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BJOG. 2012 Mar;119(4):484-92. doi: 10.1111/j.1471-0528.2011.03232.x. Epub 2012 Jan 18.

Plasma uric acid remains a marker of poor outcome in hypertensive pregnancy: a retrospective cohort study.

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1
Department of Medicine, University of Calgary, Alberta, Canada.

Abstract

OBJECTIVE:

To examine the relationship between hyperuricaemia, haemoconcentration and maternal and fetal outcomes in hypertensive pregnancies.

DESIGN:

Retrospective analysis of a database of hypertensive pregnancies.

SETTING:

St George Hospital, a major obstetric unit in Australia.

POPULATION:

A cohort of 1880 pregnant women without underlying hypertension or renal disease, referred for management of pre-eclampsia or gestational hypertension.

METHODS:

Demographic, clinical and biochemical data at time of referral and delivery were collected for each pregnancy. Women were grouped according to diagnosis (pre-eclampsia or gestational hypertension) and logistic regression analysis was used to determine the relationship between uric acid, haemoglobin, haematocrit and adverse outcomes; an α level of P < 0.01 was used for statistical significance.

MAIN OUTCOME MEASURES:

Composites of adverse maternal and fetal outcomes.

RESULTS:

In women with 'benign' GH (without proteinuria or any other maternal clinical feature of pre-eclampsia) gestation-corrected hyperuricaemia was associated with increased risk of a small-for-gestational-age infant (OR 2.5; 95% CI 1.3-4.8) and prematurity (OR 3.2; 95% CI 1.4-7.2), but not with adverse maternal outcome. In the whole cohort of hypertensive pregnant women (those with pre-eclampsia or gestational hypertension) the risk of adverse maternal outcome (OR 2.0; 95% CI 1.6-2.4) and adverse fetal outcome (OR 1.8; 95% CI 1.5-2.1) increased with increasing concentration of uric acid. Hyperuricaemia corrected for gestation provided additional strength to these associations. Haemoglobin and haematocrit were not associated with adverse pregnancy outcome.

CONCLUSIONS:

Hyperuricaemia in hypertensive pregnancy remains an important finding because it identifies women at increased risk of adverse maternal and particularly fetal outcome; the latter, even in women with gestational hypertension without any other feature of pre-eclampsia.

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