Published: 2017-02-10

Relationship of serum uric acid, serum creatinine and serum cystatin C with maternal and fetal outcomes in rural Indian pregnant women

Padma Yalamati, Aparna Varma Bhongir, Kalpana Betha, Ritika Verma, Shailendra Dandge


Background: Hypertensive disorders are the most common in pregnancy. Several studies showed a positive correlation between elevated maternal serum uric acid (UA), serum creatinine and adverse maternal and fetal outcomes, but only a few studies are available on serum cystatin C and maternal and fetal outcomes. The present study was undertaken to study the association of serum UA, creatinine and cystatin C with maternal and fetal outcomes.

Methods: Out of 116 pregnant women 69 women had no hypertension and 47 had hypertension with or without proteinuria. Serum UA, creatinine and cystatin C was measured by modified Uricase method, modified kinetic Jaffe’s reaction and particle-enhanced immunonephelometric assay respectively. Multivariate logistic regression was performed to determine the independent effects of serum UA, creatinine and cystatin C on maternal and fetal outcomes using stata 13.1.

Results: The adjusted odds ratio (OR) was 3.73 (95% CI: 1.18-11.75; P=0.024) for UA; 15.79 (95% CI: 3.04-81.94; P=0.001) for creatinine and 2.03 (95% CI: 0.70-5.87; P=0.192) for cystatin C in hypertensive disorders of pregnancy. All the three renal parameters were not significantly associated with birth weight, gestational age of delivery and mode of delivery after adjusting for the confounding factors.

Conclusions: Serum creatinine and uric acid are independent risk factors for hypertensive disorders of pregnancy. High serum uric acid is associated with low birth weight and delivery by caesarian section whereas high serum creatinine with preterm delivery only before adjustment for confounding factors and not after adjustment. Serum cystatin C was not significantly associated with the maternal and fetal outcomes.



Uric acid, Creatinine, Cystatin C, Gestational Hypertension, Preeclampsia, Gestational age, Birth weight, Caesarian section, Logistic regression

Full Text:



Matthews Z. World health report 2005: make every mother and child count. World Health. 2005:409-11.

American College of Obstetrics and Gynecology. ACOG Practice Bulletin N.33. Diagnosis and management of preeclampsia and eclampsia. Obs Gynecol. 2002;99:159-67.

Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertension in pregnancy : official journal of the International Society for the Study of Hypertension in Pregnancy. 2001. p. IX – XIV.

Redman CW, Beilin LJ, Bonnar J, Wilkinson RH. Plasma-urate measurements in predicting fetal death in hypertensive pregnancy. Lancet, 1976.

Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL. Risk factors for severe preeclampsia. Obs Gynecol. 1994;83(3):357-61.

Roberts JM, Bodnar LM, Lain KY, Hubel CA, Markovic N, Ness RB, et al. Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension. 2005;46(6):1263-9.

Laughon SK, Catov J, Powers RW, Roberts JM, Gandley RE. First trimester uric acid and adverse pregnancy outcomes. Am J Hypertens. 2011;24(4):489-95.

Parrish M, Griffin M, Morris R, Darby M, Owens MY MJ. Hyperuricemia facilitates the prediction of maternal and perinatal adverse outcome in patients with severe/superimposed preeclampsia. J Matern Fetal Neonatal Med. 2010;23:1541-5.

Sanders CL, Lucas MJ. Renal disease in pregnancy. Obstetrics and Gynecology Clinics of North America. 2001:593-600.

Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med. 1996;335(4):226-32.

Franceschini N, Qiu C, Barrow DA, Williams MA. Cystatin C and preeclampsia: a case control study. Ren Fail. 2008;30(1):89-95.

KALCKAR HM. Differential spectrophotometry of purine compounds by means of specific enzymes; determination of adenine compounds. J Biol Chem. 1947;167(2):445-9.

Knapp ML, Mayne PD. Development of an automated kinetic Jaffé method designed to minimise bilirubin interference in plasma creatinine assays. Clin Chim Acta. 1987;168(2):239-46.

Finney H, Newman DJ, Gruber W, Merle P, Price CP. Initial evaluation of cystatin C measurement by particle-enhanced immunonephelometry on the behring nephelometer systems (BNA, BN II). Clin Chem. 1997;43(6):1016-22.

Johnson AM RES. Proteins: Analysis of proteins. In: AE BC, editor. Tietz Fundamentals of Clinical Chemistry. 5th editio. Philadelphia; 2001:350.

Padma Y, Aparna VB, Kalpana B, Ritika V, Sudhakar PR. Renal markers in normal and hypertensive disorders of pregnancy in Indian women: a pilot study. Int J Reprod contraception, Obstet Gynecol. 2013;2(4):514-20.

Khadilkar VV, Khadilkar AV, Choudhury P, Agarwal KN, Ugra D, Shah NK. IAP Growth Monitoring Guidelines for Children from Birth to 18 Years. Indian Pediatr. 2007;44:187-97.

Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC WK. Section VII: Common complications of pregnancy, Preterm birth. Williams Obstetrics. 21st editi. New York: Mc Graw Hill; 2003. p. 690.

Thangaratinam S, Ismail KMK, Sharp S, Coomarasamy A, Khan KS. Accuracy of serum uric acid in predicting complications of pre-eclampsia: A systematic review. BJOG: An International Journal of Obstetrics and Gynaecology. 2006:369-78.

Siemons JM BL. The uric acid content of maternal and fetal blood. J Biol Chem. 1917;32:63-9.

Fadel HE, Northrop G, Misenhimer HR. Hyperuricemia in pre-eclampsia. A reappraisal. Am J Obstet Gynecol. 1976;125(5):640-7.

Chesley LC W LO. Renal glomerular and tubular function in relation to the hyperuricemia of preeclampsia and eclampsia. Am J Obs Gyneco. 1945;50:367-75.

Weerasekera DS, Peiris H. The significance of serum uric acid, creatinine and urinary microprotein levels in predicting pre-eclampsia. J Obstet Gynaecol. 2003;23(1):17-9.

Many A, Hubel CA, Roberts JM. Hyperuricemia and xanthine oxidase in preeclampsia, revisited. American Journal of Obstetrics and Gynecology. 1996:288-91.

Liedholm H, Montan S, Aberg A. Risk grouping of 113 patients with hypertensive disorders during pregnancy, with respect to serum urate, proteinuria and time of onset of hypertension. Acta Obstet Gynecol Scand Suppl. 1984;118:43-8.

Lancet M FI. The value of blood uric acid levels in toxemia of pregnancy. J Obs Gynaecol Br Emp. 1956;63:116-9.

CN. M. An evaluation of the serum uric acid level in pregnancy. J Obs Gynaecol Br Commonw. 1963;70:63-8.

Manjareeka M, Nanda S. Elevated levels of serum uric acid, creatinine or urea in preeclamptic women. Int J Med Sci Public Heal. 2013;2(1):43.

Bellomo G, Venanzi S, Saronio P, Verdura C, Narducci PL. Prognostic significance of serum uric acid in women with gestational hypertension. Hypertension. 2011;58(4):704-8.

Tejal P, Astha D. Relationship of Serum Uric Acid Level to Maternal and Perinatal Outcome in Patients with Hypertensive Disorders of Pregnancy. 2014;69(2):1-3.

Akahori Y, Masuyama H, Hiramatsu Y. The correlation of maternal uric acid concentration with small-for-gestational-age fetuses in normotensive pregnant women. Gynecol Obstet Invest. 2012;73(2):162-7.

Sagen N, Haram KNST. Serum urate as a predictor of fetal outcome in severe pre-eclampsia. Acta Obs Gynecol Scand. 1984;63(1):71-5.

Schuster E, Weppelmann B. Plasma urate measurements and fetal outcome in preeclampsia. Gynecol Obstet Invest. 1981;12(3):162-7.