Association Between Serum Uric Acid Levels and Premature Rupture of Membranes at Adam Malik Hospital and Affiliated Hospitals

Abstract

Premature rupture of membranes (PROM) is an important obstetric complication associated with adverse maternal and neonatal outcomes. Oxidative stress and degradation of the fetal membrane extracellular matrix are recognized mechanisms involved in membrane weakening and rupture. Serum uric acid (SUA) is an endogenous antioxidant that may protect against oxidative damage; however, both excessively low and elevated SUA concentrations may be associated with adverse biological effects. Evidence regarding the relationship between maternal SUA and PROM remains limited and inconsistent, particularly in non-diabetic pregnant populations. This study aimed to compare maternal serum uric acid levels between pregnant women with and without PROM and to determine the association between SUA status and PROM. The study also evaluated the difference in body mass index (BMI) between the two groups and examined the distribution of overweight and obesity according to PROM status. An analytical cross-sectional study was conducted at Adam Malik Hospital, Prof. Dr. Chairuddin P. Lubis Hospital, and Pirngadi Regional General Hospital, Medan, from March to July 2025. Fifty pregnant women were included, comprising 25 women with PROM and 25 women without PROM, selected using consecutive sampling. Serum uric acid levels and BMI were assessed. Differences in continuous variables were analyzed using the Mann–Whitney U test, while categorical variables were analyzed using the Chi-square or Fisher's exact test, as appropriate. The median BMI was higher among women with PROM than among women without PROM (29.2 vs. 27.5 kg/m²; p = 0.001), representing an absolute difference of 1.7 kg/m². When the analysis was restricted to overweight and obese women, obesity was more frequent in the PROM group (11/25, 44%) than in the non-PROM group (4/22, 18.2%); however, this difference did not reach statistical significance using Fisher's exact test (p = 0.070). Median serum uric acid was substantially lower in the PROM group than in the non-PROM group (3.7 vs. 5.4 mg/dL; p = 0.001), corresponding to an absolute difference of 1.7 mg/dL or approximately 31.5% lower median SUA in the PROM group. Normal SUA levels were observed in 92.0% of women with PROM compared with 60.0% of women without PROM, whereas hyperuricemia was present in 8.0% and 40.0%, respectively (p = 0.008). Maternal serum uric acid levels were significantly lower among pregnant women with PROM than among those without PROM. The findings support a potential association between maternal SUA status and PROM, although causality cannot be established because of the cross-sectional design. Further prospective studies with larger sample sizes and adjustment for potential confounders are warranted.

Keywords:  Serum uric acid; premature rupture of membranes; pregnancy; oxidative stress; body mass index