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

Veena Bhagavan, Aadhishree Rao, Ritu Sharma


Background: Hypertensive disorders of pregnancy affect 6-8% of all pregnancies and along-with haemorrhage and infection, they form a complex triad, contributing immensely to maternal morbidity and mortality. Although exact aetio-pathogenesis of pre-eclampsia is unknown, multiple factors have been implicated to have a role in it; the factors being abnormal placental implantation, endothelial dysfunction, maternal immunological tolerance, cardiovascular, genetic, nutritional and environmental factors. Increased uric acid concentration is one of the most pronounced clinical findings in preeclampsia. Hyperuricemia in preeclamptic women is primarily due to a reduction in glomerular filtration rate due to endothelial dysfunction. In this study we look to explore the relationship between elevated serum uric acid and the perinatal outcomes, especially the ability to predict adverse perinatal outcomes.

Methods: This was a hospital based retrospective study, conducted in A J institute of medical sciences and research centre, from January 2020 to December 2020. 75 study participants >20 weeks with diagnosed preeclampsia were chosen and their perinatal outcomes were measured. Chi square test and Fisher exact test was used to calculate p>0.05 was considered statistically significant. 

Results: Mean gestational age at delivery for elevated serum uric acid was 36.8 with SD=2.57 and those with normal uric acid levels is 38.43 with SD=0.89. FGR was seen in 5 patients, among which 4 (80%) had increased serum uric acid levels and 1 (20%) had normal serum uric acid levels. Total number of neonates who had APGAR score <7 was 3, among whom 2 neonates (66.66%) were born to increased uric acid level mothers. Out of 74 neonates, total number of neonates who had NICU admission were 20, among whom 9 neonates (45%) were born to mothers with increased serum uric acid levels.

Conclusions: The study concluded that elevated serum uric acid is significantly associated with adverse perinatal outcomes, like FGR, low birthweight, low APGAR score and increased NICU admissions, there was no significant association between elevated serum uric acid level and mode of delivery.



Preeclampsia, Serum uric acid, Perinatal outcome

Full Text:



Kamath S. Hypertension in pregnancy. JAPL. 2006;54:269-70.

Cunningham FG, Leveno KJ, Bloom SL. Chapter 40. Hypertensive disorders. In: Williams Obstetrics (24th edn). New York, Mc Graw-Hill. 2014;728- 79.

American College of Obstetrician and Gynecologists. Women’s Health Care Physicians. Hypertension in Pregnancy. Washington, DC. Chapter-2, Establishing the Diagnosis of Preeclampsia and Eclampsia. 2013;17-21.

Qublan H, Ammarin V, Bataineh O, Al-Shraideh Z, Tahat Y, Awamleh I et al. Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe pre-eclampsia. Int Med J Exp Clin Res. 2005;11(8):CR393-7.

Ryu A, Cho NJ, Kim YS, Lee EY. Predictive value of serum uric acid levels for adverse perinatal outcomes in preeclampsia. Medicine (Baltimore). 2019;98(18):e15462.

Martin. Chapter 40: Hypertensive disorders. Williams Obstetrics. 24th ed. New York: Mc Graw-Hill; 2014: 747

Khan KS, Wojdyla D, Say L. WHO analysis of causes of maternal death: A systematic review. Lancet 2006;367:1066.

Redman CWA, Beilin LJ, Bonnar J, Wilkinson RH. Plasma urate measurements in predicting fetal deaths in Hypertensive pregnancies. Lancet. 1976;26.

Chesley LC. Diagnosis of preeclampsia. Obstet. Gynecol. 1985;65:423-5.

Hawkins TL, Roberts JM, Mangos GJ, Davis GK, Roberts LM, Brown MA. Plasma Uric acid remains a marker of poor outcome in hypertensive pregnancy: retrospective cohort study. BJOG. 2012;119(4):484-92.

Foy RA. Uric acid in pregnancy and precclampsia: an alternative hypothesis. Aust NZ J Obstet Gynaecol. 1990;30(2):141/2.

Conde-Agudelo A, Lede R, Belizean J. Evaluation methods used in the prediction of hypertensive disorders of pregnancy. Obstet Gynecol Surv. 1994;49(3);210-22.

Yuquan WU, Fraser WD, Loo ZC. Association of uric acid with progression to preeclamsia and development of adverse conditions in Gestational hypertensive pregnancies. Am J Hypertens. 2012;25(6):711-7.

Bellomo G, Venanzi S, Saronio P, Verdure C, Luca P. Prognostic Significance of Serum uric acid in Women with Gestational hypertension. Hypertension. 2011;58(4):704-8.

Enaruna NO, Idemudia JO, Aikoriogie PI. Serum lipid profile and uric acid levels in preeclampsia in university of benin teaching hospital. Niger Med J. 2014;55(5):423-7.

Kooffreh ME, Ekott M, Ekpoudom DO. The prevalence of preeclampsia among pregnant women in the university of Calabar teaching hospital Calabar. Saudi J Health Sci. 2014;3(3):133-6.

Urato AC, Bond B, Strohsnitter WC. Admission uric acid levels and length of expectant management in preterm preeclampsia. J Perinatol. 2012;32(10):757-62.

Hawkins TA, Robert JM, Mangos JC, Davis GK, Robert LM, Brown MA. Plasma uric acid remains a marker of poor outcome in hypertensive pregnant a prospective cohort study. BJOG. 2012;119:484-92.

Livingston JR, Payne B, Brown M, Roberts JM. Uric acid as a predictor of adverse maternal and perinatal outcomes in women hospitalised with preeclampsia. J Obstet Gynaecol Can. 2014;36(10)870-7.