A Significant Increase in Maternal Blood Uric Acid Levels Accompanies the Severity of Hypertensive Disorders in Pregnancy

Peningkatan Signifikan Kadar Asam Urat Darah Ibu menyertai Keparahan Gangguan Hipertensi pada Kehamilan

Abstract

Objective: To asses the relationship between maternal serum uric acid level and severity of hypertensive disorders in pregnancy and perinatal outcomes.
Methods: A cross sectional study was conducted at Persahabatan Hospital from January 2014 to December 2018. Subject were pregnant women with hypertensive disorder. Serum uric acid levels were taken from a venous blood sample at the time the patient came for delivery. The severity of hypertensive disorders in pregnancy were grouped into chronic hypertension, gestational hypertension, preeclampsia without severe feature, preeclampsia with severe feature, and preeclampsia with severe feature and organ involvement. The perinatal outcomes were the gestational age at birth, birth weight, and the first minute APGAR score. The relationship between maternal serum uric acid level and severity of hypertensive disorders in pregnancy and perinatal outcomes were analyzed using Mann Whitney and Kruskall Wallis test.
Result: A total of 704 out of 880 pregnant women with hypertensive disorder have met the criteria as research subjects. Maternal uric acid levels were found to increase significantly (p <0.001) with increasing severity of hypertensive disorders in pregnancy. Maternal who experienced preterm delivery had significantly higher blood uric acid levels (p <0.001) than those who experienced a term delivery. Maternal blood uric acid levels of infants with small birth weight for gestational age and first minute Apgar score <7 were slightly higher but not significant compared to maternal blood uric acid levels of normal birth weight infants and first minute Apgar score >7.
Conclusions: Maternal blood uric acid levels increased significantly accompanying the severity of hypertensive disorders in pregnancy. Blood uric acid levels tend to be higher in maternal who have poor perinatal outcomes.
Keywords: APGAR score, hypertensive disorders in pregnancy, preeclampsia, uric acid.

Abstrak
Tujuan: Untuk menilai hubungan antara kadar asam urat serum ibu dan keparahan gangguan hipertensi pada kehamilan dan luaran perinatal.
Metode: Studi potong lintang dilakukan Rumah Sakit Persahabatan periode Januari 2014 sampai Desember 2018. Subjek penelitian adalah ibu hamil dengan gangguan hipertensi. Kadar asam urat darah diambil dari sampel darah vena pada saat ibu hamil datang untuk melahirkan. Tingkat keparahan gangguan hipertensi pada kehamilan dikelompokkan menjadi hipertensi kronik, hipertensi gestasional, preeklamsia tanpa gejala berat, preeklamsia dengan gejaka berat, dan preeklamsia dengan gejala berat dan keterlibatan organ. Luaran perinatal adalah usia kehamilan saat lahir, berat badan bayi lahir, dan skor APGAR menit pertama. Hubungan antara kadar asam urat darah ibu dan tingkat keparahan gangguan hipertensi pada kehamilan dan luaran perinatal dianalisis menggunakan uji Mann Whitney atau uji Kruskall Wallis.
Hasil: Sebanyak 704 dari 880 ibu hamil penderita hipertensi telah memenuhi kriteria sebagai subjek penelitian. Kadar asam urat darah ibu meningkat secara signifikan (p <0,001) dengan meningkatnya keparahan gangguan hipertensi pada kehamilan. Ibu yang melahirkan preterm memiliki kadar asam urat darah yang lebih tinggi secara bermakna (p < 0,001) dibandingkan ibu yang melahirkan aterm. Kadar asam urat darah ibu dari bayi dengan berat lahir kecil untuk usia kehamilan dan skor Apgar menit pertama < 7, sedikit lebih tinggi tetapi tidak signifikan, dibandingkan kadar asam urat darah ibu dari bayi berat lahir normal dan skor Apgar menit pertama pertama > 7.
Kesimpulan: Kadar asam urat darah ibu meningkat secara signifikan menyertai beratnya gangguan hipertensi pada kehamilan. Kadar asam urat darah cenderung lebih tinggi pada ibu yang memiliki luaran perinatal kurang baik.
Kata kunci: APGAR, asam urat, hipertensi dalam kehamilan, preeklamsia.