Accuracy of serum uric acid as a predictive test for maternal complications in pre-eclampsia: Bivariate meta-analysis and decision analysis

Koopmans, Corine M.; Pampus, Maria G. van; Groen, Henk; Aarnoudse, Jan G.; Berg, Paul P. van den; Mol, Ben W J

doi:10.1016/j.ejogrb.2009.05.014

Cited by 63 publications

(55 citation statements)

References 32 publications

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“…In our study, although the mean creatinine level in PE group was significantly higher in comparison with the two groups with normal pregnancy (p<0.0001), creatinine serum level was above the reference range in only 25% of patients with PE. Hyperuricemia in PE is mostly result of decreased GFR and increased tubular re-absorption, but it may occur also due to increased placental production of uric acid (due to increased breakdown of purines in placenta), acidosis, higher activity of xanthine oxidase/dehydrogenase, thus being not only a marker of pathological state and renal dysfunction but also having a role in PE pathogenesis [41]. In our study serum uric acid was above reference range for control group in 37.5% of PE patients, with significant differences between mean values in three groups (p<0.0001).…”

Section: International Journal Ofmentioning

confidence: 99%

Antioxidant Status in Normal Pregnancy and Preeclampsia upon Multivitamin-Mineral Supplementation in the Region of Vojvodina

Ćebović¹,

Marić²,

Nikolić³

et al. 2013

IJBBB

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Abstract-Normal pregnancy is associated with oxidative stress and this is even increased during preeclampsia (PE). The decrease in total antioxidant capacity is the pathophysiological basis for vitamin supplementation during pregnancy, but the beneficial effect of this approach is still unclear. Levels of creatinine, urea, cystatin, malondialdehyde (MDA), superoxide dysmutase activity (SOD), glutathione peroxidase (GSH-Px) activity and acidum ascorbicum were measured in the serums of all women. Mean MDA level in maternal plasma in normal pregnancies was significantly lower than in PE pregnancies (2,78 ±0.78 pmol/mg vs 3.20±0.91 pmol/mg, p< 0.05), as well as mean GSH-Px levels (811 ±206 U/l vs 1350±575 U/l, p< 0.05. Mean ascorbic acid values were significantly higher in normal than in PE pregnancies (9,85 ±2,43 mg/L vs 5.54±1.81 mg/L, p< 0.001), as well as mean SOD values (26.8 ±18.45% vs 12.3±10.3%, p< 0.001). There were no significant differences in normal pregnancy group with and without multivitamin supplementation. MDA levels were significantly lower in PE pregnancies with vitamin supplementation (2.99 ± 0.81 pmol/mg vs 3.42 ± 1.01 pmol/mg, p< 0.05), as well as GSC-Px levels (1200 ± 500 U/l vs 1500 ± 650 U/l, p< 0.05). Ascorbic acid values were significantly higher in the PE group with vitamin supplementation (6.16 ± 1.66 mg/L vs 4.92 ± 1.96 mg/L, p< 0.05), as well as SOD levels (13 ± 11.4 % vs 11.6 ± 9.2%, p< 0.001).

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Section: International Journal Ofmentioning

confidence: 99%

Antioxidant Status in Normal Pregnancy and Preeclampsia upon Multivitamin-Mineral Supplementation in the Region of Vojvodina

Ćebović¹,

Marić²,

Nikolić³

et al. 2013

IJBBB

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“…En el embarazo normal, los niveles de ácido úrico son dinámicos, caracterizándose por una reducción inicial en los primeros meses de embarazo, seguido de un aumento continuo en el tercer trimestre hasta el parto, y una posterior reducción hasta alcanzar una concentración similar a antes del embarazo 5 . Para determinar la presencia de hiperuricemia en mujeres embarazadas se consideran como puntos de corte, un nivel de ácido úrico de 5,8 mg/dL o 350 μmol/L 5 , o la elevación de al menos un desvío estándar por sobre la media, considerando la edad gestacional 1 .…”

Section: áCido úRico Y Pre-eclampsiaunclassified

“…15 mostraron que los niveles altos de ácido úrico podrían predecir eventos fetales adversos en mujeres con hipertensión del embarazo. Posterior a ello, varios estudios resumidos en revisiones recientes 5,[16][17][18] , confirman un elevado riesgo (~2 veces) de presentar resultados perinatales adversos, tanto en la madre como en el recién nacido en mujeres hipertensas con hiperuricemia. Concretamente, en relación a los resultados adversos en el recién nacido, Roberts y cols.…”

Section: áCido úRico Y Pre-eclampsiaunclassified

“…Así, las mujeres hipertensas e hiperuricémicas tienen mayor riesgo de parto pretermino, retardo de crecimiento intrauterino (RCIU) y pre-eclampsia de origen temprano (< 34 semanas), que aquellas mujeres con embarazos normales o mujeres pre-eclámpticas sin hiperuricemia 3,4 . Conjuntamente, una serie de estudios [5][6][7] sugieren que los embarazos con preeclampsia cursan con altos niveles de purinas (i.e., ATP, ADP, AMP, adenosina). Las causas o efectos de este aumento en el metabolismo de las purinas hasta ácido úrico no se conocen; sin embargo, dado que pre-eclampsia (principalmente de origen temprano) se asocia a un aumento en la liberación de restos celulares hacia la circulación materna, es posible que estos constituyan el principal sustrato para el metabolismo de las purinas, y finalmente formación de ácido úrico 8 .…”

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Purinas y ácido úrico en pre-eclampsia: interacciones fisiopatológicas y proyecciones en investigación

et al. 2013

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Uric acid and purine plasma levels as plausible markers for placental dysfunction in pre-eclampsia E l ácido úrico, producto final del metabolismo de las purinas, es utilizado como marcador de daño renal y factor de riesgo de morbilidad materna y neonatal en embarazos con pre-eclampsia 1-3 . Así, las mujeres hipertensas e hiperuricémicas tienen mayor riesgo de parto pretermino, retardo de crecimiento intrauterino (RCIU) y pre-eclampsia de origen temprano (< 34 semanas), que aquellas mujeres con embarazos normales o mujeres pre-eclámpticas sin hiperuricemia 3,4 . Conjuntamente, una serie de estudios 5-7 sugieren que los embarazos con preeclampsia cursan con altos niveles de purinas (i.e., ATP, ADP, AMP, adenosina). Las causas o efectos de este aumento en el metabolismo de las purinas hasta ácido úrico no se conocen; sin embargo, dado que pre-eclampsia (principalmente de origen temprano) se asocia a un aumento en la liberación de restos celulares hacia la circulación materna, es posible que estos constituyan el principal sustrato para el metabolismo de las purinas, y finalmente formación de ácido úrico 8 . Por ello, el aumento de ácido úrico y purinas en embarazos con pre-eclampsia no sólo obedecería a la alteración de la función renal, sino que sería un marcador de disfunción placentaria. El objetivo de este trabajo es contribuir en el análisis del rol de las purinas y el ácido úrico en la fisiopatología de pre-eclampsia y con ello replantear su potencial rol predictivo en pre-eclampsia y enfermedades cardiovasculares. Es necesario indicar que este es un análisis de la literatura disponible en el cual nos permitimos especular sobre estas posibles conexiones.

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“…Some studies have suggested that it is suboptimal as a predictor of preeclampsia; [4][5][6] however, uric acid does appear to correlate with adverse maternal and neonatal outcomes. [7][8][9][10][11][12][13][14][15][16][17] Current management of the patient with mild preeclampsia who is preterm (that is, <37 weeks gestation) often includes hospital admission, the administration of steroids to promote fetal lung maturity (if <34 weeks), and ongoing maternal and fetal surveillance. Patients with severe preeclampsia are typically delivered by 34 weeks.…”

Section: Introductionmentioning

confidence: 99%

Admission uric acid levels and length of expectant management in preterm preeclampsia

et al. 2011

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Objective: Uric acid is known to be elevated in preeclampsia. We sought to determine if uric acid levels on admission correlate with the length of expectant management in preterm patients with preeclampsia.Study Design: A retrospective chart review was conducted on singleton preeclamptic pregnancies delivered between 24 0/7 and 37 0/7 weeks' gestation at Tufts Medical Center between January 2005 and December 2007. Patients with a multiple gestation and those transferred or discharged before delivery were excluded. Data regarding signs and symptoms of preeclampsia, laboratory values, pregnancy complications and outcome were abstracted from the medical records. Correlation between admission uric acid level and days of expectant management was assessed. The relative risk (RR) was used to estimate the effect of uric acid levels on expectant management length >7 days. Mantel-Haenszel w 2 values were used to construct 95% confidence intervals (CIs) around the RR.Result: Four hundred seventy-one charts were reviewed. Of these, 190 met inclusion criteria. In all, 55 patients (28.9%) were managed expectantly for >1 week. Admission uric acid level correlated with days of expectant management (P<0.0001). Uric acid levels at admission were categorized as p4.0 mg dl -1 (low uric acid level), 4.1 to 6.0 mg dl -1 (medium) and X6.1 mg dl -1 (high). Relative to women with high uric acid levels at admission, we observed a sevenfold higher rate of extending expectant management for >1 week among women with low uric acid level (7.0; 95% CI: 3.34 to 14.68). Women with medium uric acid levels at admission also had a higher likelihood of prolonging pregnancy relative to women with high uric acid levels (RR: 2.81; 95% CI: 1.32 to 5.96) (P-value for trend <0.0001).Conclusion: Admission uric acid levels correlate with the length of expectant management in preterm patients with preeclampsia. Pregnancy prolongation for >1 week is significantly more likely in patients with low and medium uric acid levels at the time of admission. Uric acid levels may be helpful in assessing disease severity and counseling preeclamptic patients regarding likelihood of extended expectant management.

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Accuracy of serum uric acid as a predictive test for maternal complications in pre-eclampsia: Bivariate meta-analysis and decision analysis

Cited by 63 publications

References 32 publications

Antioxidant Status in Normal Pregnancy and Preeclampsia upon Multivitamin-Mineral Supplementation in the Region of Vojvodina

Antioxidant Status in Normal Pregnancy and Preeclampsia upon Multivitamin-Mineral Supplementation in the Region of Vojvodina

Purinas y ácido úrico en pre-eclampsia: interacciones fisiopatológicas y proyecciones en investigación

Admission uric acid levels and length of expectant management in preterm preeclampsia

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