Advanced maternal age is associated with a higher likelihood of preeclampsia, but practical biomarkers for early risk assessment remain limited. Published in Frontiers in Cardiovascular Medicine, this retrospective cohort study examined whether the serum uric acid–to–creatinine ratio (SUA/sCr) is associated with preeclampsia risk among pregnant women aged ≥35 years.

The analysis included 2296 participants. Associations between SUA/sCr and preeclampsia were evaluated using multivariable logistic regression, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). Dose-response patterns and potential non-linear relationships were assessed using restricted cubic spline models, along with two-segment regression approaches.

Preeclampsia was reported in 14.29% of the cohort. After adjustment for confounders, each standard deviation increase in SUA/sCr corresponded to a higher risk of preeclampsia (OR 1.29; 95% CI, 1.13-1.47; P=0.0001). Spline modeling did not demonstrate evidence supporting a non-linear association (P=0.354).

Further analysis suggested a potential turning point at an SUA/sCr value of approximately 8.18 (95% CI, 7.60-8.55), although this pattern did not achieve statistical significance. Below this level, SUA/sCr showed a positive association with preeclampsia risk, whereas no clear relationship was observed at higher values.

An E-value of 1.73 indicated moderate resistance to unmeasured confounding. Subgroup findings varied according to proteinuria status (P for interaction=0.0146), and these results should be interpreted with caution.

Higher SUA/sCr levels were associated with increased preeclampsia risk in women of advanced maternal age.