Paper Title
STUDY ON ASSOCIATION OF SERUM URIC ACID IN PRE-ECLAMPSIA IN COMPARISON WITH NORMOTENSIVE PREGNANCY

Abstract
Abstract - Hypertensive (HTN) disorders of pregnancy are 3rd most common cause of maternal mortality.Incidence of HTN disorders in pregnancy ranges from 5-10%.Preeclampsia (PE) is a major cause of maternal & perinatal morbidity & mortality. PE is defined as ‘triad of gestational or chronic hypertension, proteinuria and oedema occurring after 20 weeks gestation in a previously normotensive woman. Hyperuricemia is a characteristic finding in pre-eclampsia.It is known risk factor for HTN, cardiovascular & renal diseases. Also, severity of preeclampsia increases with increasing uric acid levels, which suggests that uric acid has a role in patho-physiology of preeclampsia. Thus, serum uric acid may be an important marker in preeclampsia. Objectives - a) To estimate levels of serum uric acid in preeclamptic patients. b) To estimate the differences in serum uric acid levels among preeclampsia with that of normotensive pregnancies Methodology - AComparative descriptive cross-sectional study at Obstetrics out-patient and In-patient wings of Obstetrics &Gynecology Department at Basaveshwara Medical College & Hospital, Chitradurga, among128 diagnosed cases of preeclampsia and 128 controls who were antenatal women in their third trimester. Study was conducted for a period of 02 Years from 1st March 2021 to 28th February 2023. All Pregnant females between 20-35 years of age who gave informed consent were included in the study. Exclusion Criteria consisted of those patients suffering from any other medical disorders like hypothyroidism, gestational diabetes mellitus, chronic hypertension, chronic renal disease, haemoglobinopathies Study Procedure - Participants’ age, parity, socio- economic and educational status were recorded.Clinical examination, anthropometric evaluation were done. Severity of proteinuria was assessed using the dipstick method & patients with reading of ≥1+ and blood pressure ≥ 140/90 mm Hg were included in the study group. They were further be divided into 3 groups based on their BP levels according to National Institute for Health and Care Excellence (NICE) guidelines as mild, moderate and severe preeclampsia: Mildpreeclampsia:Systolic blood pressure between 140-149 mmHg, diastolic blood pressure between 90-99 mmHg.Moderatepreeclampsia: Systolic blood pressure between 150-159 mmHg, diastolic blood pressure between 100-109 mmHg.Severepreeclampsia: Systolic blood pressure 160 mmHg or greater, diastolic blood pressure 110 mmHg or greater. Information of socio-demographic profile, clinical history was noted down in a preformed study proforma. Detailed clinical examination was conducted.BP was measured using mercury sphygmomanometer in sitting position, in the right arm, machine placed at level of the heart, after 10 minutes of resting. 2 readings were taken 6 hours apart. Laboratory tests performed - 5 ml of venous blood sample obtained under aseptic conditions, collected in a sterile plain tube. Serum Uric acid estimation was done by using Johnson and Johnson Vitros 4600 dry chemistry auto-analyzer. Urine sample was collected in a sterile container and analysed for urine protein by dipstick method. Statistical Analysis - Data compiled in MS Excel spreadsheet & Analyzed with SPSS software v:16.0., All characteristics were summarized descriptively. Continuous variables summarized as N, mean, standard deviation(SD) . Categorical data is summarized in number/frequency and percentages.To test significance of associations,Chi square test (categorical variables), Independent student t’ test (continuous variables) were applied. Results - Among the preeclampsia group there were 19.5% mildcases of preeclampsia, 61.7% were moderate cases of preeclampsia and 18.8% severe cases of preeclampsia. 128 age and parity matched pregnant females were taken as controls. Serum Uric Acid Levels (mg/dl) among preeclampsia group was 6.5 ± 0.24mg/dl. And the serum uric acid levels among controls was 4.1± 0.3 mg/dl. This difference in the mean serum uric acid levels was found to be statistically significant. Serum uric acid levels were analysed according to severity of preeclampsia in study group. It was found that average levels of serum uric acid was significantly higher among moderate and severe preeclampsia cases (6.52± 0.2, 6.91 ±0.3 mg/dl respectively) compared to that of mild cases (6.07±0.3 mg/dl ) Discussion - Hyperuricemia is very commonly found in severe compared to mild and moderate pre-eclampsia patients. Uric acid has multiple origins in cases of pre-eclampia like abnormal renal function due to renin activity and vasoconstriction, increased tissue breakdown, acidosis and increased activity of xanthine oxidase dehydrogenase.Hyperuricemia is one of the earliest and most consistent observations noted in preeclamptic pregnancies. Conclusion - It is concluded from this study that high levels of uric acid are found in the serum of pre-eclamptic cases as compared to normotensive cases of the study population. The levels of uric acid are higher in severe cases as compared to the levels in mild and moderate cases. Keywords - Marker of preeclampsia, Serum uric acid, Mild preeclampsia, Severe preeclampsia, Hyperuricemia, Marker of preeclampsia.