Maternal serum uric acid levels and blood pressure during pregnancy: A community-based cohort study

Studies find both very low and high serum uric acid (UA) levels are related to oxidative stress and to conditions such as cardiovascular diseases and chronic kidney disease in the general population. Pregnancy studies have focused only on high maternal UA. In present study, we tested whether unusually high and low levels of maternal serum UA are associated with increases in blood pressure (BP) during pregnancy.

The Pregnancy Outcomes and Community Health Study enrolled 3019 pregnant women between their 16th-27th week of pregnancy from 52 clinics in 5 Michigan communities (1998-2004). UA levels were measured in maternal blood collected at enrollment from a sub-cohort of 1223 participants. BP was abstracted from prenatal medical records; these analyses used highest recorded diastolic BP (DBP) and its companion systolic BP (SBP). Mean arterial pressure (MAP) was calculated using the formula of (2 × DBP + SBP)/3. Covariates, including maternal race/ethnicity, age at enrollment, education level, medical insurance status, body mass index before pregnancy, parity, smoking during pregnancy, alcohol use during pregnancy, and gestational week at blood collection, were considered as potential confounding variables. Associations between UA levels and BP were evaluated with linear spline or multiple linear regression models. Models' robustness was examined with bootstrap estimation of variance, sensitivity analysis, and 10-fold cross-validation.

Both DBP and MAP had a J-shaped relationship with maternal UA; the breakpoints (nadirs) were 0.153 and 0.161 mmol/L UA, respectively. For DBP versus UA, adjusted regression coefficient (β) = -95.67 (standard error (SE) = 37.67 and p = 0.01) for the left and adjusted β = 48.95 (SE = 9.56 and p < 0.01) for the right; for MAP versus UA, adjusted β = -58.48 (SE = 31.42 and p = 0.06) for the left and adjusted β = 52.23 (SE = 11.39 and p < 0.01) for the right. Maternal SBP followed a positive linear trend with UA levels (adjusted β = 37.75, SE = 12.93, and p < 0.01). All results were robust.

Extreme high and low maternal serum UA levels may be informative in studying maternal blood pressure during pregnancy.