Vol. 7, Issue 2, Part A (2025)

Background: Adverse birth outcomes remain a significant public health concern, particularly in developing countries. Early identification of maternal risk factors and biochemical markers is essential to mitigate associated neonatal morbidity and mortality.
Objective: To evaluate the demographic, clinical, and biochemical predictors of adverse birth outcomes among pregnant women, with a specific focus on serum uric acid and cystatin C levels.
Methods: This hospital-based case-control study was conducted at the Department of Obstetrics and Gynecology, Tikrit Teaching Hospital, from October 1, 2024, to June 30, 2025. A total of 120 pregnant women at delivery were recruited, comprising 60 women with adverse birth outcomes (cases) and 60 with normal outcomes (controls). Maternal demographic characteristics, clinical conditions, delivery data, and biochemical markers were collected. Serum uric acid and cystatin C levels were measured. Data were analyzed using independent t-tests, chi-square tests, binary logistic regression, and receiver operating characteristic (ROC) curve analysis.
Results: Women with adverse outcomes had significantly higher rates of nulliparity (60.0%, P=0.001), BMI ≥25 kg/m² (66.7%, P=0.028), anemia (43.3%, P=0.002), gestational diabetes (26.7%, P=0.010), preeclampsia (30.0%, p<0.001), and pregnancy-induced hypertension (23.3%, P=0.015). Cesarean section was more frequent among the case group (63.3%), as was preterm birth (100.0%). Serum uric acid (6.45±0.82 mg/dL) and cystatin C (1.34±0.23 mg/L) were significantly elevated compared to controls (4.87±0.71 mg/dL and 0.98±0.19 mg/L) (p<0.001). ROC analysis revealed cut-off values of >5.5 mg/dL for uric acid (AUC=0.882; sensitivity=81.7%; specificity=83.3%) and >1.1 mg/L for cystatin C (AUC=0.901; sensitivity=85.0%; specificity=86.7%). Both biomarkers were significantly negatively correlated with birth weight, length, and gestational age (p<0.001).
Conclusion: Elevated maternal serum uric acid and cystatin C levels are strongly associated with adverse birth outcomes and can serve as sensitive and specific predictors. Early screening for these biomarkers, alongside monitoring of clinical risk factors such as nulliparity, elevated BMI, and hypertensive disorders, may enhance antenatal surveillance and improve maternal-fetal outcomes.