Association between serum uric acid and elevated blood pressure among pregnant women in Bangladesh: a cross-sectional study

Hypertensive disorders of pregnancy remain a leading cause of maternal and fetal morbidity worldwide. Serum uric acid (SUA) has emerged as a potential biomarker of endothelial dysfunction and cardiometabolic risk during pregnancy, yet evidence from Bangladesh is scarce. This study investigated the association between SUA concentrations and elevated blood pressure among pregnant women in Bangladesh. This cross-sectional study included 194 pregnant women attending antenatal care in two districts of Bangladesh. Serum SUA and cardiometabolic biomarkers were measured using standard laboratory methods. Participants were categorized into SUA quartiles, and multivariable logistic regression was used to evaluate the association between SUA and elevated blood pressure. The mean age of the participants was 25 ± 5 years, while 16.9% had hypertensive disorders of pregnancy and 12.4% had preeclampsia. Women in the highest SUA quartile (≥ 5.5 mg/dL) had significantly higher systolic blood pressure (129.4 vs. 113.5 mmHg), diastolic blood pressure (81.8 vs. 71.4 mmHg), and mean arterial pressure (97.7 vs. 81.3 mmHg) than those in the lowest quartile (all P < 0.01). Increasing SUA levels were also associated with higher TG, TG/HDL-C ratio, and LDL/HDL-C ratio, whereas HDL-C levels decreased significantly ( P < 0.05). The prevalence of elevated blood pressure increased across SUA quartiles. In multivariable analysis, each 1 mg/dL increase in SUA was associated with a 38% higher odds of elevated blood pressure (adjusted OR: 1.38, 95% CI 1.03–1.86; P < 0.05). Compared with women in the lowest SUA quartile, those in the higher quartiles had approximately three- to four-fold greater odds of elevated blood pressure after adjustment for potential confounders. Overall, in all models SUA showed a significant association with elevated blood pressure. In conclusion, higher SUA concentrations were independently associated with elevated blood pressure and an adverse cardiometabolic profile among pregnant women in Bangladesh. However, due to the cross-sectional design, modest sample size, and lack of temporal assessment, the study findings should be interpreted as associations rather than evidence of causality or prospective predictive ability. Larger prospective studies are needed to determine whether SUA measured earlier in pregnancy provides additional value for identifying women who subsequently develop gestational hypertension or preeclampsia.