In the realm of obstetrics, the intricate interplay between maternal health and perinatal outcomes continues to captivate researchers worldwide. Among the multifaceted conditions affecting pregnancy, pre-eclampsia stands as a significant concern, characterized by hypertension and proteinuria after 20 weeks of gestation. ^[1] While advancements in medical understanding and management have improved maternal outcomes, the impact on foetal well- being remains a pivotal area of investigation. ^[2]

This study endeavours to delve into a promising avenue: the association between serum uric acid levels and perinatal outcomes in women grappling with pre-eclampsia. Over the years, uric acid has emerged as a potential biomarker, reflective of vascular dysfunction and oxidative stress, both hallmarks of pre-eclampsia's pathophysiology. ^[3] However, its precise role in influencing perinatal outcomes, encompassing birth weight, gestational age at delivery, and neonatal complications, warrants meticulous exploration. ^[4]

By embarking on this journey, we aim to contribute nuanced insights that could inform clinical practice and augment the holistic care provided to expectant mothers navigating the complexities of pre-eclampsia. ^[5] Through rigorous data collection, statistical analysis, and collaboration with multidisciplinary teams, we endeavour to unravel the intricate connections between maternal uric acid levels and the well-being of both mother and child. ^[6]

As we embark on this journey, we anticipate that our findings will not only enrich the scientific discourse but also potentially pave the way for tailored interventions aimed at optimizing perinatal outcomes in the realm of pre-eclampsia. ^[7]

Pre-eclampsia remains a significant challenge in obstetrics, with its potential to impact both maternal and foetal health profoundly. Amidst the array of biomarkers under scrutiny, serum uric acid levels have emerged as a promising candidate for understanding the pathophysiology of this condition. ^[8]

This prospective study aims to delve into the association between uric acid levels and fetomaternal complications in pre-eclampsia. By examining this relationship, we strive to elucidate potential predictive and prognostic markers that could guide clinical management and improve outcomes for both mother and child. ^[9].

This is a Prospective and Observational Study was conducted in the Department of Obstetrics and Gynaecology, Medical College Kolkata from December 2022 to April 2024.

Inclusion Criteria: Pregnant women diagnosed with Pre-eclampsia in their third trimesters are being included in this study.

Exclusion criteria: Pregnant women with Pre-eclampsia who are current smokers, alcoholic and those with diabetes mellitus,thyroid disorders and renal dysfunction were excluded. Patients with chronic diseases like APLA Syndrome and heart diseases were also excluded.

Study variables:

• Age
• Parity
• Systolic blood pressure at delivery
• Diastolic blood pressure at delivery

Laboratory Investigations

• Routine investigations like Complete Hemogram, serum electrolyte levels, urea, creatinine, serum TSH
• Fasting and post prandial blood sugar levels
• Serum Uric Acid levels at third trimester of pregnancy

Other Investigations

• Transabdominal USG with Colour Doppler

Procedure

All patients with Pre-eclampsia in their third trimesters were asked to test their Serum Uric Acid levels at their third trimesters of pregnancy. These patients were then followed up till delivery and the presence/absence of maternal complications and perinatal outcome were observed. The association between serum uric acid levels and perinatal outcome was then assessed.

After receiving clearance from the ethical committee, data collection was done for 12 months. Analysis was done for another 2 months and then Thesis writing was done for another 2 months. So, a total of around 16months was my study period.

Statistical analysis

Data obtained from this study was analysed using standard statistical methods. Statistical analysis was performed using the software SPSS for windows version 22. After analysing the data, appropriate tests of significance were performed.

P value ≤ 0.05 was taken to be statistically significant.

Table 1: Age Distribution

In our study 11 pre-eclamptic females (9.56%) were ≤20 years of age, 16 (13.91%) were between 21 to 25 years of age, 41(35.65%) were between 26 to 30 years of age, 39(33.91%) were between 31 to 35 years of age and 8( 6.95%) were≥ 36 years of age.

Table 2: Mean Age

The mean age of pre-eclamptic females with uric acid levels more than 6 mg/dl  is 28.90 ±5.150 (Mean± SD).The mean age of pre-eclamptic females with uric acid levels ≤6 mg/dl is 27.720 ±4.411(mean ± SD

Table 3: Parity Distribution

In our study,51 pre-eclamptic females (44.34%) were primigravida while 64 females (55.65%) were multigravida.

Table 4: Mean Gestational Age at Diagnosis

In our study ,the mean Gestational age at diagnosis in pre-eclamptic females with uric acid levels more than 6 milligrams per decilitre is 35.97 ±2.51 weeks (mean± SD). The mean gestational age at diagnosis in pre-eclamptic females in our study with uric acid ≤ 6 milligrams per decilitre is 37.73 ±1.13 weeks(mean± SD).

Table 6 :Mean Gestational Age At Delivery

In our study the mean Gestational Age at delivery in pre-eclamptic females with uric acid levels more than 6 milligrams per decilitre is 36.06 ±2.52 weeks( mean ± SD). The mean gestational age at delivery in pre-eclamptic females in our study with uric acid ≤ 6 milligrams per decilitre is 37.88±1.2 weeks (mean ± SD).

Table 7: Mean Systolic Blood Pressure at Delivery

In our study, the mean Systolic Blood Pressure at delivery in pre-eclamptic females with uric acid levels more than 6 milligrams per decilitre is 166.52 ±15.34 mmHg(mean± SD).

Table 8: Mean Diastolic Blood Pressure at Delivery

In our study, the mean Diastolic Blood Pressure at delivery in pre-eclamptic females with uric acid levels more than 6 milligrams per decilitre is 101.91 ±8.50 mmHg(mean ± SD).

Table 9: Uric Acid Distribution

In our study ,out of 115 participants, 3 (2.60%) had uric acid levels ≤4 milligrams per decilitre, 22(19.13%) had uric acid levels between 4.1 to 6.0 milligrams per decilitre ,61 (53.0% )had uric acid levels between 6.1 to 7.9 milligrams per decilitre and 29 (25.2%) had uric acid levels ≥ 8 milligrams per decilitre.

Table 10: Assosciation of Blood Pressure at Delivery with Uric Acid

In our study, we calculated the association of Blood Pressure at delivery with serum uric acid levels. It was found to be statistically significant (p value is 0.0035). Data are expressed as percentage. Test applied: Fisher's exact test. The row/column association is statistically significant. The relative risk is 1.833. 95% confidence interval is between 1.116 to 3.011.

In our study 9.56% females were ≤ 20 years of age, 13.91% were between 21 to 25 years age, 35.65% were within 26 to 30 years of age and 33.91% were within 31 to 35 years of age 6.95% females were ≥ 36 years of age. The mean age of females with serum uric acid levels more than 6 milligrams per decilitre was 28.90±5.150. Hence, in our study ,out of 115 pre- eclamptic females, majority were within 26 to 35 years of age.

In a study conducted by Veena Bhagawan in 2021, 4% patients were less than 20 years of age ,20% patients were within 21 to 25 years of age, 46.6% patients were within 26 to 30 years of age, 26.6% were within 31 to35 years of age and 2.6% were more than 35 years of age. ^[10]

In our study 44.34% females were primigravida and 55.65% females were multigravida. Veena Bhagawan in her study conducted in 2021 had 36% patients as primary gravida, 31.66% patients as second gravida, 23.66 patients as 3rd gravida and 10.66 patients as 4th gravida. ^[10]

In our study the mean Systolic blood pressure at delivery in preeclamptic females with uric acid levels≤ 6 milligram per decilitre is 156.92 ±11.52 while the mean Systolic blood pressure at delivery in preeclamptic females with serum uric acid levels more than 6 milligram per decilitre is 166.52±15.34. So, the mean Systolic blood pressure at delivery is higher in the group with uric acid >6 mg/dl.

In a study conducted by Ryu in 2019, in patients with pre-eclampsia serum uric acid levels had a positive correlation with systolic blood pressure. ^[11-17]

In our study the mean Diastolic blood pressure at delivery in preeclamptic females with serum uric acid levels ≤ 6 milligram per decilitre is 95.44 ± 8.95 while the mean Diastolic blood pressure at delivery in preeclamptic females with serum uric acid levels more than 6 milligram per decilitre is 101.91±8.50. Hence, the mean Diastolic blood pressure was also higher in the group with uric acid >6 mg/dl.

In our study, out of 115 participants, we calculated the association of increased blood pressure at delivery with serum uric acid levels. We found out that it was statistically significant with Relative Risk being 1.833 and P value being 0.0035. Hence ,we found that there is a positive correlation with Blood Pressure at delivery with serum uric acid levels. Higher the uric acid level, more is the blood pressure (Systolic/Diastolic) at delivery.

In our study out of 115 participants,2.6% pre-eclamptic females in their 3rd trimester have serum uric acid ≤ 4 milligram per decilitre, 9.13% have serum uric acid levels between 4.1 to 6.0 milligrams per decilitre, 53% females have their serum uric acid levels between 6.1 to 7.9 milligrams per decilitre and 25.2% pre-eclamptic females have serum uric acid levels ≥8 milligrams per decilitre. Hence, majority had their serum uric acid levels between 6.1 to 7.9 mg/dl.

We also calculated the mean uric acid levels and found out that in pre-eclamptic females with serum uric acid levels ≤ 6 milligrams per decilitre in our study the mean uric acid level is 5.14 ± 0.66 milligrams per decilitre while in pre-eclamptic females with serum uric acid levels > 6 milligram per decilitre, the mean uric acid level is 7.59 ±0.65 milligrams per decilitre.

Hence, from our results, we can surmise that serum uric acid levels have a significant association with perinatal outcome in women with pre-eclampsia and hence, can be used as prognostic marker to predict development of complications in these pre-eclamptic females.

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