Maternal Serum Uric Acid as a Biochemical Prognostic Marker for Predicting Maternal and Fetal Outcome in Pregnancy-Induced Hypertension – A Prospective Study

Abstract

Introduction: Pregnancy-induced hypertension (PIH),
encompassing conditions such as gestational hypertension,
pre-eclampsia, and eclampsia, remains a significant cause
of maternal and perinatal morbidity and mortality worldwide,
particularly in developing countries. It typically manifests
after 20 weeks of gestation and is characterized by elevated
blood pressure with or without proteinuria or other systemic
involvement. Despite advancements in obstetric care,
early prediction and effective management of PIH remain
challenging due to its unpredictable progression and complex
pathophysiology. Among various biomarkers explored for
early detection and prognostication of PIH, serum uric acid
has emerged as a potential candidate. Uric acid, a final
product of purine metabolism, is known to increase during
normal pregnancy, but elevated levels beyond the expected
physiological range have been correlated with adverse maternal
and fetal outcomes in hypertensive pregnancies. Hyperuricemia
in PIH is believed to reflect reduced renal clearance, oxidative
stress, endothelial dysfunction, and systemic inflammation—all
of which are central to the disease process. The aim was to
study serum uric acid as a biochemical prognostic marker for
predicting maternal and fetal outcome in pregnancy-induced
hypertension.
Material & Methods: A total of 200 antenatal women were
enrolled in the study. The control group consisted of 100
healthy normotensive women with no history of raised blood
pressure or renal disease, and the case group consisted of 100
preeclamptic antenatal women. All patients’ blood pressure
was measured at admission and after 4 hours, and their venous
samples were taken and sent for serum uric acid estimation and
compared for their significance in predicting pre-eclampsia,
correlating severe grades of hypertension and fetomaternal
outcome. Statistical analysis was done using various tests like
Mann-Whitney, chi-square test, Fisher test, etc.
Results: The mean uric acid value in normotensives was 4.20 ±
0.83 mg/dl, increased with increasing severity of hypertension,
maximum in the eclamptic group, 9.75 ± 3.31 mg/dl. There is
a positive correlation between uric acid and the severity of
hypertension. The maternal complications like LSCS, HELLP
syndrome, post-partum eclampsia, and fetal complications
like low APGAR score, low birth weight, and NICU admission
were higher when the uric acid level was above 6.5 (p <0.05).
Conclusion: Serum uric acid was found to be a useful
prognostic indicator for fetomaternal outcomes in women with
pre-eclampsia and eclampsia.