Association between serum uric acid and fetomaternal outcomes in preeclamptic women at Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background: Preeclampsia (PET) is one of hypertensive disorder of pregnancy with a high mortality and morbidity worldwide. Uric acid is a metabolic end product of purines found elevated in preeclamptic patients and it’s closely related to occurrence of adverse maternal and immediate perinatal outcomes (pregnant outcomes). Its use in pregnant complicated with PET is controversial. Objective: To describe the association between serum uric acid and fetomaternal outcomes among preeclamptic women in Moi teaching and referral hospital (MTRH). Methods: This was a cross-section comparative study carried out at MTRH post natal ward. Consenting preeclamptic women were recruited into 55 PET women with elevated uric acid ( > 340mmol/l) and 110 PET women with normal uric acid (<340mml/l) and a systematic sampling technique was used to achieve sample size in each group. Researcher administered structured questionnaire was used to collect data on maternal and feta variable. Fetal variables included; birth weight, fetal growth restriction, Apgar score at five minutes, admission in NICU. Maternal variables included; placenta abruption, organ failure, admission to ICU and severity of PET. PET was classified into PET without severe features and PET with severe feature that included systolic Bp of >160mmgh or diastolic Bp of >110mmgh, thrombocytopenia of <100,000/mL and end organ damage. Descriptive data was summarized as means and corresponding standard deviation. Chi square and Fisher’s exact test were done at bivariate level to compare uric acid levels and other categorical variables. Multivariable logistic regression was done to determine the factors associated with elevated uric acid. The data was presented using odds ratio with 95% confidence interval and a statistical significance level set at p-value < 0.05. The study duration was one year from August 2021 to August 2022. Approval of the study was sought from relevant authorities. Results: A total of 165 participants were recruited in the study, 55 and 110 women in elevated uric acid (EUA) and normal uric acid (NUA) arm respectively. Women with PET with severe features had significantly high uric acid compared to women with PET without severe features (492.8±74.1 vs 296.3±41.5) respectively. The magnitude of adverse perinatal in preeclamptic women with elevated uric acid (EUA) was 85.7% low APGAR score, 73.7% low birth weight, 67.8% NICU admission and 77 % for fetal non viability syndrome. Majority (62.7%) of PET women with EUA were more likely to develop severe maternal complications (p<0.001) like HELLP syndrome and preterm labor. In adjusted model, elevated uric acid (340umol/I) once adjusted for preeclampsia grades, maternal age, parity, and gestation age, it revealed an increased risk in low APGAR scores ( aOR 4.63,95% CI,1.57-13.71), low birth weight (aOR 4.08,95% CI,1.62-10.29), preterm labor (aOR 6.27,95% CI, 2.07- 18.95) and severe maternal complications (aOR 3.52,95% CI, 0.91-13.61). Conclusion: Higher serum uric acid levels was associated with disease severity, poor perinatal outcome and maternal outcomes. Recommendation: We recommend the use of serum uric acid in evaluating preeclampsia severity, perinatal and maternal outcomes.