Maternal hyperuricemia and adverse neonatal outcomes in normotensive pregnancies: Evidence from a prospective cohort study in Eastern Uganda

Abstract

Abstract
Background: Maternal hyperuricemia is a potential biomarker of adverse pregnancy outcomes, but evidence among normotensive women in low- and middle-income countries is limited. We aimed to assess the association between elevated maternal serum uric acid (SUA) levels and adverse neonatal outcomes.
Methods: We conducted a prospective cohort study at Jinja Regional Referral Hospital, Uganda, from 1st October 2024-1st February 2025, enrolling 352 normotensive women in latent labor. SUA was measured using gestational-age-specific cutoffs, classifying women as hyperuricemic or normouricemic. Outcomes included preterm birth, small-for-gestational-age (SGA) birth, stillbirth, and low Apgar score. Poisson regression with robust standard errors estimated adjusted relative risks (aRR) and 95% confidence intervals.
Results: Adverse neonatal outcomes occurred in 37.5% of participants. Hyperuricemic women had significantly higher composite risk (62.5% vs. 12.5%; aRR = 4.32, 95% CI 2.92-6.39). Hyperuricemia independently predicted preterm birth (aRR = 3.63, 95% CI 1.70-7.72), SGA (aRR = 2.80, 95% CI 1.61-4.86), and stillbirth (aRR = 5.00, 95% CI 1.47-16.99). Maternal age ≥ 40 years, low education, < 4 antenatal visits, previous preterm birth, previous stillbirth, and obesity were also associated with adverse outcomes. Conclusions. Maternal hyperuricemia is a strong predictor of preterm birth, SGA, and stillbirth. Routine SUA screening during antenatal care, combined with closer monitoring of high-risk women, could help improve neonatal outcomes.
Copyright: © 2026 Hafsa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.