母体高尿酸血症对妊娠结局和新生儿合并症影响的回顾性巢式病例对照研究

The effect of maternal hyperuricemia on pregnancy outcomes and neonatal complications: A retrospective nested case-control study

背景高尿酸血症(HUA)患病率逐年增高,不仅与痛风、尿酸盐肾病和肾结石有关,还与内分泌代谢、心脑血管等系统疾病的发生和发展有关。目的探讨孕母妊娠晚期血尿酸水平与不良妊娠结局、新生儿尿酸水平及新生儿合并症的关系。设计回顾性巢式病例对照研究。方法以2020年1~12月在北京大学人民医院产检的孕母为队列人群,根据孕母妊娠晚期血尿酸水平分为HUA组和非HUA组,比较两组妊娠结局和新生儿临床结局。根据孕母妊娠晚期血尿酸水平(μmol·L^(-1))分为低浓度(<360)、中浓度(~420)和高浓度(>420),采用线性回归和Logistic回归模型分析孕母血尿酸水平与早产、低出生体重、小于胎龄儿的关系。孕母妊娠晚期尿酸值及新生儿生后24 h尿酸值相关性分析采用Spearman秩相关分析。主要结局指标孕母血尿酸水平与早产、低出生体重和小于胎龄儿的关系。结果共纳入孕母2397例(新生儿2581例),HUA组216例(9.0%),非HUA组2181例。HUA组孕母所生新生儿出生体重低于非HUA组(2925 g vs 3260 g,P<0.001),差异均有统计学意义;而早产(18.5%vs 8.9%)、低出生体重(23.1%vs 7.1%)、小于胎龄儿(29.2%vs 10.6%)和转儿科比例(19.9%vs 11.1%)均高于非HUA组,差异均有统计学意义(P<0.001)。尿酸水平高浓度组孕母分娩的新生儿出生体重较低浓度组低54.0 g(95%CI:-106.5~-1.6,P=0.043),发生早产的风险增加74%(OR=1.74,95%CI:1.08~2.8,P=0.023),发生小于胎龄儿的风险增加85%(OR=1.85,95%CI:1.26~2.73,P=0.002)。新生儿生后24 h内尿酸水平与孕母妊娠晚期尿酸水平呈中等相关(r=0.613,P=0.000)。两组早产儿合并症差异无统计学意义。结论母体妊娠晚期HUA与早产、低出生体重、小于胎龄儿的发生相关。

Background The prevalence of hyperuricemia(HUA)is increasing,which is not only related to gout,urate nephropathy and kidney stones,but also related to the occurrence and development of endocrine metabolism,cardiovascular and cerebrovascular diseases.Objective To assess the association of maternal hyperuricemia with adverse pregnancy outcomes and neonatal disease.Design Retrospective nested case-control study.Methods Data were retrospectively collected from People's Hospital of Peking University between January 1st 2020 and December 31st 2020.According to the maternal uric acid value in the third trimester of pregnancy,the newborns were divided into the group of HUA and normal uric acid.The pregnancy outcomes and clinical outcomes of neonates in two groups were compared.According to the maternal uric acid value in the third trimester of pregnancy(μmol·L^(-1)),pregnant women were divided into the group of low concentration(<360),medium concentration(~420)and high concentration(>420).Linear regression and logistic regression models were used to analyze the relationship between maternal uric acid value and preterm,low birth weight and small-for-gestational-age infants.Spearman rank correlation analysis was used to analyze the correlation between maternal uric acid value in the third trimester of pregnancy and neonatal uric acid value at 24 hours after birth.Main outcome measures The relationship between maternal uric acid value and preterm and low birth weight and small-for-gestational-age infants.Results A total of 2397 pregnant women(2581 newborns)were enrolled,of which 216 cases(9%)were in the HUA group.The birth weight of newborns in the HUA group was lower than that of the non-HUA group(2925 g vs 3260 g,P<0.001).The proportions of preterm birth(18.5%vs 8.9%),low birth weight(23.1%vs 7.1%),small for gestational age(29.2%vs 10.6%),and transfer to pediatrics(19.9%vs 11.1%)were higher in the HUA group(P<0.001).The birth weight of newborns in the high concentration group was lower than those in the low concentration group(-54g,95%CI:-106.48--1.63,P=0.043).The risk of newborns with preterm and small-for-gestational-age infants delivery increased by 74%(OR=1.74,95%CI:1.08-2.8,P=0.023)and 85%(OR=1.85,95%CI:1.26-2.73,P=0.002),respectively.The uric acid value of the newborn at 24 hours after birth was moderately correlated with the uric acid value of the pregnant mother in the third trimester of pregnancy(r=0.613,P=0.000).There was no significant difference in neonatal complications between the two groups.Conclusion Maternal hyperuricemia in the third trimester of pregnancy is associated with the occurrence of perterm,low birth weight and small-for-gestational-age infants.