{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T07:39:26Z","timestamp":1773041966099,"version":"3.50.1"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Maternal serum uric acid (SUA) has been suggested as a biomarker for adverse pregnancy outcomes, but findings remain inconsistent. This systematic review and meta-analysis evaluated the association between elevated maternal SUA levels and key obstetric and neonatal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted through December 2024. Observational studies reporting associations between high maternal SUA levels and pregnancy outcomes were included. Data were pooled using a random-effects model as odds ratios (ORs). Heterogeneity was assessed using the\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 30 studies met the inclusion criteria. Elevated maternal SUA levels were significantly associated with increased odds of preterm birth (PTB; OR\u202f=\u202f2.05, 95% CI: 1.55\u20132.72,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f90.22%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f20), preeclampsia (PE; OR\u202f=\u202f3.84, 95% CI: 2.17\u20136.77,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f92.35%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f8), neonatal intensive care unit (NICU) admission (OR\u202f=\u202f2.20, 95% CI: 1.63\u20132.97,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f0.00%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f5), cesarean delivery (OR\u202f=\u202f1.44, 95% CI: 1.16\u20131.79,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f92.59%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f8), and intrauterine growth restriction (IUGR; OR\u202f=\u202f3.03, 95% CI: 1.16\u20137.91,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f84.23%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f8). Elevated SUA levels were also associated with low Appearance, Pulse, Grimace, Activity, and Respiration scores at 1\u202fmin (OR\u202f=\u202f3.63, 95% CI: 1.47\u20138.95,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f62.75%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f4) and 5\u202fmin (OR\u202f=\u202f4.66, 95% CI: 2.45\u20138.85,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f0%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f4). Conversely, high SUA levels were associated with reduced odds of spontaneous vaginal delivery (SVD; OR\u202f=\u202f0.68, 95% CI: 0.51\u20130.91,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f93.29%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f8) and a non-significant reduction in live birth (OR\u202f=\u202f0.65, 95% CI: 0.41\u20131.02,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f55.98%,\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f4).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta-analysis shows an association between elevated maternal SUA levels and adverse maternal and neonatal outcomes. However, the evidence is derived from heterogeneous observational studies and does not support causal inference or routine SUA-based screening in clinical practice. Maternal SUA may be a promising biomarker, but large, well-designed prospective studies are needed to validate these findings and clarify its incremental predictive value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      CRD420251038421,\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251038421<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1704136","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:48:37Z","timestamp":1773038917000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal hyperuricemia and adverse maternal-fetal outcomes: a systematic review and meta-analysis of observational studies"],"prefix":"10.3389","volume":"13","author":[{"given":"Ahmed","family":"Abu-Zaid","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khawlah Habib","family":"AlShammari","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specializations","place":["Kuwait City, Kuwait"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara N.","family":"Alenezi","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specializations","place":["Kuwait City, Kuwait"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reem","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland","place":["Dublin, Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatemah Sayer","family":"Althaher","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences, Arabian Gulf University","place":["Manama, Bahrain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Murad","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences, Arabian Gulf University","place":["Manama, Bahrain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fajer Ali","family":"Alkandari","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specializations","place":["Kuwait City, Kuwait"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manar M.","family":"Alshammari","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Sharjah","place":["Sharjah, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah M.","family":"Alharran","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences, Arabian Gulf University","place":["Manama, Bahrain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Baradwan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center","place":["Jeddah, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Abuzaid","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Al Birk General Hospital","place":["Al Birk, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osama","family":"Alomar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1038\/s41392-024-01916-y","article-title":"Hyperuricemia and its related diseases: mechanisms and advances in therapy","volume":"9","author":"Du","year":"2024","journal-title":"Signal Transduct Target Ther"},{"key":"ref2","first-page":"3167","article-title":"Update on the epidemiology, genetics, and therapeutic options of hyperuricemia","volume":"12","author":"Li","year":"2020","journal-title":"Am J Transl Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s13340-023-00662-w","article-title":"The predictive role of serum uric acid levels before pregnancy in the development of gestational diabetes mellitus","volume":"15","author":"Ghanei","year":"2024","journal-title":"Diabetol 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