# Maternal hyperuricemia and adverse maternal-fetal outcomes: a systematic review and meta-analysis of observational studies

## TL;DR

High uric acid levels in pregnant women are linked to increased risks of complications like preterm birth and preeclampsia, but more research is needed to confirm these findings.

## Contribution

This study provides a comprehensive meta-analysis showing elevated maternal uric acid is associated with multiple adverse pregnancy outcomes.

## Key findings

- Elevated maternal SUA is significantly linked to preterm birth and preeclampsia.
- High SUA levels correlate with increased NICU admissions and reduced odds of vaginal delivery.
- The study highlights the need for further prospective research to validate SUA as a clinical biomarker.

## Abstract

Maternal serum uric acid (SUA) has been suggested as a biomarker for adverse pregnancy outcomes, but findings remain inconsistent. This systematic review and meta-analysis evaluated the association between elevated maternal SUA levels and key obstetric and neonatal outcomes.

A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted through December 2024. Observational studies reporting associations between high maternal SUA levels and pregnancy outcomes were included. Data were pooled using a random-effects model as odds ratios (ORs). Heterogeneity was assessed using the I2 statistic.

A total of 30 studies met the inclusion criteria. Elevated maternal SUA levels were significantly associated with increased odds of preterm birth (PTB; OR = 2.05, 95% CI: 1.55–2.72, I2 = 90.22%, n = 20), preeclampsia (PE; OR = 3.84, 95% CI: 2.17–6.77, I2 = 92.35%, n = 8), neonatal intensive care unit (NICU) admission (OR = 2.20, 95% CI: 1.63–2.97, I2 = 0.00%, n = 5), cesarean delivery (OR = 1.44, 95% CI: 1.16–1.79, I2 = 92.59%, n = 8), and intrauterine growth restriction (IUGR; OR = 3.03, 95% CI: 1.16–7.91, I2 = 84.23%, n = 8). Elevated SUA levels were also associated with low Appearance, Pulse, Grimace, Activity, and Respiration scores at 1 min (OR = 3.63, 95% CI: 1.47–8.95, I2 = 62.75%, n = 4) and 5 min (OR = 4.66, 95% CI: 2.45–8.85, I2 = 0%, n = 4). Conversely, high SUA levels were associated with reduced odds of spontaneous vaginal delivery (SVD; OR = 0.68, 95% CI: 0.51–0.91, I2 = 93.29%, n = 8) and a non-significant reduction in live birth (OR = 0.65, 95% CI: 0.41–1.02, I2 = 55.98%, n = 4).

This meta-analysis shows an association between elevated maternal SUA levels and adverse maternal and neonatal outcomes. However, the evidence is derived from heterogeneous observational studies and does not support causal inference or routine SUA-based screening in clinical practice. Maternal SUA may be a promising biomarker, but large, well-designed prospective studies are needed to validate these findings and clarify its incremental predictive value.

CRD420251038421, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038421.