Uric acid is produced in the body during metabolic activities and later eliminated by the kidneys. However, there is constant fluctuation in the levels of serum uric acid in pregnancy. These fluctuations occur due to hormonal and renal blood flow changes. Hence, it is an important marker for maternal and fetal health (1).
Increased uric acid levels in pregnancy may indicate complications such as high blood pressure, gestational hypertension, and preeclampsia (2). Read on to know more about the complications and management of elevated uric acid levels during pregnancy.
Normal Levels Of Uric Acid During Pregnancy
According to the Journal of Human Hypertension, the serum concentration of uric acid may remain at around 185μM (31.1mg/L) in the first trimester (2). However, the uric acid level increases as the pregnancy proceeds and may reach around 278μM (46.7mg/L) in the third trimester. This increase in serum uric acid concentration is common and not a sign of any disorder.
However, women with preeclampsia have a higher level of serum uric acid in the third trimester than women without the disorder.
Complications Of High Uric Acid Levels During Pregnancy
- Higher risk of preterm birth and reduced time of delivery
- Risk of poor fetal prognosis and pregnancy outcomes in women
- Lower glomerular filtration rate and reduced renal function
- Some studies suggest that elevated levels of maternal serum uric acid can cause hypertensive pregnancy. However, other reputed studies counter this argument, suggesting that although a high uric acid level signifies a complication, it does not contribute to it.
- Elevated uric acid and hypertensive pregnancy may cause complications to the various organ systems in the body.
- High levels of uric acid can lead to maternal complications, including endothelial injury and dysfunction.
- Uric acid crystal deposition in the joints can cause gout, a condition of painful joints. However, gout is rarely seen in pregnant women (6) due to elevated estrogen levels, which help remove uric acid.
Treatment Options For High Uric Acid Levels During Pregnancy
A study suggests that lowering the elevated serum uric acid level has limited benefits for gestational hypertension and preeclampsia (7). Thus, it is important to maintain health parameters along with maintaining lower serum uric acid levels.
The following are some available treatment options for high uric acid conditions in pregnancy (8):
- Chronic hypertension can be managed using hypertensive medications. Regular checkups to maintain healthy blood pressure limits are crucial during pregnancy for hypertensive women, and immediate care is required if the blood pressure is >160/110 mm Hg.
- Pregnant women with preeclampsia may receive magnesium sulfate treatment based on clinical signs of proteinuria and severe hypertension.
- Medications can be taken in consultation with your health care provider to reduce the elevated serum uric acid
Prevention Of The Complications Of High Uric Acid Levels During Pregnancy
Increased serum uric acid may pose a risk of serious complications, some of which can be prevented in the following ways (8):
- Fetal monitoring and ultrasound to check for growth constraints.
- Doctors may suggest preterm delivery based on the disease severity and clinical risk factors such as
- Repeated occurrences of severe hypertension despite regular monitoring and medication
- Thrombocytopenia or reduced platelet count
- Abnormal liver or renal function and renal disease
- Pulmonary edema or cardiovascular risk factors
- Reduced fetal health and high risk of adverse pregnancy outcomes
Tips To Maintain Lower Serum Uric Acid Levels During Pregnancy
- Maintain a healthy weight by adhering to a strict exercise regime and diet plan.
- Keep diabetes in check with a healthy diet plan and reduce consumption of processed sugar and refined carbohydrates such as white bread.
- Consume vegetables and low-fat dairy products, and avoid purine-rich food such as red meat, poultry, oily fish, and seafood.
- Avoid saturated fatty processed foods and increase the intake of high fiber plant-based foods.
- If you do not have a renal problem, increase your fluid intake to remove the uric acid accumulated in the body.
Frequently Asked Questions
1. Can high uric acid cause miscarriage?
High uric acid levels and deposition in the joints could lead to gout (a rare condition in pregnancy causing pain and inflammation). Consequently, one study reported a possible association between gout in pregnancy and spontaneous abortion (the women in the study also had other complications). Hence, more studies are needed to prove this (10).
2. What level of uric acid indicates preeclampsia?
A study suggested that ⩽4.0 mg/dl uric acid levels as low, 4.1 to 6.0 mg/dl as a medium, and ⩾6.1 mg/ dl as high. Also, uric acid levels could be used to assess the severity of preeclampsia and management of pregnancy prolongation (11).
Uric acid is a metabolic byproduct that can accumulate and cause complications such as hypertension in pregnant women, increasing the risk of fetal complications. Therefore, pregnant patients must take preventive measures, including lifestyle changes, to maintain a normal uric acid level.
- An increase in the level of pregnancy uric acid beyond 46.7mg/L is considered a sign of concern.
- High uric acid during pregnancy may increase the risks for premature birth and fetal and maternal complications.
- Maintaining a healthy lifestyle and avoiding processed foods are some effective ways to prevent this condition in expectant mothers.
- Richard J Johnson et al.; (2011); Uric acid: A Clinically Useful Marker to Distinguish Preeclampsia from Gestational Hypertension.
- Serum uric acid may not be involved in the development of preeclampsia.
- Shannon A Bainbridge and James M Roberts; (2008); Uric Acid as a Pathogenic Factor in Preeclampsia.
- Uric acid and hypertension.
- Wei Cai et al.; (2017); Uric Acid Induces Endothelial Dysfunction by Activating the HMGB1/RAGE Signaling Pathway.
- Gout and Diet.
- Anna L Sampson; (2017); Uric acid-lowering therapies for preventing or delaying the progression of chronic kidney disease.
- Hypertensive Disorders of Pregnancy.
- High uric acid or Gout – Causes, Prevention and Treatment.
- Kevin Pierre et al., (2020); Gout in Pregnancy: A Rare Phenomenon.
- A C Urato et al., (2011); Admission uric acid levels and length of expectant management in preterm preeclampsia.