Uric Acid: Friend or Foe?

Abstract

Introduction. Adverse Pregnancy outcomes (APO) continue to trouble physicians worldwide, and uric acid has become a marker of interest in its prediction. Despite this, the correlation of uric acid in the third trimester is rarely studied, and the reference value for normal uric acid levels in pregnancy has yet to be established. This study was done to evaluate the association of uric acid levels in the third trimester of pregnancy and the development of APO, specifically gestational hypertension (GH), pre-eclampsia (PE), gestational diabetes mellitus (GDM), small for gestational age (SGA) and to determine a cut-off value of serum uric acid levels for screening of the APO. Materials and methods. A retrospective observational study was conducted among 374 women who delivered at Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and developed the APO of interest and had serum uric acid levels taken during the third trimester of pregnancy. A cut off value of 309 µmol/L was used to assess the sensitivity and specificity in predicting the APO. Results. Associations are observed between 309 µmol/L and the development of GH (p<0.0005), PE (p<0.0005), GDM (p<0.0005), SGA (p=0.0264). Plotted ROC curves with cutoff point of 309 µmol/L demonstrated moderate predictive value of serum uric acid and the development of GH (AUC 0.639), PE (AUC 0.713), SGA (AUC 0.649) and low predictive value for GDM (AUC 0.4). Conclusion. Serum uric acid level of 309 µmol/L in the third trimester of pregnancy is a moderate predictor of GH, PE, SGA and a poor predictor of GDM.
 KEYWORDS: Uric acid; pregnancy trimester, third; pregnancy outcome

Maternal uric acid levels and risk of gestational diabetes mellitus: A systematic review and dose–response meta‐analysis of cohort studies including 105,380 participants

“…Furthermore, 19 studies were excluded after the full-text screening. Finally, 23 studies were eligible for inclusion in the present study [18][19][20][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] . Table 1 summarizes the characteristics of the included studies.…”

“…The maternal blood uric acid concentration during pregnancy was measured in 21 of 23 studies at or before the 20th week of gestation [18][19][20]25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] , and the remaining studies measured it after the 20th week of gestation 26,44 . The maternal blood uric acid concentration during pregnancy was measured using calorimetric assays 18,20,25,27,28,[30][31][32][33][36][37][38][39]41 or a spectrometric method 29 , whereas eight out of 23 included studies did not provide data regarding the method of maternal blood uric acid measurement 19,26,34,35,40,[42][43][44] . Among the 23 included studies, five studies collected blood samples after 8-12 h of fasting for the measurement of maternal uric acid…”

“…The maternal blood uric acid concentration during pregnancy was measured using calorimetric assays 18,20,25,27,28,[30][31][32][33][36][37][38][39]41 or a spectrometric method 29 , whereas eight out of 23 included studies did not provide data regarding the method of maternal blood uric acid measurement 19,26,34,35,40,[42][43][44] . Among the 23 included studies, five studies collected blood samples after 8-12 h of fasting for the measurement of maternal uric acid 19,27,33,34,39 ; the remaining studies did not report the method by which blood samples were collected 18,20,25,26,[28][29][30][31][32][35][36][37][38][40][41][42][43][44] . Among the studies included in this systematic review, 13 studies were carried out on participants who were primiparous or multiparous…”

“…Among the 23 included studies, five studies collected blood samples after 8-12 h of fasting for the measurement of maternal uric acid 19,27,33,34,39 ; the remaining studies did not report the method by which blood samples were collected 18,20,25,26,[28][29][30][31][32][35][36][37][38][40][41][42][43][44] . Among the studies included in this systematic review, 13 studies were carried out on participants who were primiparous or multiparous 18,25,[29][30][31]33,[35][36][37][38][39][40]43 , seven studies were carried out on participants who were primiparous 19,20,26,27,32,41,44 and four studies did not mention the participants' parity status 28,34,42 . Furthermore, out of all eligible studies, no studies have been carried out on pregnant women who were multiple pregnancies (two or more babies ...…”

“…All studies had a longitudinal design, which were cohort 18,20,[27][28][29][30][31][32][33][34][35][36][37][38][39][41][42][43] and retrospective cohort designs 19,25,26,40,44 . The quality assessment of the included studies using the Newcastle-Ottawa scale is provided in Table 2.…”