EFFECT OF MATERNAL SERUM URIC ACID LEVELS ON FOETAL OUTCOME IN PRE-ECLAMPTIC AND NORMOTENSIVE PREGNANT WOMEN AT THE FEDERAL MEDICAL CENTRE, IDO-EKITI, NIGERIA

Abstract

Background: Pre-eclampsia is a major cause of maternal and foetal morbidity and mortality in both developed and developing countries. Hyperuricaemia is often associated with pre-eclampsia and when this occurs, foetal outcome may become worse.

Objective: To determine the prognostic significance of serum uric acid on foetal outcome in pre-eclamptic patients and compare with that of normotensive pregnant women at the Federal Medical Centre, Ido-Ekiti, Ekiti State.

Method: This case control study was done at Federal Medical Centre, Ido-Ekiti between 1st April, 2015 and 30th March, 2016. The study recruited 55 eligible pre- eclamptic patients admitted at term (37 to 42 completed weeks) for vaginal or abdominal delivery at the Obstetrics and Gynaecology Departments and were matched in terms of age and gestational age with 55 consecutive normotensive pregnant women managed at the same period in the study location. Data analysis was carried out using SPSS version 21 and statistical significance between variables was determined using independent t-test, Chi-square and Fisher’s exacttest as appropriate. The level of statistical significance was set at P-value <0.05.Results: The pre-eclamptic and normotensive pregnant women were similar in terms of age (mean age=31.9±5.2years vs. 30.9±4.3 years, p=0.325), gestational

age (mean gestational age = 38.3±1.29weeks vs. 38.8±1.51weeks, P=0.070), ethnicity, religion, educational and occupational distribution patterns. More than half (63.6%) of the pre-eclamptic women were unbooked while only about one- third (36.4%) of the normotensive women were unbooked (P=0.004). The systolic blood pressure (SBP) and diastolic blood pressure DBP at presentation were significantly higher in the cases than the controls (mean SBP = 170 ± 16.2mmHg vs. 110±12.3mmHg and mean DBP = 110 ± 18.2mmHg vs. 70 ± 7.8mmHg respectively, P<0.001). More women in the pre-eclamptic group were delivered by caesarean section when compared with the control (83.6% vs. 69.1%), however, this was not statistically significant (P=0.073). In addition, the mean serum uric acid levels of the subjects was significantly higher than that of their normotensive counterparts (12.7±7.8 vs. 4.9±1.2 mg/dl, P=0.000). Likewise, babies with Low Birth Weight (LBW), Apgar scores (at 5th minute of life) of less than seven and those who required neonatal unit admission occurred significantly among the pre- eclamptic women when compared with the controls (P=0.000). The birth outcome of the two groups was however comparable (P=0.079) with three (5.5%) stillbirths noted only in the pre-eclamptic group. In terms of relationship with serum uric acid, binary logistic regression analysis confirmed that hyperuricaemia is more likely to be associated with pre-eclampsia (OR=18.8; 95% CI=1.22- 289.35, P=0.035) and LBW babies (OR=4.41; 95% CI=0.76 – 25.5, P=0.097), although,

the relationship between elevated serum uric acid and LBW babies was not statistically significant (p=0.097).

Conclusion and Recommendation: This study established that pre-eclampsia was associated with unbooked status, hyperuricaemia, higher incidence of babies with LBW, Apgar scores (at 5th minute of life) of < 7 and those who required neonatal intensive care unit admission. The study did not however demonstrate any significant relationship between elevated serum uric acid in pre-eclamptics at term and LBW babies, low Apgar score, stillbirth and need for neonatal admission. Further multicentre study is however recommended to support the result of the present study.

EFFECT OF MATERNAL SERUM URIC ACID LEVELS ON FOETAL OUTCOME IN PRE-ECLAMPTIC AND NORMOTENSIVE PREGNANT WOMEN AT THE FEDERAL MEDICAL CENTRE, IDO-EKITI, NIGERIA