Uric Acid Is as Important as Proteinuria in Identifying Fetal Risk in Women With Gestational Hypertension

Abstract

Abstract-Gestational hypertension is differentiated into higher and lower risk by the presence or absence of proteinuria.We asked if hyperuricemia, a common finding in pregnancy hypertension, might also be an indicator of increased risk. We examined fetal outcome data from 972 pregnancies collected from 1997 to 2002 in a nested case-control study. Participants were nulliparous with no known medical complications. The frequency of preterm birth, the duration of pregnancy, frequency of small-for-gestational-age infants, and birth weight centile were determined for pregnancies assigned to 8 categories by the presence or absence of combinations of hypertension, hyperuricemia, and proteinuria. In women with gestational hypertension, hyperuricemia was associated with shorter gestations and smaller birth weight centiles and increased risk of preterm birth and small-for-gestational-age infants. Hyperuricemia increased the risk of these outcomes in the presence or absence of proteinuria. Risk was also increased in a small group of women with hyperuricemia and proteinuria without hypertension. Women with only hypertension and hyperuricemia have similar or greater risk as women with only hypertension and proteinuria. Those with hypertension, proteinuria, and hyperuricemia have greater risk than those with hypertension and proteinuria alone. The risk of these outcomes increased with increasing uric acid. Hyperuricemia is at least as effective as proteinuria at identifying gestational hypertensive pregnancies at increased risk. Uric acid should be reexamined for clinical and research utility. Key Words: gestational hypertension Ⅲ preeclampsia Ⅲ pregnancy Ⅲ uric acid Ⅲ intrauterine growth restriction Ⅲ preterm birth Ⅲ risk assessment H ypertensive disorders during pregnancy increase maternal and infant risk. The greatest impact is associated with the pregnancy-specific syndrome, preeclampsia. 1 Preeclampsia, conventionally diagnosed by the gestational onset of hypertension and proteinuria, increases perinatal mortality 5-fold 1 and kills 50,000 women yearly worldwide. 2 Its management, delivery to halt the progression of the pathophysiology, is responsible for 15% of preterm births in developed countries. 3 Gestational hypertension without proteinuria has much less of an adverse effect on maternal or fetal outcome, whereas the major risk from hypertension that antedates pregnancy is the superimposition of preeclampsia. 4 The importance of differentiating these conditions is reflected in several classification schemes in which gestational hypertension with proteinuria is separated from gestational hypertension without proteinuria and hypertension that antedates pregnancy. 4 -6 These diagnostic criteria currently used to discriminate high-risk from lower risk women with gestational hypertension are arbitrary. The term "preeclampsia" was coined in the early 20th century when it was recognized that hypertension and proteinuria could be precursors to a pregnancy-specific seizure disorder, eclampsia, which had been recognized for...

Comparative study of serum LDH and uric acid in hypertensive versus normotensive pregnant woman

“…This finding is in accordance with the study done by Punthumapol et al [19]. It is found that estimation of serum UA is as important as proteinuria in identifying the risk of renal involvement and fetal compromise [20]. Maternal hyperuricemia is found to be a strong predictor of maternal disease progression and fetal outcome.…”

Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

“…However, the inclusion of these women is consistent with the additional risks surrounding hyperuricemia 21 and with our wider aim of developing a generalizable model.…”

Purinas y ácido úrico en pre-eclampsia: interacciones fisiopatológicas y proyecciones en investigación

“…Concretamente, en relación a los resultados adversos en el recién nacido, Roberts y cols. 3 mostraron que las mujeres hipertensas e hiperuricémicas, tienen mayor riesgo de diagnóstico de bajo peso para la edad gestacional (~3 veces) o parto < 37 semanas (~10 veces). Evidencia confirmada por otro grupo en Australia 19 .…”

“…E l ácido úrico, producto final del metabolismo de las purinas, es utilizado como marcador de daño renal y factor de riesgo de morbilidad materna y neonatal en embarazos con pre-eclampsia [1][2][3] . Así, las mujeres hipertensas e hiperuricémicas tienen mayor riesgo de parto pretermino, retardo de crecimiento intrauterino (RCIU) y pre-eclampsia de origen temprano (< 34 semanas), que aquellas mujeres con embarazos normales o mujeres pre-eclámpticas sin hiperuricemia 3,4 .…”

“…Así, las mujeres hipertensas e hiperuricémicas tienen mayor riesgo de parto pretermino, retardo de crecimiento intrauterino (RCIU) y pre-eclampsia de origen temprano (< 34 semanas), que aquellas mujeres con embarazos normales o mujeres pre-eclámpticas sin hiperuricemia 3,4 . Conjuntamente, una serie de estudios [5][6][7] sugieren que los embarazos con preeclampsia cursan con altos niveles de purinas (i.e., ATP, ADP, AMP, adenosina).…”