Serum uric acid levels as predictor of perinatal outcomes among patients with pre-eclampsia admitted at Muhimbili National Hospital

Abstract

Preeclampsia is one of the hypertensive disorders of pregnancy with significantly high morbidity and mortality to both mother and fetus/neonate. Globally it complicates 2%-8% of all pregnancies whereas in Tanzania it accounts for 19.9% of maternal mortality. Uric acid is a metabolic end product of purines which is commonly found to be elevated in pre-eclamptic patients, but yet its utility in predicting perinatal outcome is still controversial. Serum uric acid is among the routine laboratory investigations done in pre-eclamptic patients admitted at Muhimbili National Hospital (MNH) maternity ward. Aim of the study To determine the utility of serum uric acid levels in predicting perinatal outcome among pre-eclamptic patients hospitalized at MNH. Methodology ‘This was a hospital based cross-sectional study which involved pre-eclamptic women admitted at MNH maternity ward. The proportion of pre-eclamptic patients with hyperuricemi. Univariate and multivariate logistic regression was used to identify the association between independent variables (uric acid, Hb, age, parity, pre-eclampsia grade etc) and the perinatal outcomes (birth weight, Apgar score, stillbirth, preterm delivery). P value of <0.05 was considered statistically significant. Results Among 268 recruited participants 78.7% had raised serum uric acid, whereas an overall mean serum uric acid level was 0.42±0.09mmol/L. The magnitude of adverse perinatal outcome among pre-eclamptic patients was 19% stillbirth, 68.7% low birth weight, 12.3% Neonatal Intensive Care Unity (NICU) admission, 26.9% low Apgar score and 70.9% for preterm delivery. In adjusted model raised serum uric acid level (≥0.35mmol/L) once adjusted for pre-eclampsia grade, parity, maternal age, hemoglobin level and delivery mode, it revealed an increased risk in low birth weight (aOR 2.16, 95% CI 1.11-4.20), stillbirth (aOR 11.29, 95%CI 1.49-85.87), low Apgar score (aOR 4.63, 95%CI 1.57-13.71) and preterm delivery (aOR 2.02, 95%CI 1.03-3.95). Conclusion Raised serum uric acid is a good predictor of adverse perinatal outcome among hospitalized patients with pre-eclampsia at MNH.