Association between hyperuricemia and adverse perinatal outcomes among women with preeclampsia at a tertiary hospital in Southwestern Uganda: a prospective cohort study

Abstract

Background: Pre-eclampsia is a major cause of adverse perinatal outcomes, such as preterm birth and perinatal deaths, at Mbarara Regional Referral Hospital (MRRH). While serum uric acid is a crucial marker for predicting adverse outcomes, it is not routinely assessed. This study aimed to compare the incidence of adverse perinatal outcomes between women with and without hyperuricemia and determine the association between hyperuricemia and adverse perinatal outcomes among women with preeclampsia at MRRH.

Methods: We conducted a prospective cohort study from March 2024 to June 2024 at the maternity ward of MRRH. We consecutively enrolled women diagnosed with preeclampsia who were at least 26 weeks gestational age and assessed their serum uric acid levels upon admission. The primary exposure was hyperuricemia (>6mg/dl) while the primary outcome was adverse perinatal outcomes. We compared the incidence of adverse perinatal outcomes among those with and without hyperuricemia using Chi-square and used multivariable modified Poisson regression analysis to determine the association between hyperuricemia and adverse perinatal outcomes among women with preeclampsia.

Results: Among the 111 women enrolled (mean age 28.3 ± 6.5 years), 43 (38.7%) had hyperuricemia. Adverse perinatal outcomes occurred in 55.9% (62/111). Women with hyperuricemia had higher rates of adverse outcomes (88%, n = 38/43) than those without (35%, n = 24/68). Specific outcomes were significantly more frequent among hyperuricemic women: fresh stillbirth (21% vs. 0%), low birth weight (49% vs. 26%), Apgar score <7 at 5 min (26% vs. 1%), NICU admission (76% vs. 26%), and early neonatal death (32% vs. 0%), p < 0.05. Hyperuricemia was linked to a two-fold increased risk of one or more adverse outcomes (aRR 2.42, 95% CI: 1.54-3.80), fresh stillbirth (aRR 3.14, 95% CI: 1.79-5.48), low Apgar score (aRR 31.5, 95% CI: 3.8-260.9), NICU admission (aRR 2.44, 95% CI: 1.86-4.49), and early neonatal death (aRR 12.1, 95% CI: 4.22-33.98).

Conclusion: Hyperuricemia is common in preeclamptic women at MRRH and is associated with significantly higher rates of complications. Routine serum uric acid testing is recommended for early detection and timely intervention to improve maternal and neonatal health outcomes.

Keywords: Preeclampsia; adverse perinatal outcomes; hyperuricemia in pregnancy; neonatal health; resource limited setting; serum uric acid.