PLASMA-URATE MEASUREMENTS IN PREDICTING FETAL DEATH IN HYPERTENSIVE PREGNANCY

doi:10.1016/S0140-6736(76)93024-5

The Lancet

Volume 307, Issue 7974, 26 June 1976, Pages 1370-1373

https://doi.org/10.1016/S0140-6736(76)93024-5 Get rights and content

Abstract

The relation of perinatal mortality to plasma-urate concentrations and blood-pressure was studied in 332 pregnant patients with hypertension. Perinatal mortality was markedly increased when maternal plasma-urate concentrations were raised, generally in association with severe pre-eclampsia of early onset. Plasma-urate was a better indicator than blood-pressure of prognosis for the fetus. Maternal hypertension, even severe, without hyperuricæmia, was associated with an excellent prognosis for the fetus. Conversely, when maternal hypertension was mild and hyperuricæmia was severe, the prognosis for the fetus was poor. These findings suggest that, in terms of fetal health, changes in renal handling of urate may be a more important feature of pre-eclampsia than the hypertension.

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Cited by (215)

Is salivary uric acid, a putative biomarker of pre-eclampsia, of maternal, placental, or fetal origin?
2024, European Journal of Obstetrics and Gynecology and Reproductive Biology
Increased salivary uric acid (sUA) represents a potential biomarker predictive of pre-eclampsia (PE), but its origin is unclear. The study explores whether sUA levels reflect maternal or feto-placental physiological stress and whether sUA levels in these cases correlate with amniotic fluid (fetal origin), maternal blood (maternal origin), or cord blood (fetal vs placental origin).
Pregnant women (n = 39) undergoing amniotomy or caesarean section after 34 gestational weeks were designated into three groups of either maternal, feto-placental, or no signs of physiological stress: women (n = 15) in the established first phase of active labour and without any signs of fetal growth restriction (FGR) or PE were assigned to the maternal stress group, women (n = 6) with an ultrasound-based diagnosis of FGR, with or without PE, were assigned to the feto-placental stress group, and women (n = 18) not yet in active labour and without any signs of FGR or PE, were assigned to the control group. Uric acid levels in corresponding samples of amniotic fluid, saliva, maternal blood, and cord blood were compared between groups and between body compartments within each group.
The feto-placental stress group showed increased UA levels in saliva (median, interquartile range [IQR]: 0.47 [0.38] mmol/L, P = 0.023) and maternal blood (0.42 [0.13] mmol/L, P = 0.032), but no differences in amniotic fluid or cord blood compared with the other groups. Within the control and maternal stress group, sUA levels were lower compared with maternal blood (0.20 [0.08] vs 0.25 [0.08] mmol/L, P_control = 0.018; 0.20 [0.06] vs 0.26 [0.08] mmol/L, P_maternal = 0.001) and highest in amniotic fluid (control group (0.49 [0.18] mmol/L): P_{maternal,blood} = 0.001, P_{umbilical,artery} = <0.001, P_{umbilical,vein} = <0.001, P_saliva = <0.001) (maternal stress group (0.56 [0.23] mmol/L): P_{maternal,blood} = 0.021, P_{umbilical,artery} = 0.006, P_{umbilical,vein} = 0.004, P_saliva = 0.003). Levels did not differ between compartments in the feto-placental stress group.
Salivary and maternal blood UA levels were increased in the feto-placental stress group with salivary levels increasing more than blood levels compared with the maternal stress and control groups, whilst UA in amniotic fluid were not different between the groups, suggesting a placental origin and potential use of sUA as a biomarker of placental dysfunction, including FGR and severe PE.
The Kidney in Normal Pregnancy and Preeclampsia
2021, Chesley’s Hypertensive Disorders in Pregnancy
Renal function profoundly changes during normal pregnancy, and many of these physiological alterations are disrupted in preeclampsia. In Chapter 14, The Kidney in Normal Pregnancy and Preeclampsia, the authors first discuss the changes in renal blood flow and glomerular filtration and in the renal handling of proteins and uric acid that occur during normal pregnancy, and then describe the perturbation of these gestational alterations of kidney function in preeclampsia. Osmoregulatory changes of pregnancy , as well as a comprehensive description of renal morphology in normal pregnancy and preeclampsia, and the indications for renal biopsy in pregnancy are presented. The clinical implications of changes in kidney function and morphology during normal pregnancy and preeclampsia are also described, including underlying cellular and molecular mechanisms. Finally, a thorough examination of the epidemiology, pathophysiology, and diagnosis of superimposed preeclampsia in women with chronic kidney disease is presented. This extensively revised and updated Chapter for the 5th edition of Chesley’s Hypertensive Disorders in Pregnancy should be informative for both the basic scientist and clinician interested in learning more about the kidney during normal pregnancy and preeclampsia.
Epidemiology of Hypertensive Disorders in Pregnancy
2021, Chesley’s Hypertensive Disorders in Pregnancy
The epidemiologic literature relating to hypertension in pregnancy has grown exponentially since Chesley’s 20-page chapter in the first edition of his 1978 treatise. New data characterize the occurrence, risk factors, predictors, natural history, and molecular epidemiology of preeclampsia. Those epidemiologic findings and the methods used to conduct them are critically assessed in this updated revision of the chapter. New evidence indicating that preeclampsia is a syndrome secondary to multiple pathophysiological pathways is presented. We address the heterogeneity among risk factors and clinical predictors that serve as “markers” of the disorder, but also consider the possibility that preeclampsia is a potential cause of future cardiovascular disease.
Investigating the diagnostic capacity of uric acid in the occurrence of preeclampsia
2020, Pregnancy Hypertension
Citation Excerpt :
According to a previous study [8], in women who eventually develop preeclampsia, the UA level is increased as soon as the tenth week of gestation which is much earlier than the clinical presentation of preeclampsia. Several studies have shown that there is an association between the excessive amount of UA with both the severity of preeclampsia and neonatal morbidity [9–11]. Studies have been conducted to evaluate the utility of UA levels in high-risk pregnancies.
To compare the distribution of uric acid (UA) concentration in women with normal and preeclamptic pregnancy, to investigate the significance of UA concentration in diagnosis of preeclampsia, and to estimate the UA rate of change over time before delivery.
A case-control study of singleton pregnancies was completed at a tertiary care center in Kingston, Ontario. Patients with preeclampsia were recruited through two prospective cohort studies (n = 218); the Preeclampsia New Emerging Team (September 2003–October 2009) and the Maternal Health Clinic (May 2011–June 2016). Individuals who had an uncomplicated pregnancy and delivered (July 2016–August 2017), were included in the control arm (n = 73).
Longitudinal analysis using a linear mixed-effects model examined the UA rate of change over time. The distribution of the UA level was compared using a t-test. The significance of the UA level in the diagnosis of preeclampsia was examined using multiple logistic regression.
The rate of change in UA before delivery had an increasing non-constant logarithmic trend with time. Mean UA level in preeclamptic pregnancies (369.53 ± 75.78 μmol/l) was significantly elevated compared with the normal pregnancies (292.55 ± 54.73 μmol/l). UA had an adjusted odds ratio of 1.39 (95%CI: 1.14–1.69; P = 0.001) associated with the incidence of preeclampsia and UA level >349 μmol/l close to delivery is an accurate measurement for diagnosing preeclampsia.
The UA concentration in preeclamptic pregnancies is significantly increased compared to normal pregnancies and the level of UA may have diagnostic ability in the occurrence of preeclampsia.
Giants in Obstetrics and Gynecology Series: a profile of Christopher Redman, MB, BChir, MRCP, FRCP
2019, American Journal of Obstetrics and Gynecology
Significance of Serum Uric Acid in Pregnancy Induced Hypertension
2017, Journal of the National Medical Association
Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Uric acid (UA) is filtered, reabsorbed and secreted by the kidney. Thus, this study was conducted to assess the serum UA levels in PIH and to evaluate the diagnostic value of serum UA level in PIH.
This is a hospital based comparative cross-sectional study conducted in BPKIHS. Ninety study participants were included; forty five participants were diagnosed of PIH and forty five in control group after obtaining informed consent from study participants from August 2014 to May 2015. Serum UA was done by Uricase method and serum creatinine was done by Jaffe's alkaline picrate method in cobas c311 autoanalyser. Data were expressed in frequency, percentage, mean ± S.D., median (IQR), and Independent t-test, Mann–Whitney U test were applied. p Value <0.05 is considered to be significant.
Mean serum UA levels was higher in PIH compared to control group (5.46 ± 1.51 vs 4.03 ± 0.69) respectively. ROC curve demonstrated that serum UA showed a superior diagnostic efficiency (Sensitivity – 79.07%, Specificity – 71.19%) compared to creatinine (Sensitivity – 62.75%, Specificity – 27.45%) in PIH respectively.
The present study shows that serum UA is significantly raised in PIH compared to the control group. Assessment of uric acid is a convenient and cost-effective method for determination of severity in PIH. Thus, serum uric acid can still be used as prevalent marker for risk assessment in PIH.

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PLASMA-URATE MEASUREMENTS IN PREDICTING FETAL DEATH IN HYPERTENSIVE PREGNANCY

Abstract

J. biol. Chem.

Am. J. Obstet. Gynec.

Am. J. Obstet. Gynec.

Am. J. Obstet. Gynec.

Am. J. Obstet. Gynec.

Am. J. Obstet. Gynec.

Am. J. Med.