Predictive value of serum uric acid levels for adverse maternal and perinatal outcomes in pregnant women with high blood pressure. A systematic review and meta-analysis

•In pre-eclampsia, the increase of uric acid production from maternal, fetal or placental tissues and the consequent increase of XO activity could also explain its increased concentration.•The clinical utility of hyperuricemia in the management of pre-eclampsia is controversial. Despite the fact that hyperuricemia is not recommended as diagnostic criterion for pre-eclampsia and not considered a useful aid to women management, but measurement of serum uric acid could be a useful test to predict maternal complications under realistic assumptions.•Whith a supposed prevalence of pre-eclampsia of 10%, a pooled sensitivity of 74% and a pooled specificity of 66%, out of 100 people with a positive test result 19 women would actually have predict PE. High serum uric acid seems to be associated with pre-eclampsia. The expected utility of uric acid is related to the probability of occurrence of maternal and neonatal complications. We evaluated the accuracy of uric acid in predicting adverse maternal and perinatal outcomes in pregnant women with high blood pressure. We performed an electronic search for studies evaluating the accuracy of high serum uric acid levels in pregnant women with high blood pressure. The assessment of risk of bias was performed using the QUIPS tool. For each included study, we collected data about study characteristics and diagnostic test accuracy to construct 2 × 2 tables. Pooled sensitivity (Se), specificity (Sp) and diagnostic odds ratio (DOR) were estimated using a bivariate model. Grading the quality of the evidence was assessed using the GRADE approach. Twenty-one studies, testing more than 6,000 women, met the inclusion criteria. The majority of studies were at low risk of bias. Ten studies evaluated the role of serum uric acid to predict pre-eclampsia, the pooled Se was 0.74 (95%CI 0.71-0.77), Sp was 0.66 (95%CI 0.63-0.68), and DOR was 9.67 (95%CI 4.57-20.47). The overall quality of evidence was evaluated as low. The GRADE rating was downgraduate for risk of bias and inconsistency. No robust evidence currently exists to suggest that uric acid measurement is useful in predicting maternal and perinatal adverse outcomes.