Maternal Serum Uric Acid as an Index of Perinatal Outcomes in Severe Preeclampsia
https://doi.org/10.24017/science.2018.2.13
Abstract views: 1416 / PDF downloads: 713Abstract
Preeclampsia is a multisystem disorder characterized by gestational hypertension after the 20th week of gestation with proteinuria, is common and dangerous adverse event of pregnancy. Several studies reported relationship between uric acid concentrations and severity of disease in pregnant women. The objective of this study was to explore the relation between serum uric acid level and perinatal outcomes. A case–control study conducted in Sulaimani Maternity Teaching Hospital from January 2014 to July 2014. Included 100 pregnant women in third trimester with signs and symptoms of labour, who had no comorbid diseases. Grouped to 30 control without hypertension, 30 with pregnancy induced hypertension (PIH) and 40 with severe preeclampsia based on clinical and laboratory evaluation. SPSS v21 was used for obtain mean, standard deviation, frequency and percentage. One way ANOVA test used to obtain P value with consider <0.05 significant value. Results show serum uric acid mean and standard deviation (±SD) for control, PIH and severe preeclampsia groups were (5.83 ± 9.544), (4.35 ± 1.372) and (7.59 ± 0.508) respectively. The positive and significant (? 0.001) correlation coefficient was found between high serum uric acid level and oligohydramnios, low birth weight and low Apgar score. The highest level of serum uric acid was recorded in preeclampsia group and the lowest level was in PIH group. Significant and adverse perinatal outcomes relation were noted in the patients with high serum uric acid (>7 mg/dl); decreased amniotic fluid index (AFI), caused low birth weight and low Apgar score. In
conclusion that severity of illness in pregnant preeclampsia cases can be estimated by serum uric acid level and high serum uric acid indicate high risk cases. Maternal serum uric acid is a useful index for estimate fetal health status and predict neonate outcomes.
Keywords:
preeclampsia, uric acid, pregnancy induced hypertension (PIH), maternal serum uric acid.
References
[1] M. A. Brown, M. D. Lindheimer, M. de Swiet, A. V. Assche, and J.-M. Moutquin, "The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP)," ed: Taylor & Francis, 2001.
https://doi.org/10.3109/10641950109152635
[2] S. Lisonkova and K. Joseph, "Incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease," American journal of obstetrics and gynecology, vol. 209, pp. 544. e1-544. e12, 2013.
https://doi.org/10.1016/j.ajog.2013.08.019
[3] C. J. Berg, J. Chang, W. M. Callaghan, and S. J. Whitehead, "Pregnancy-related mortality in the United States, 1991-1997," Obstetrics & Gynecology, vol. 101, pp. 289-296, 2003.
https://doi.org/10.1097/00006250-200302000-00015
[4] Y. Wu, X. Xiong, W. D. Fraser, and Z.-C. Luo, "Association of uric acid with progression to preeclampsia and development of adverse conditions in gestational hypertensive pregnancies," American journal of hypertension, vol. 25, pp. 711-717, 2012.
https://doi.org/10.1038/ajh.2012.18
[5] A. Many, C. Hubel, and J. Roberts, "Hyperuricemia and xanthine oxidase in preeclampsia, revisited," American Journal of Obstetrics & Gynecology, vol. 174, pp. 288-291, 1996.
https://doi.org/10.1016/S0002-9378(96)70410-6
[6] Y. Zhou, S. J. Fisher, M. Janatpour, O. Genbacev, E. Dejana, M. Wheelock, et al., "Human cytotrophoblasts adopt a vascular phenotype as they differentiate. A strategy for successful endovascular invasion?," The Journal of clinical investigation, vol. 99, pp. 2139-2151, 1997.
https://doi.org/10.1172/JCI119387
[7] J. M. Roberts, L. M. Bodnar, K. Y. Lain, C. A. Hubel, N. Markovic, R. B. Ness, et al., "Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension," Hypertension, vol. 46, pp. 1263-1269, 2005.
https://doi.org/10.1161/01.HYP.0000188703.27002.14
[8] A. C. Martin and M. A. Brown, "Could uric acid have a pathogenic role in pre-eclampsia?," Nature reviews nephrology, vol. 6, p. 744, 2010.
https://doi.org/10.1038/nrneph.2010.125
[9] C. Punthumapol and B. Kittichotpanich, "Serum calcium, magnesium and uric acid in preeclampsia and normal pregnancy," Medical journal of the Medical Association of Thailand, vol. 91, p. 968, 2008.
[10] K.-H. Lim, S. A. Friedman, J. L. Ecker, L. Kao, and S. J. Kilpatrick, "The clinical utility of serum uric acid measurements in hypertensive diseases of pregnancy," American journal of obstetrics and gynecology, vol. 178, pp. 1067-1071, 1998.
https://doi.org/10.1016/S0002-9378(98)70549-6
[11] D.-H. Kang, J. Finch, T. Nakagawa, S. A. Karumanchi, J. Kanellis, J. Granger, et al., "Uric acid, endothelial dysfunction and pre-eclampsia: searching for a pathogenetic link," Journal of hypertension, vol. 22, pp. 229-235, 2004.
https://doi.org/10.1097/00004872-200402000-00001
[12] A. Corominas, S. Balconi, M. Ortíz, N. Martinez, and A. Damiano, "Diagnostic performance of uric acid for prediction of preeclampsia," Placenta, vol. 62, p. 79, 2018.
https://doi.org/10.1016/j.placenta.2017.12.006
[13] N. O. Enaruna, J. O. Idemudia, and P. I. Aikoriogie, "Serum lipid profile and uric acid levels in preeclampsia in University of Benin Teaching Hospital," Nigerian medical journal: journal of the Nigeria Medical Association, vol. 55, p. 423, 2014.
https://doi.org/10.4103/0300-1652.140387
[14] P. Tejal and D. Astha, "Relationship of serum uric acid level to maternal and perinatal outcome in patients with hypertensive disorders of pregnancy," Gujarat Medical Journal, vol. 69, pp. 1-3, 2014.
[15] A. Gawde and U.T.Bhosale, " A Study of Maternal and Perinatal Outcome in Preeclampsia," International Journal of Recent Trends in Science And Technology 2014, vol. 10, 2014.
[16] S. A. Bainbridge and J. M. Roberts, "Uric acid as a pathogenic factor in preeclampsia," Placenta, vol. 29, pp. 67-72, 2008.
https://doi.org/10.1016/j.placenta.2007.11.001
[17] K. L. Cheung and R. A. Lafayette, "Renal physiology of pregnancy," Advances in chronic kidney disease, vol. 20, pp. 209-214, 2013.
https://doi.org/10.1053/j.ackd.2013.01.012
[18] K. A. Pennington, J. M. Schlitt, D. L. Jackson, L. C. Schulz, and D. J. Schust, "Preeclampsia: multiple approaches for a multifactorial disease," Disease models & mechanisms, vol. 5, pp. 9-18, 2012.
https://doi.org/10.1242/dmm.008516
[19] A. Jeyabalan and K. P. Conrad, "Renal function during normal pregnancy and preeclampsia," Front Biosci, vol. 12, pp. 2425-2437, 2007.
https://doi.org/10.2741/2244
[20] S. L. Mumford, S. S. Dasharathy, A. Z. Pollack, N. J. Perkins, D. R. Mattison, S. R. Cole, et al., "Serum uric acid in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study," Human reproduction, vol. 28, pp. 1853-1862, 2013.
https://doi.org/10.1093/humrep/det085
[21] A. Shah, B. Fawole, J. M. M'Imunya, F. Amokrane, I. Nafiou, J. J. Wolomby, et al., "Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa," International Journal of Gynecology & Obstetrics, vol. 107, pp. 191-197, 2009.
https://doi.org/10.1016/j.ijgo.2009.08.013
[22] D. M. Sherer, "A review of amniotic fluid dynamics and the enigma of isolated oligohydramnios," American journal of perinatology, vol. 19, pp. 253-266, 2002.
https://doi.org/10.1055/s-2002-33084
[23] S. Ladella, T. Leung, and C. Cortez, "Effects of Amniotic Fluid Index on Perinatal Outcomes in Preterm Premature Rupture of Membranes [37o]," Obstetrics & Gynecology, vol. 129, p. S162, 2017.
https://doi.org/10.1097/01.AOG.0000514786.52391.ba
[24] J. Morris, K. Thompson, J. Smithey, G. Gaffney, I. Cooke, P. Chamberlain, et al., "The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study," BJOG: An International Journal of Obstetrics & Gynaecology, vol. 110, pp. 989-994, 2003.
https://doi.org/10.1111/j.1471-0528.2003.02417.x
[25] A. A. Bachhav and M. Waikar, "Low amniotic fluid index at term as a predictor of adverse perinatal outcome," The Journal of Obstetrics and Gynecology of India, vol. 64, pp. 120-123, 2014.
https://doi.org/10.1007/s13224-013-0489-9
[26] S. Agrawal and N. Maitra, "Prediction of adverse maternal outcomes in preeclampsia using a risk prediction model," The Journal of Obstetrics and Gynecology of India, vol. 66, pp. 104-111, 2016.
https://doi.org/10.1007/s13224-015-0779-5
[27] F. Yassaee, "Hyperuricemia and perinatal outcomes in patients with severe preeclampsia," Iranian Journal of Medical Sciences, vol. 28, pp. 198-199, 2015.
[28] C. M. Koopmans, D. Bijlenga, H. Groen, S. M. Vijgen, J. G. Aarnoudse, D. J. Bekedam, et al., "Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial," The Lancet, vol. 374, pp. 979-988, 2009.
https://doi.org/10.1016/S0140-6736(09)60736-4
[29] A. Singh, P. Sharma, R. Malla, and S. Singh, "Raised Uric Acid Level and Fetal Outcome in Hypertensive Disorders of Pregnancy," Nepal Journal of Obstetrics and Gynaecology, vol. 9, pp. 78-81, 2014.
https://doi.org/10.3126/njog.v9i1.11196
[30] D. Shah and G. Reed, "Parameters associated with adverse perinatal outcome in hypertensive pregnancies," Journal of human hypertension, vol. 10, pp. 511-515, 1996.
[31] A. U. Hosna, A. M. Bhuiyan, E. Noor, M. K. Ahmed, M. A. Siddique, M. Salman, et al., "Effects of hyperuricemia on perinatal outcome in hypertensive disorder of pregnancy," University Heart Journal, vol. 4, pp. 36-40, 2008.
https://doi.org/10.3329/uhj.v4i2.2074
[32] P. Acien, G. Lloret, and M. Lloret, "Perinatal morbidity and mortality in pregnancy hypertensive disorders: prognostic value of the clinical and laboratory findings," International Journal of Gynecology & Obstetrics, vol. 32, pp. 229-235, 1990.
https://doi.org/10.1016/0020-7292(90)90350-T
https://doi.org/10.3109/10641950109152635
[2] S. Lisonkova and K. Joseph, "Incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease," American journal of obstetrics and gynecology, vol. 209, pp. 544. e1-544. e12, 2013.
https://doi.org/10.1016/j.ajog.2013.08.019
[3] C. J. Berg, J. Chang, W. M. Callaghan, and S. J. Whitehead, "Pregnancy-related mortality in the United States, 1991-1997," Obstetrics & Gynecology, vol. 101, pp. 289-296, 2003.
https://doi.org/10.1097/00006250-200302000-00015
[4] Y. Wu, X. Xiong, W. D. Fraser, and Z.-C. Luo, "Association of uric acid with progression to preeclampsia and development of adverse conditions in gestational hypertensive pregnancies," American journal of hypertension, vol. 25, pp. 711-717, 2012.
https://doi.org/10.1038/ajh.2012.18
[5] A. Many, C. Hubel, and J. Roberts, "Hyperuricemia and xanthine oxidase in preeclampsia, revisited," American Journal of Obstetrics & Gynecology, vol. 174, pp. 288-291, 1996.
https://doi.org/10.1016/S0002-9378(96)70410-6
[6] Y. Zhou, S. J. Fisher, M. Janatpour, O. Genbacev, E. Dejana, M. Wheelock, et al., "Human cytotrophoblasts adopt a vascular phenotype as they differentiate. A strategy for successful endovascular invasion?," The Journal of clinical investigation, vol. 99, pp. 2139-2151, 1997.
https://doi.org/10.1172/JCI119387
[7] J. M. Roberts, L. M. Bodnar, K. Y. Lain, C. A. Hubel, N. Markovic, R. B. Ness, et al., "Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension," Hypertension, vol. 46, pp. 1263-1269, 2005.
https://doi.org/10.1161/01.HYP.0000188703.27002.14
[8] A. C. Martin and M. A. Brown, "Could uric acid have a pathogenic role in pre-eclampsia?," Nature reviews nephrology, vol. 6, p. 744, 2010.
https://doi.org/10.1038/nrneph.2010.125
[9] C. Punthumapol and B. Kittichotpanich, "Serum calcium, magnesium and uric acid in preeclampsia and normal pregnancy," Medical journal of the Medical Association of Thailand, vol. 91, p. 968, 2008.
[10] K.-H. Lim, S. A. Friedman, J. L. Ecker, L. Kao, and S. J. Kilpatrick, "The clinical utility of serum uric acid measurements in hypertensive diseases of pregnancy," American journal of obstetrics and gynecology, vol. 178, pp. 1067-1071, 1998.
https://doi.org/10.1016/S0002-9378(98)70549-6
[11] D.-H. Kang, J. Finch, T. Nakagawa, S. A. Karumanchi, J. Kanellis, J. Granger, et al., "Uric acid, endothelial dysfunction and pre-eclampsia: searching for a pathogenetic link," Journal of hypertension, vol. 22, pp. 229-235, 2004.
https://doi.org/10.1097/00004872-200402000-00001
[12] A. Corominas, S. Balconi, M. Ortíz, N. Martinez, and A. Damiano, "Diagnostic performance of uric acid for prediction of preeclampsia," Placenta, vol. 62, p. 79, 2018.
https://doi.org/10.1016/j.placenta.2017.12.006
[13] N. O. Enaruna, J. O. Idemudia, and P. I. Aikoriogie, "Serum lipid profile and uric acid levels in preeclampsia in University of Benin Teaching Hospital," Nigerian medical journal: journal of the Nigeria Medical Association, vol. 55, p. 423, 2014.
https://doi.org/10.4103/0300-1652.140387
[14] P. Tejal and D. Astha, "Relationship of serum uric acid level to maternal and perinatal outcome in patients with hypertensive disorders of pregnancy," Gujarat Medical Journal, vol. 69, pp. 1-3, 2014.
[15] A. Gawde and U.T.Bhosale, " A Study of Maternal and Perinatal Outcome in Preeclampsia," International Journal of Recent Trends in Science And Technology 2014, vol. 10, 2014.
[16] S. A. Bainbridge and J. M. Roberts, "Uric acid as a pathogenic factor in preeclampsia," Placenta, vol. 29, pp. 67-72, 2008.
https://doi.org/10.1016/j.placenta.2007.11.001
[17] K. L. Cheung and R. A. Lafayette, "Renal physiology of pregnancy," Advances in chronic kidney disease, vol. 20, pp. 209-214, 2013.
https://doi.org/10.1053/j.ackd.2013.01.012
[18] K. A. Pennington, J. M. Schlitt, D. L. Jackson, L. C. Schulz, and D. J. Schust, "Preeclampsia: multiple approaches for a multifactorial disease," Disease models & mechanisms, vol. 5, pp. 9-18, 2012.
https://doi.org/10.1242/dmm.008516
[19] A. Jeyabalan and K. P. Conrad, "Renal function during normal pregnancy and preeclampsia," Front Biosci, vol. 12, pp. 2425-2437, 2007.
https://doi.org/10.2741/2244
[20] S. L. Mumford, S. S. Dasharathy, A. Z. Pollack, N. J. Perkins, D. R. Mattison, S. R. Cole, et al., "Serum uric acid in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study," Human reproduction, vol. 28, pp. 1853-1862, 2013.
https://doi.org/10.1093/humrep/det085
[21] A. Shah, B. Fawole, J. M. M'Imunya, F. Amokrane, I. Nafiou, J. J. Wolomby, et al., "Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa," International Journal of Gynecology & Obstetrics, vol. 107, pp. 191-197, 2009.
https://doi.org/10.1016/j.ijgo.2009.08.013
[22] D. M. Sherer, "A review of amniotic fluid dynamics and the enigma of isolated oligohydramnios," American journal of perinatology, vol. 19, pp. 253-266, 2002.
https://doi.org/10.1055/s-2002-33084
[23] S. Ladella, T. Leung, and C. Cortez, "Effects of Amniotic Fluid Index on Perinatal Outcomes in Preterm Premature Rupture of Membranes [37o]," Obstetrics & Gynecology, vol. 129, p. S162, 2017.
https://doi.org/10.1097/01.AOG.0000514786.52391.ba
[24] J. Morris, K. Thompson, J. Smithey, G. Gaffney, I. Cooke, P. Chamberlain, et al., "The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study," BJOG: An International Journal of Obstetrics & Gynaecology, vol. 110, pp. 989-994, 2003.
https://doi.org/10.1111/j.1471-0528.2003.02417.x
[25] A. A. Bachhav and M. Waikar, "Low amniotic fluid index at term as a predictor of adverse perinatal outcome," The Journal of Obstetrics and Gynecology of India, vol. 64, pp. 120-123, 2014.
https://doi.org/10.1007/s13224-013-0489-9
[26] S. Agrawal and N. Maitra, "Prediction of adverse maternal outcomes in preeclampsia using a risk prediction model," The Journal of Obstetrics and Gynecology of India, vol. 66, pp. 104-111, 2016.
https://doi.org/10.1007/s13224-015-0779-5
[27] F. Yassaee, "Hyperuricemia and perinatal outcomes in patients with severe preeclampsia," Iranian Journal of Medical Sciences, vol. 28, pp. 198-199, 2015.
[28] C. M. Koopmans, D. Bijlenga, H. Groen, S. M. Vijgen, J. G. Aarnoudse, D. J. Bekedam, et al., "Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial," The Lancet, vol. 374, pp. 979-988, 2009.
https://doi.org/10.1016/S0140-6736(09)60736-4
[29] A. Singh, P. Sharma, R. Malla, and S. Singh, "Raised Uric Acid Level and Fetal Outcome in Hypertensive Disorders of Pregnancy," Nepal Journal of Obstetrics and Gynaecology, vol. 9, pp. 78-81, 2014.
https://doi.org/10.3126/njog.v9i1.11196
[30] D. Shah and G. Reed, "Parameters associated with adverse perinatal outcome in hypertensive pregnancies," Journal of human hypertension, vol. 10, pp. 511-515, 1996.
[31] A. U. Hosna, A. M. Bhuiyan, E. Noor, M. K. Ahmed, M. A. Siddique, M. Salman, et al., "Effects of hyperuricemia on perinatal outcome in hypertensive disorder of pregnancy," University Heart Journal, vol. 4, pp. 36-40, 2008.
https://doi.org/10.3329/uhj.v4i2.2074
[32] P. Acien, G. Lloret, and M. Lloret, "Perinatal morbidity and mortality in pregnancy hypertensive disorders: prognostic value of the clinical and laboratory findings," International Journal of Gynecology & Obstetrics, vol. 32, pp. 229-235, 1990.
https://doi.org/10.1016/0020-7292(90)90350-T
Downloads
How to Cite
[1]
R. Yassin Khalil and A. Saber Muhammed, “Maternal Serum Uric Acid as an Index of Perinatal Outcomes in Severe Preeclampsia”, KJAR, vol. 3, no. 2, pp. 80–84, Jul. 2018, doi: 10.24017/science.2018.2.13.
Published
23-07-2018
Issue
Section
Pure and Applied Science
