Maternal Hyperuricemia and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis of Observational Studies

Ahmed Abu-Zaid^1*Khawlah Habib AlShammari²Sara N Alenezi²Reem Mohammad³Fatemah Sayer Althaher⁴Mohammad Redha Qasem Murad⁴Fajer Ali Alkandari²Manar M Alshammari⁵Abdullah M Alharran⁴Saeed Baradwan⁶Mohammed Abuzaid⁷Osama Alomar⁶

• ¹College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
• ²Kuwait Institute for Medical Specializations, Kuwait City, Kuwait
• ³Royal College of Surgeons in Ireland, Dublin, Ireland
• ⁴Arabian Gulf University, Manama, Bahrain
• ⁵University of Sharjah, Sharjah, United Arab Emirates
• ⁶King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
• ⁷Al Birk General Hospital, Al Birk, Saudi Arabia

Background: 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. Methods: 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 and pregnancy outcomes were included. Data were pooled using a random-effects model as odds ratio (OR). Heterogeneity was assessed using the I² statistic. Results: Thirty 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), 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 was also linked to low APGAR scores at 1 minute (OR=3.63, 95% CI: 1.47–8.95, I²=62.75%, n=4) and 5 minutes (OR=4.66, 95% CI: 2.45–8.85, I²=0%, n=4). Conversely, high SUA was 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). Conclusion: This meta-analysis demonstrates 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.