{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T12:03:31Z","timestamp":1769688211505,"version":"3.49.0"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82103827"],"award-info":[{"award-number":["82103827"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82470134"],"award-info":[{"award-number":["82470134"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Young Elite Scientists Sponsorship Program by CAST","award":["2023QNRC001"],"award-info":[{"award-number":["2023QNRC001"]}]},{"name":"Program of National Key Research and Development Project of China","award":["2022YFC2304600"],"award-info":[{"award-number":["2022YFC2304600"]}]},{"name":"Program of National Key Research and Development Project of China","award":["2023YFC2509500"],"award-info":[{"award-number":["2023YFC2509500"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"abstract":"<jats:p>Serum uric acid, a key metabolic marker, has been linked to pregnancy complications, yet its association with postpartum hemorrhage (PPH)\u2014especially non-linear relationships and underlying mechanisms\u2014remains uninvestigated.<\/jats:p>\n                  <jats:p>We conducted a multicentre cohort study (pregnant women) and nested case-control study (1:2 matching) in China (2017\u20132024). Third-trimester serum uric acid was measured. PPH was defined per World Health Organization criteria (\u2265500 mL vaginal\/\u22651000 mL cesarean blood loss). Logistic regression, restricted cubic spline (RCS) analysis, mediation analysis, and predictive model evaluation were performed.<\/jats:p>\n                  <jats:p>In the cohort, serum uric acid was stratified into quintiles (Q1:&lt;251.0, Q2:251.0\u2013289.6, Q3:289.7\u2013327.0 [reference], Q4:327.1\u2013377.9, Q5:\u2265378.0 \u03bcmol\/L). Adjusted for confounders, Q1 (odds ratio [OR]=1.56, 1.18\u20132.08) and Q5 (OR=1.38, 1.03\u20131.85) had higher PPH risk vs. Q3. RCS revealed a significant U-shaped association (Pnon-linearity=0.0038) with inflection point at 281.4 (244.70\u2013318.10) \u03bcmol\/L\u2014validated in nested case-control (n=1,551) and sensitivity analyses (excluding pre-enrolment hyperuricemia). Stratified analyses showed the U-shape was confined to non-GDM and non-preeclampsia subgroups. Mediation analysis demonstrated low serum uric acid (&lt;281.4 \u03bcmol\/L) was statistically associated with increased PPH risk via hemoglobin (16.75% statistical mediation effect) and fibrinogen (7.87%); high serum uric acid (\u2265281.4 \u03bcmol\/L) showed a statistical association with PPH risk via D-dimer (13.60%). An extended PPH predictive model (traditional variables\u2009+\u2009uric acid\u2009+\u2009hemoglobin\u2009+\u2009fibrinogen\u2009+\u2009D-dimer) had higher area under the receiver operating characteristic curve (0.739 vs. 0.702) and net benefit (0\u201320% risk threshold) vs. traditional models.<\/jats:p>\n                  <jats:p>Third-trimester serum uric acid exhibits a U-shaped association with PPH risk in Chinese pregnant women (inflection point:281.4 \u03bcmol\/L), confined to non-GDM\/non-preeclampsia subgroups; these associations are supported by statistical mediation effects of hemoglobin, fibrinogen, and D-dimer.<\/jats:p>","DOI":"10.1055\/a-2788-3102","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:12:11Z","timestamp":1769645531000},"source":"Crossref","is-referenced-by-count":0,"title":["U-shaped Association of Third-trimester Serum Uric Acid with Postpartum Hemorrhage: Statistical Mediation Effects of Hemoglobin, Fibrinogen, and D-dimer\u2014A Multicenter Cohort Study"],"prefix":"10.1055","author":[{"given":"Liang V.","family":"Tang","sequence":"first","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"},{"name":"Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Hu","sequence":"first","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"},{"name":"Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiating","family":"Li","sequence":"additional","affiliation":[{"name":"Diagnostic Science Centre, Alberta Precision Laboratories, Calgary, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqing","family":"Zhai","sequence":"additional","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huafang","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Deng","sequence":"additional","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhipeng","family":"Cheng","sequence":"additional","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengjuan","family":"Fan","sequence":"additional","affiliation":[{"name":"Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"},{"name":"Key Laboratory of Biological Targeted Therapy (Huazhong University of Science and Technology), Ministry of Education, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Biobank, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"De","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biobank, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"issue":"17","key":"ref2","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1056\/NEJMra1513247","article-title":"Postpartum hemorrhage","volume":"384","author":"J L Bienstock","year":"2021","journal-title":"N Engl J Med"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"103578","DOI":"10.1016\/j.eclinm.2025.103578","article-title":"Evaluating shock index for prediction of adverse maternal outcomes related to postpartum haemorrhage and maternal sepsis in Sierra Leone: 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