Pregnancy-Induced Hypertension: Hyperuricemia as a Predictor of Perinatal Outcomes
Keywords:
Serum uric acid, Hyperuricemia, Pre-eclampsia, Pregnancy induced hypertensionAbstract
Aim/Objective
The aim of this study to determine the relationship between hyperuricemia and perinatal outcome in pregnancy induced hypertension.
Material & Methods
This prospective and observational study was carried out in the Department of Obstetrics & Gynecology of Tanta University. The study included (100) primigravida female patients in the third trimester (after 32 weeks gestation) with pregnancy induced hypertension .Serum uric acid assay was done then the patients were classified into three groups according to uric acid level; Group I (low hyperuricemia) uric acid below 25th percentile (<3.7 mg/dl ), group II (middle hyperuricemia) uric acid from 25th to 75th percentile (3.8 to 5.7 mg/dl ) and group III (high hyperuricemia) uric acid above 75th percentile (>5.8 mg/dl).
Follow up of maternal outcome as (eclampsia, HELLP, acute renal failure and accidental hemorrhage) and fetal outcomes (stillbirth, prematurity, IUGR and IUFD).
Other obstetric complication that can affect pregnancy, other medical disease and severe pre-eclampsia that need urgent termination were excluded.
Result
The results showed statistically significant increase of serum uric acid, urea and creatinine in high group compared to middle and low ones. Bad fetal outcome and pregnancy complications were directly proportionate to the serum uric acid level.
Conclusion
These data reinforce the general agreement about the utility of hyperuricemia in the prognosis of adverse perinatal outcomes in pregnancy induced hypertension. Serum uric acid level measurements are a useful and inexpensive marker for predicting adverse perinatal outcomes.
References
Muti M, Tshimanga M, Gombe N, Chonzi P. Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe. BMC Car-diovascular Disorders. 2015; 15: 111. doi: 10.1186/s12872-015-0110-5
Lin S, Leonard D, Co MA, et al. Pre-eclampsia has an adverse impact on maternal and fetal health. Transl Res. 2015; 165(4): 449- 63. doi: 10.1016/j.trsl.2014.10.006
Nardozza LMM, Caetano AC, Zamarian ACP, et al. Fetal growth restriction: Current knowledge. Arch Gynecol Obstet. 2017; 295: 1061-1077. doi: 10.1007/s00404-017-4341-9
Von Dadelszen P, Payne B, Li J, et al. Prediction of adverse maternal outcomes in preeclampsia: Developmentand validation of the full PIERS model. Lancet. 2011; 377: 219-227. doi: 10.1016/ S0140-6736(10)61351-7
Magee LA, Pels A, Helewa M, et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014; 4 (2): 105-145. doi: 10.1016/j.preghy.2014.01.003
Goldenberg RL, Jones B, Griffin JB, et al. Reducing maternal mortality from preeclampsia and eclampsia in low-resource coun-tries - what should work? Acta Obstet Gynecol Scand. 2015; 94(2): 148-155. doi: 10.1111/aogs.12533
Claven T, Djurovic S, Henriksen T. Dyslipidemia in early 2nd tri-mester is mainly a feature of women with early onset preeclampsia . BJOG. 2001; 108(10); 1081-1087.
Damien S, Patric G, Francies P, et al. Aspirin (100mg) used for prevention of preeclampsiain nulliparous women: The Essai Re-gional Aspirin Mere - Enfant study (Part-1). BJOG. 2003; 110: 475- 484.
Shaker el Sayed Azzaz AM. Antenatal care booking during preg-nancy and its effect on maternal and fetal outcomes. (Doctoral thesis). Universidad de Sevilla, Sevilla; 2017.
von Dadelszen P, Magee LA. Preventing deaths due to the hy-pertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynae-col. 2016; 36: 83-102. doi: 10.1016/j.bpobgyn.2016.05.005
Livingston JR, Payne B, Brown M, et al. Uric Acid as a predic-tor of adverse maternal and perinatal outcomes in women hospi-talized with preeclampsia. J Obstet Gynaecol Can. 2014; 36(10): 870- 877. doi: 10.1016/S1701-2163(15)30435-7
Zhou G, Holzman C, Luo Z, Margerison C. Maternal serum 20 Khalil SSH, et al uric acid levels and blood pressure during pregnancy: A commu-nity-based cohort study. Eur J Obstet Gynecol Reprod Biol. 2018; 222: 64-69. doi: 10.1016/j.ejogrb.2018.01.008
Kang DH, Finch J, Nakagawa T, et al. Uric acid, endothelial dysfunction and preeclampsia: Searching for a pathogenetic link. J Hypertens. 2004; 22(2): 229-235.
Bainbridge SA, Roberts JM. Uric acid as a pathogenic factor in preeclampsia. Placenta. 2008; 29(Suppl A): S67-S72. doi: 10.1016/j. placenta.2007.11.001
Martin AC, Brown MA. Could uric acid have a pathogenic role in pre-clampsia? Nat Rev Nephrol. 2010; 6: 744-748. doi: 10.1038/ nrneph.2010.125
Lisonkova S, Sabr Y, Mayer C, et al. Maternal morbidity associ-ated with early-onset and late-onset preeclampsia. Obstet Gynecol. 2014; 124: 771-781. doi: 10.1097/AOG.0000000000000472
Wolak T, Sergienko R, Wiznitzer A, Paran E. High uric acid level during the first 20 weeks of pregnancy is associated with higher risk for gestational diabetes mellitus and mild preeclampsia. Hypertens Pregnancy. 2012; 31: 307-315. doi: 10.3109/10641955.2010.507848
Phad N, Dahlstrom JE, Ellwood D, Kent AL. The effect of pregnancy-induced hypertensive disorders on placental growth along short and long axes and neonatal outcomes. Aust N Z J Obstet Gynaecol. 2015; 55: 239-244. doi: 10.1111/ajo.12308
Khaleeq A, Waheed K, Ejaz S, Kamal A. Hyperuricemia as a predictor of poor fetal outcome in pre-eclamptic women. Journal of Rawalpindi Medical College (JRMC). 2015; 171-173.
Patel K, Kaur P, Deepak A, et al. Association of serum uric acid and C-reactive protein levels in prediction of preeclamp-sia. Int J Reprod Contracept Obstet Gynecol. 2016; 5(2): 495-502. doi: 10.18203/2320-1770.ijrcog20160398
Ul Hosna A, Bhuiyan AKMM, E-Ferdous N, et al. Effects of hyperuricemia on perinatal outcome in hypertensive disorder of pregnancy. University Heart Journal. 2008; 4(2): 36-40. doi: 10.3329/ uhj.v4i2.2074
Niraula A, Lamsal M, Majhi S, Khan SA, Basnet P. Significance of serum uric acid in pregnancy induced hypertension. J Natl Med Assoc. 2017; 109(3): 198-202. doi: 10.1016/j.jnma.2017.01.009
Escudero C, Bertoglia P, Acurio J, Escudero A. Hyperuricemia in the prognosis of adverse perinatal outcomes: An International. Journal of Women’s Cardiovascular Health. 2012; 2: 240-339.
Amini E, Sheikh M, Hantoushzadeh S. Maternal hyperuricemia in normotensive singleton pregnancy, a prenatal finding with con-tinuous perinatal and postnatal effects. BMC Pregnancy Childbirth. 2014; 14: 104. doi: 10.1186/1471-2393-14-104
Kondareddy T, Prathap T. Uric acid as an important biomark-er in hypertensive disorders in pregnancy. Int J Reprod Contracept Obstet Gynecol. 2016; 5(12): 4382-4384. doi: 10.18203/2320-1770. ijrcog20164348
Hussain SS, Choudhury MBK, Akhter J, et al. Fetal outcome of pre-eclamptic mothers with hyperuricemia. J Dhaka National Med. Submit your article to this journal | https://openventio.org/submit-manuscript/ Khalil SSH, et al Coll. Hos. 2011; 17 (01): 41-43. doi: 10.3329/jdnmch.v17i1.12192
Hawkins T, Roberts J, Mangos G, et al. Plasma uric acid remains a marker of poor outcome in hypertensive pregnancy: A retro-spective cohort study. BJOG. 2012; 484-492. doi: 10.1111/j.1471- 0528.2011.03232.x
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Gynecology and Obstetrics Research (GOR) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
