The Correlation And Predictive Value Of Maternal Serum Uric Acid With Hypertensive Disorders During Pregnancy And Neonatal Outcomes

Objective:Hypertensive disorders of pregnancy(HDP)is a common cause of increased hospitalisation and mortality rate in mothers and infants,and the lack of serological indicators for early detection and treatment of HDP is a serious risk to the safety of mothers and infants.The aim of this paper is to investigate the relationship between serum uric acid(UA)levels and the progression of HDP and neonatal outcomes,and to analyse the predictive role of UA on the severity of HDP and adverse neonatal outcomes,so as to provide guidance for the determination of HDP and neonatal outcomes.Methods:Baseline data were collected from January 2021 to October 2022 from mothers at The First Affiliated Hospital of Dalian Medical University.158 women who sati sfied the standard were chosen as the HDP group.115 healthy women who were h ospitalized and delivered during the same period were chosen as the normal group using random sampling.According to the mean UA level,a UA level < 352.97 umo l/L was defined as low uric acid and a UA level ≥ 352.97umol/L was defined as hi gh uric acid.The normal and HDP were divided into normal group with low UA(group A),normal group with high UA(group B),HDP group with low uric acid(group C)and HDP group with high uric acid(group D)according to the uric acid level.The HDP group was divided into the hypertension in pregnancy group,the p re-eclampsia group and the severe pre-eclampsia group according to HDP status.Fo r statistical analysis,baseline maternal and neonatal data,serological indicators and delivery outcomes were collected.The relationship between UA and HDP and adve rse birth outcomes in newborns was investigated.To also analyse the value of UA in predicting the severity of HDP and neonatal outcome.Approved by the hospital e thics committee(Batch number:PJ-KS-KY-2022-428).Results:1.In the comparison between the normal and HDP groups,there were statistical differences in weight,body mass index(BMI),albumin,globulin,total protein,UA,urea and creatinine(P<0.05),with a greater difference in UA levels in the serological indices,with the UA level of 374.0(324.5,440.0)umol/L in the HDP group being significantly higher than that of 289.0(255.0,350.0)umol/L in the normal group.Age and height were no statistically difference(P>0.05).Comparison by grade of HDP disease: Albumin,globulin,total protein,UA,urea and creatinine were statistically difference between the three groups(P<0.05),with the greatest variability in UA levels,the lowest being 350,0(294.5,408.5)umol/L in the gestational hypertension group,352.5(308.5,386.3)umol/L in the pre-eclampsia group,and 352.5(308.5,386.3)umol/L and 431.0(371.0,515.0)umol/L were highest in the severe pre-eclampsia group.Age,height,weight and BMI were no statistically difference(P>0.05).2.Comparison between the four groups: weight,BMI,albumin,total protein,urea and creatinine were statistically different(P<0.05)in the low level uric acid normal group(group A),high level uric acid normal group(group B),low level uric acid HDP group(group C)and high level uric acid HDP group(group D).Age,height and globulin were not statistically different(P>0.05).Comparison of neonatal outcomes: there were statistically significant differences in birth weight(BW),gestational age at birth,umbilical blood gas Cl-and lactic acid(LAC)(P<0.05);there were no statistically significant differences in terminal blood glucose,umbilical blood gas Ca2+,umbilical blood gas K+ and umbilical blood gas Na+(P>0.05).The incidence of adverse outcomes was compared:There was a statistically significant difference(P< 0.05)in the incidence of preterm birth,low birth weight(LBW),small gestational age(SGA),intrauterine growth restriction(IUGR),neonatal asphyxia,NICU transfer and neonatal hyperbilirubinemia(NH),with a higher incidence of the above-mentioned adverse outcomes in high levels of UA than in low levels of uric acid,and a comparison between the four groups revealed that the incidence of adverse outcomes was highest in the HDP high level UA group and lowest in the normal low level UA group.There was no statistical difference in the incidence of neonatal hypoglycaemia(P> 0.05).3.The results indicate that urea(OR 1.382,95% CI 1.032-1.850)and UA(OR 1.013,95% CI 1.008-1.017)were independent risk factors for HDP(P<0.05).Total protein,albumin,globulin and creatinine were not risk factors for HDP(P>0.05).Logistic regression analysis of UA as a continuous variable for association with neonatal outcome,adjusted for severity of HDP status and maternal BMI,showed that UA was an independent risk factor for preterm delivery(OR 1.009;95% CI 1.002 to 1.015),low birth weight(OR 1.013;95% CI : 1.005 to 1.021),small for gestational age(OR 1.010;95% CI1.002-1.019),intrauterine growth restriction(OR 1.005;95% CI: 0.997-1.013),neonatal asphyxia(OR 1.008,95% CI 0.999-1.018),transfer to NICU(OR 1.005,95% CI1.000-1.010)and neonatal hyperbilirubinemia(OR 1.001,95% CI 1.001).UA was not a factor influencing neonatal hypoglycaemia(P>0.05).4.The receiver operator characteristic(ROC)curve indicated that UA and urea were predictive of hypertensive disorders of pregnancy(P<0.05),with UA having better predictive performance with an area under the curve of 0.791,sensitivity of 77.4%,specificity of 87.3% and a best UA cut-off value of 415umol/l.The ROC curve indicated that UA was predictive of preterm delivery,low birth weight,small size for gestational age and intrauterine growth restriction(P<0.05),and had better predictive performance.The ROC curve indicated that UA was predictive of preterm delivery,low birth weight,small size for gestational age and intrauterine growth restriction(P<0.05).Conclusion:1.UA levels are higher in HDP than in normal pregnancy,increase with disease severity and have an independent influence on HDP.2.Elevated uric acid levels increase the incidence of adverse neonatal outcomes(preterm delivery,low birth weight,low gestational age,intrauterine growth retardation,transfer to neonatal intensive care unit,neonatal birth asphyxia and neonatal hyperbilirubinemia),with high levels of uric acid in HDP have the highest incidence of adverse neonatal outcomes.3.UA may be used as a predictor of the severity of HDP and adverse neonatal outcomes.