Researchers have found that elevated maternal serum uric acid levels in the first trimester are associated with a significant increase in the risk of congenital heart diseases (CHDs) in offspring. A recent study was published in Heliyon by Minli Zhao and colleagues. This underlines the importance of early uric acid monitoring and management in pregnancy to offset these risks.
Congenital heart diseases are among the most common kinds of birth defects, which annually hit thousands of newborn babies worldwide. The role of early pregnancy concentrations of uric acid in mothers' serum has not been well documented until now, though many risk factors have been identified. This study aimed to find out the relationship between those levels and the occurrence of CHD in offspring.

This was a prospective cohort study conducted in southeast China from 2019 to 2022, involving 21 425 pregnant women. The participants were recruited from the Fujian birth cohort study and had their fasting blood samples taken at about 11·3 weeks of gestation for the estimation of serum uric acid levels. The perinatal outcome was followed up in relation to the incidence of CHDs in their offspring. All CHDs were confirmed by expert echocardiography doctors and pediatric cardiologists.
Key Findings
• The study found a strong association between higher maternal serum uric acid levels in the first trimester and an increased risk of CHDs in offspring.
• Maternal log2-transformed serum uric acid levels were linked to a 58.9% higher risk of CHDs (adjusted odds ratio [AOR] 1.589, 95% CI [1.149, 2.198]).
• When comparing the lowest quartile of maternal uric acid levels to higher quartiles, the study observed a significant increase in risk.

• The AORs for the second, third, and highest quartiles were 1.363 (95% CI [1.036, 1.793]), 1.213 (95% CI [0.914, 1.610]), and 1.472 (95% CI [1.112, 1.949]), respectively.
• Pregnant women with hyperuricemia in the first trimester faced an 83.7% increased risk of CHDs in their offspring (AOR 1.837, 95% CI [1.073, 3.145]).
• The restricted cubic spline (RCS) model demonstrated a linear relationship between maternal serum uric acid levels and the risk of CHDs, with no evidence of nonlinearity (P = 0.71).
These results further underscore the fact that there is no need for monitoring, much less managing, the levels of uric acid in the serum during the first trimester of pregnancy. Based on a strong relationship with an increased risk for CHD, health providers may want to consider looking at uric acid levels as part of routine prenatal care, especially in at-risk populations.
This study identified that elevated first-trimester maternal serum uric acid levels are one of the major risk factors for the occurrence of congenital heart diseases in their offspring. These results, therefore, underscore early detection and management strategies to achieve improved perinatal outcomes.
Reference:
Zhao, M., Wang, X., Zhang, D., Li, H., Zhu, Y., & Cao, H. (2024). Relationship between maternal serum uric acid in the first trimester and congenital heart diseases in offspring: a prospective cohort study. Heliyon, e35920, e35920. https://doi.org/10.1016/j.heliyon.2024.e35920