly higher in women with preeclampsia with severe features compared to those without (6.44 ± 1.44 vs 5.87 ± 1.53 mg/dL, p-value = .016). Uric acid greater than 7 mg/dL was associated with renal involvement and preeclampsia with severe features. Uric acid 5–7 and greater than 7 mg/dL correlated with preterm birth (OR 2.67, 95% CI 1.59–4.49 and OR 4.89, 95% CI 2.75–8.68, respectively). Uric acid greater than 7 mg/dL also increased the risk of RDS and NICU admission. In conclusion, a high uric acid level is associated with preeclampsia with severe features and adverse pregnancy outcomes and may be the predictor of the severity of preeclampsia. Impact statement What is already known on this subject? Hyperuricaemia is a common finding in preeclamptic pregnancy due to reduction of uric acid clearance secondary to reduced glomerular filtration rate, increased reabsorption, and decreased secretion. The correlation of increase maternal uric acid level and preeclampsia including adverse pregnancy outcomes has been evaluated and supported the use of uric acid as a predictor for preeclampsia development. However, its clinical utility is still debateable. What the results of this study add? The present study demonstrated the association between higher maternal serum uric acid level and severity of preeclampsia. Particularly, serum uric acid greater than 7 mg/dL was associated with preeclampsia with severe features. Additionally, serum uric acid level 5–7 mg/dL and greater than 7 mg/dL had a positive correlation with adverse maternal and neonatal outcomes. What the implications are of these findings for clinical practice and/or further research? Maternal serum uric acid may be used as the predictor of severity of preeclampsia. However, the sensitivity and specificity and the precise clinical utility of uric acid related to preeclampsia need to be further evaluated in larger sample size.

Using Innovative Machine Learning Methods to Screen and Identify Predictors of Congenital Heart Diseases.

Objective: Congenital heart diseases (CHDs) are associated with an extremely heavy global disease burden as the most common category of birth defects. Genetic and environmental factors have been identified as risk factors of CHDs previously. However, high volume clinical indicators have never been considered when predicting CHDs. This study aimed to predict the occurrence of CHDs by considering thousands of variables from self-reported questionnaires and routinely collected clinical laboratory data using machine learning algorithms.Methods: We conducted a birth cohort study at one of the largest cardiac centers in China from 2011 to 2017. All fetuses were screened for CHDs using ultrasound and cases were confirmed by at least two pediatric cardiologists using echocardiogram. A total of 1,127 potential predictors were included to predict CHDs. We used the Explainable Boosting Machine (EBM) for prediction and evaluated the model performance using area under the Receive Operating Characteristics (ROC) curves (AUC). The top predictors were selected according to their contributions and predictive values. Thresholds were calculated for the most significant predictors.Results: Overall, 5,390 mother-child pairs were recruited. Our prediction model achieved an AUC of 76% (69-83%) from out-of-sample predictions. Among the top 35 predictors of CHDs we identified, 34 were from clinical laboratory tests and only one was from the questionnaire (abortion history). Total accuracy, sensitivity, and specificity were 0.65, 0.74, and 0.65, respectively. Maternal serum uric acid (UA), glucose, and coagulation levels were the most consistent and significant predictors of CHDs. According to the thresholds of the predictors identified in our study, which did not reach the current clinical diagnosis criteria, elevated UA (>4.38 mg/dl), shortened activated partial thromboplastin time (<33.33 s), and elevated glucose levels were the most important predictors and were associated with ranges of 1.17-1.54 relative risks of CHDs. We have developed an online predictive tool for CHDs based on our findings that may help screening and prevention of CHDs.Conclusions: Maternal UA, glucose, and coagulation levels were the most consistent and significant predictors of CHDs. Thresholds below the current clinical definition of “abnormal” for these predictors could be used to help develop CHD screening and prevention strategies.

Maternal serum uric acid: a reliable prognostic indicator of foetal outcome among pre-eclamptic patients in a low resource setting

Background Pre-eclampsia is a major cause of maternal and fetal morbidity and mortality in both developed and developing countries. Hyperuricemia is often associated with pre-eclampsia and when this occurs, fetal outcome may become worse. We evaluated the role of maternal serum uric acid as a prognostic indicator of fetal outcome in pre-eclamptic mothers. Methods A prospective case-control study in which 55 eligible pre-eclamptic patients at term were matched in maternal age and gestational age with 55 consecutive normotensive pregnant women. Venous blood samples were obtained and analyzed for serum uric acid. Following delivery, the fetal outcomes in the pre-eclamptic group and controls were determined. Data analysis was carried out using SPSS (version 21) and the level of statistical significance was set at p-value <.05. Results The mean serum uric acid levels of the pre-eclamptic subjects was significantly higher compared to their normotensive counterparts (12.7 ± 7.8 vs. 4.9 ± 1.2 mg/dL, p = .000). Babies with low birth weight, poor Apgar scores (at 1st and 5th minute of life) and those who required neonatal unit admission occurred more significantly among the pre-eclamptic women when compared with the controls (p = .000). However, the live birth rate of the case and control groups was comparable (94.5% vs. 100%, p = .079), Binary logistic regression analysis revealed a positive association between hyperuricemia and pre-eclampsia (OR = 18.8; 95% CI = 1.22–289.35, p = .035). Pre-eclamptic mothers with hyperuricemia had 4.41 odds of delivering babies with low birth weight when compared with pre-eclamptics without hyperuricemia (OR = 4.41; 95% CI = 0.76–25.5, p = .097); but Apgar scores and need for neonatal admission showed no association with maternal serum uric acid levels. Conclusion This study therefore suggests that hyperuricemia is a strong prognostic indicator of LBW babies among women with pre-eclampsia.

Interleukin-1β and uric acid as potential second-trimester predictive biomarkers of preeclampsia

ABSTRACT Methods: The prospective study was conducted at the University Hospital from February 2020 to December 2020. The study population (n = 88) included women who later developed PE (n = 42), as well as women who were healthy at birth (n = 46) in the second trimester of pregnancy. Serum levels of CRP, IL-1β, uric acid, creatinine, AST, ALT, MPV, Hb, PC, vitamin D, Ca, and Mg were compared between the groups. Results: Serum IL-1β and uric acid levels were significantly higher in subjects who eventually developed PE compared with those who did not. Conclusions: IL-1β and uric acid may be a predictive markers for PE. Maternal serum IL-1β and uric acid levels in the second trimester of pregnancy may be a predictive markers for PE.

Serum uric acid level between normotensive and pre-eclamptic patients in third trimester of pregnancy and perinatal outcome

Background : Preeclampsia is associated with maternal and neonatal complications. It has been indicated that increased uric acid might have a predictive role on preeclampsia. Several studies have demonstrated a relation between elevated maternal serum uric acid levels and adverse maternal and fetal outcome. The aim of this study was to find out the association of serum uric acid level between normotensive and pre-eclamptic (PE) patients in third trimester of pregnancy and perinatal outcome.&#x0D; Methodology : A case control study was conducted in the department of the Obstetrics and Gynaecology in Dhaka Medical College Hospital from July 2017 to June 2018. A total number of 100 pregnant women in third trimester of pregnancy attending in Obstetrics and Gynaecology department of Dhaka Medical College Hospital were selected purposively as study subjects. Among them 50 diagnosed cases of preeclampsia were selected as cases with age range of 18-35 years and 50 normal healthy age matched pregnant women as controls. Pregnant women with pre-existing hypertension, diabetes mellitus and renal disease were excluded from the study by history, clinical examination and relevant laboratory investigations.&#x0D; Results : The mean serum uric acid level was found 4.49±1.72 mg/dl in normotensive group and 7.03±1.89 mg/dl in preeclampsia group. Serum uric acid was significantly higher (p&lt;0.05) in pre-eclampsia group than normotensive group. Regarding outcome take home as alive neonate was found 48(96.0%) in normotensive group and 41(82.0%) in preeclampsia group. Early neonatal death was 1(2.0%) in normotensive and 4(8.0%) in pre-eclampsia group. Still birth was 1(2.0%) and 5(10.0%) in normotensive and pre-eclampsia group respectively.&#x0D; Conclusion : Hyperuricemia is most basic and reliable observations in pre-eclamptic pregnancies. While elevated concentrations of circulating uric acid are not uniformly increased in every woman with PE. But hyperuricemia is found in a subset of pre-eclamptic women who had higher risk for maternal and fetal complications. Therefore, measurement of serum uric acid concentration seems to be a useful test to predict maternal and fetal complications in a women with preeclampsia.&#x0D; Northern International Medical College Journal Vol. 11 No. 1 July 2019, Page 419-422

Maternal Serum Uric Acid Levels and Adverse Pregnancy Outcomes in Women with Hypertensive Disorders of Pregnancy

Introduction: Hypertensive Disorders of Pregnancy (HDP) are the major cause of maternal morbidity and mortality worldwide. The maximum burden of maternal mortality and morbidity is due to HDP and its related complications which is further followed by obstetric haemorrhage, pre-existing medical diseases, infections and abortions. Aim: To study the association between the serum uric acid level in hypertensive pregnant women and their association with maternal and foetal morbidity and mortality. Materials and Methods: It was a prospective observational study conducted at BLDE (Deemed to be) University, Shri BM Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India from January to June 2019. A total of 165 pregnant women with HDP were included (44 (27%) had Gestational Hypertension (GH); 86 (52%), Pre-eclampsia (PE) and 35 (21%) eclampsia) in each group in the study and they were subjected for obstetric history, examination and laboratory evaluation. The laboratory evaluation included complete blood count, liver function test, renal function test, serum uric acid level and urine albumin, sugars and microscopy. The maternal and foetal outcomes were measured, which included mode of delivery, Neonatal Intensive Care Unit (NICU) admission, neonatal outcomes in terms of preterm or term delivery, intrauterine death, fresh still born, neonatal deaths. Results: A total of 165 cases with HDP were enrolled in the study. Mean serum uric acid level in GH, PE and eclampsia group was 5.13±1.32, 5.34±1.4, 6.05±1.67, respectively. A total of 118 participants presented at term and 47 were preterm (11 in GH, 20 in PE and 16 in eclampsia group). About 103 (62.42%) had vaginal delivery and 62 (31.51%) underwent caesarean section (14 in GH, 28 in PE and 20 in eclampsia group). All the perinatal deaths occurred were in women with PE (n=5) and eclampsia (n=2) and was not statistically analysed. Conclusion: Present study shows that increased levels of maternal serum uric acid levels were associated with PE and eclampsia compared to GH patients and were associated with adverse foetal outcomes and increase in the instrumental and operative interventions.

Maternal Serum Uric Acid as a Predictor of Severity of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study.

Objective: To assess the relationship between maternal serum uric acid and severity of Hypertensive disorders of pregnancy in a rural tertiary care centre.Materials and Methods: Present study was conducted in Obstetrics and Gynaecology department of rural tertiary care cen-tre of Northern India over seven months (October 2016-May 2017) on 110 women admitted with a Hypertensive disorder of pregnancy (Gestational hypertension, Pre-eclampsia, Eclampsia) at ≥34 weeks gestation. Maternal serum uric acid levels were compared in three groups in relation to disease severity, mode of delivery, maternal outcome.Results: Of total 110 women with a Hypertensive disorder of pregnancy; 35 (31.81%) had Gestational Hypertension, 49 (44.54%) preeclampsia and 26 (23.63%) had eclampsia. Mean±SD values for serum uric acid were 5.47±1.93 mg/dl in women with Gestational Hypertension; 6.72±2.15 mg/dl in Pre-eclampsia and 8.71±2.97 mg/dl in the eclamptic group. Of 110 women 34(97.14%) with gestational hypertension, 27(55.10%) with pre-eclampsia and one (3.85%) with eclampsia re-mained stable in post-partum period, 17 (34.69%) women with severe pre-eclampsia and 15 (57.69%) with eclampsia re-quired intensive care in postpartum period and one (2.86%) women with gestational hypertension, five (10.20%) with pre-eclmapsia and ten (38.46%) with eclampsia required ventilator support and high dependency unit care. Of these 16 women with the severe disease, ten succumbed to death. Also, in women with serum uric acid,>6mg/dl, most common mode of de-livery was a lower segment cesarean section (50.90%).Conclusion: Significant correlation was observed between maternal serum uric acid, disease severity and maternal outcome.

Predictive value of serum uric acid levels for adverse perinatal outcomes in preeclampsia.

Preeclampsia is a multisystem disorder associated with pregnancy and is a common cause of perinatal morbidity. The aim of this study was to determine whether elevated serum uric acid levels, alone or in combination with other laboratory factors could predict preeclampsia in women with adverse perinatal outcomes.We conducted a prospective observational study of women who were admitted to Soonchunhyang University Cheonan Hospital from January 2016 to December 2016. Demographic, clinical and laboratory data were collected for each pregnancy at the time of delivery. Women were grouped according to status (preeclampsia or normotensive), and a logistic regression analysis was used to determine the relationship between serum uric acid levels and adverse outcomes.The mean age of the study participants was 31.3 ± 5.0 years. In patients with preeclampsia, serum uric acid level was associated with the severity of preeclampsia, including blood pressure (R = 0.321, P = .014), serum creatinine levels (R = 0.505, P < .001), and proteinuria (P = .014), as well as adverse fetal outcomes, including preterm labor (P = .027) and low birth weight delivery (P = .001). The optimal maternal serum uric acid threshold that predicted low birth weight at delivery was 6.35 mg/dL (sensitivity, 0.58; specificity, 0.95). The multivariable logistic regression model that was used to predict low birth weight at delivery displayed an area under the receiver-operating characteristic curve of 0.902 (95% confidence interval, 0.817–0.986).In women with preeclampsia, maternal serum uric acid level is an important parameter for predicting low birth weight. Additionally, the combination of uric acid, hemoglobin, and bilirubin levels appear to be optimal for predicting low birth weight in women with preeclampsia.

Maternal serum uric acid concentration and pregnancy outcomes in women with pre-eclampsia/eclampsia.

ObjectivesTo determine the relationship between maternal serum uric acid levels and fetal/neonatal complications in women with pre‐eclampsia/eclampsia, and to establish a predictive threshold value.MethodsA diagnostic test and historical cohort study conducted by prospective cross‐sectional data collection on pregnant women with pre‐eclampsia/eclampsia at Hue University Hospital, Vietnam, between March 2015 and July 2017. Pre‐eclampsia was diagnosed based on ACOG criteria. Serum uric acid levels were measured by enzymatic colorimetric testing using a Cobas c 501 analyzer (Roche Diagnostics, Mannheim, Germany). Fetal complications included intrauterine growth restriction, preterm delivery, fetal death, and neonatal death.ResultsThere were 205 women enrolled. Serum uric acid at a cutoff of 393 μmol/L is a good predictor of fetal/neonatal complications (AUC 0.752), with 64.4% sensitivity and 79.5% specificity. High uric acid level (≥393 μmol/L) resulted in increased risk of preterm birth (OR 6.367, 95% CI 3.009–13.084), low Apgar scores (OR 5.514, 95% CI 1.877–16.198), intrauterine growth restriction (OR 7.188, 95% CI 3.592–14.382), and neonatal death (OR 7.818, 95% CI 1.614–37.867). There was no relationship between uric acid level and fetal death (OR 1.803, 95% CI 0.355–9.168).ConclusionsMaternal serum uric acid concentration is a good predictor of fetal/neonatal outcomes in women with pre‐eclampsia/eclampsia.

Maternal serum uric acid levels in pregnancy and fetal growth

Objective: Studies of maternal serum uric acid (UA) in pregnancy focus primarily on high levels of UA, however, both low and high UA levels can be markers of oxidative stress, a biological state potentially linked to fetal growth. We therefore aimed to test whether low and high maternal serum UA levels during pregnancy are associated with atypical fetal growth (unusually small or large) measured as birthweight (BW) for gestational age.Methods: The Pregnancy Outcomes and Community Health Study enrolled 3019 pregnant women between their 16th–27th week of pregnancy from 52 clinics in five Michigan communities (1998–2004). Maternal UA levels were measured in blood collected at enrollment among a subcohort of 1291 participants. Infant BW and gestational age were used to calculate gestational age-specific BW Z-score. Infants were grouped as small (SGA = BW < 10th percentile), appropriate (AGA = BW 10th–90th percentile), or large (LGA) = BW > 90th percentile) for their gestational age. Analyses considered multiple potential confounders. Linear spline or multiple linear regression models were applied to evaluate the relationship between maternal UA levels and BW Z-score overall and within SGA, AGA, and LGA groups. Model robustness was tested through bootstrap, sensitivity analysis, and cross-validation techniques.Results: The relation between maternal UA levels and BW Z-score varied by infant group. Among SGA infants, the relation was nonlinear (J-shape): both extremes of UA had lower BW Z-score with a breakpoint of 0.267 mmol/L UA (adjusted regression coefficient β = 2.32, p = .01 for lower UA; adjusted β = −37.38, p < .01 for higher UA). Among AGA infants, there was no significant association, and among LGA infants, the relation was linear (adjusted β = 2.86, p = .03).Conclusions: Future research on maternal UA levels in pregnancy may benefit from considering both very low and high levels, and identifying in utero conditions associated with the two extremes.

Maternal serum uric acid levels and blood pressure during pregnancy: A community-based cohort study

ObjectiveStudies find both very low and high serum uric acid (UA) levels are related to oxidative stress and to conditions such as cardiovascular diseases and chronic kidney disease in the general population. Pregnancy studies have focused only on high maternal UA. In present study, we tested whether unusually high and low levels of maternal serum UA are associated with increases in blood pressure (BP) during pregnancy. Study designThe Pregnancy Outcomes and Community Health Study enrolled 3019 pregnant women between their 16th–27th week of pregnancy from 52 clinics in 5 Michigan communities (1998–2004). UA levels were measured in maternal blood collected at enrollment from a sub-cohort of 1223 participants. BP was abstracted from prenatal medical records; these analyses used highest recorded diastolic BP (DBP) and its companion systolic BP (SBP). Mean arterial pressure (MAP) was calculated using the formula of (2 × DBP + SBP)/3. Covariates, including maternal race/ethnicity, age at enrollment, education level, medical insurance status, body mass index before pregnancy, parity, smoking during pregnancy, alcohol use during pregnancy, and gestational week at blood collection, were considered as potential confounding variables. Associations between UA levels and BP were evaluated with linear spline or multiple linear regression models. Models’ robustness was examined with bootstrap estimation of variance, sensitivity analysis, and 10-fold cross-validation. ResultsBoth DBP and MAP had a J-shaped relationship with maternal UA; the breakpoints (nadirs) were 0.153 and 0.161 mmol/L UA, respectively. For DBP versus UA, adjusted regression coefficient (β) = −95.67 (standard error (SE) = 37.67 and p = 0.01) for the left and adjusted β = 48.95 (SE = 9.56 and p < 0.01) for the right; for MAP versus UA, adjusted β = −58.48 (SE = 31.42 and p = 0.06) for the left and adjusted β = 52.23 (SE = 11.39 and p < 0.01) for the right. Maternal SBP followed a positive linear trend with UA levels (adjusted β = 37.75, SE = 12.93, and p < 0.01). All results were robust. ConclusionExtreme high and low maternal serum UA levels may be informative in studying maternal blood pressure during pregnancy.