A Study of Strength of Association between Changes in Serum Uric Acid, Serum Calcium, Urine Albumin Creatinine Ratio and Pre Eclampsia and Its Impact on Outcome

BACKGROUND: Hypertensive disorders of pregnancy complicate almost 7-10% of all pregnancies. The development of hypertension and proteinuria after 20wks of gestation is referred to as pre eclampsia. It is a major cause of maternal morbidity and mortality and is also associated with increased perinatal problems. Recent studies have shown the relationship between the aggravation of the hypertensive complications and the change in concentration of various chemistries in mothers serum. Interestingly, variable serum calcium, magnesium and uric acid levels are found in pre-eclamptic mothers. Studies have also demonstrated the diagnostic value of Albumin Creatinine ratio (ACR) in a single voided urine sample for quantification of proteinuria, compared to those of 24 hours of sample in patients with preeclampsia. OBJECTIVES: 1. To estimate the strength of association between the changes in the serum uric acid, serum calcium, urine albumin creatinine ratio in pre-eclampsia. 2. To know whether these factors in pre-eclampsia influence on maternal and perinatal outcome. MATERIALS AND METHODS: The study included 50 pre-eclamptic patients, and 50 normal pregnant Women in the age group of 18-35 yrs between 28 – 32 weeks. Serum calcium, uric acid and spot urinaryalbumin creatinine ratio were estimated in these subjects. Serum calcium was estimated by Arsenazo-III, Serum uric acid was estimated byenzymatic colorimetric method, Urinary albumin was estimated by immunoturbidimetricmethod and Urinary creatinine was estimated by colorimetic method. RESULTS: The serum calcium in pre-eclamptic women was significantly lower (8.29 ± 0.69mg/dl), in comparison to controls whose value was 9.73 ± 0.72mg/dl(p<0.001)) and serum uric acid in pre-eclamptic women was significantly higher (6.7 ± 1.7 mg/dl) in comparison to controls whose value was 4.26 ± 1.03 (p<0.001). The Urinary albumin/creatinineratio in preeclamptic women was significantly higher (157.8± 48.7 mg/g) in comparison to controls whose value was (28.1± 25 .1 mg/g) (p<0.001). CONCLUSION: In pre-eclampsia, the serum levels of calcium, magnesium, uric acid are altered, and spot UACR is significantly increased, suggesting strong association between these factors and severity of pre-eclampsia. Thus it can be concluded that, the careful monitoring of these markers in pregnant women may help in the mortality and morbidity reduction and thereby helpful in the favourable outcome of the pregnancy.