DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20192430

First trimester uric acid level: a reliable marker for gestational diabetes mellitus

Suvarna Jyothi Ganta, Sunanda R. Kulkarni

Abstract


Background: The prevalence of diabetes mellitus (DM) is increasing worldwide and more in developing countries like India. The diabetic epidemic experienced in India can be due to strong genetic factors coupled with increasing urbanization, sedentary lifestyle, changes in the dietary patterns and increasing obesity. Indians are at an 11-fold increased risk of developing gestational glucose intolerance and hence universal screening is essential. Uric acid is a known marker of oxidative stress. Hyperuricemia in early pregnancy may be an indicator of the existing metabolic disturbance which can hinder the maternal physiological adaptations generally seen in pregnancy thus making the pregnant women more vulnerable to the development of gestational diabetes mellitus. The objective of this study was to investigate the association between elevated uric acid levels in the first trimester of pregnancy with gestational diabetes.

Methods: This prospective observational study was conducted in Chinmaya mission hospital, Bangalore from June 2016 to March 2017 (10 months). Three hundred and twelve (312) pregnant women of gestational age less than 12 weeks who attended the OBG outpatient department within this time of period for regular antenatal check-up were enrolled in the study. Along with the other antenatal investigations serum uric acid levels were estimated before 12 weeks and also between 24-28 weeks. At 24-28 weeks screening for GDM was done by OGCT using 75 gms of glucose (IADPISG criteria). Other parameters like age, parity, BMI, family history of diabetes was noted and compared.

Results: In our study, among the 312 pregnant women, 88 (28%) developed GDM. Of these 74 Women (84%) with GDM had uric acid levels above 3.5 mg/dl and 14 women (15.9%) with GDM had uric acid levels below 3.5 mg/dl. Women with higher BMI showed high uric acid levels.

Conclusions: Elevated serum uric acid in the first trimester has a significant correlation with development of GDM. In present study; the cut-off level of maternal serum uric acid of 3.5 mg/dl in the first trimester appears to have a good sensitivity and specificity in identifying those patients who are most likely to develop GDM later in pregnancy.


Keywords


Glucose challenge test, GDM, Hyperuricemia, Serum uric acid

Full Text:

PDF

References


Romero American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):14-80.

Agarwal S, Gupta AN. Gestational Diabetes. J Assoc Physicians India. 1982;30:203-5.

Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A. Gestational diabetes mellitus in India. J Assoc Physicians India. 2004;52:707-11.

Nahum GG, Wilson SB, Stainslaw. Early pregnancy glucose screening for GDM. J Reprod Med. 2002;47(8):656-62.

Swami SR, Mehetre R, Shivane V, Bandgar TR, Menon PS, Shah NS. Prevalence of carbohydrate intolerance of varying degrees in pregnant females in western India. J Indian Med Assoc. 2008;106:712-4.

Singh U, Mehrotra S, Singh R, Sujata, Gangwar ML, Shukla B. Serum uric acid: A novel risk factor for GDM. Int J Med Res Rev. 2015;3(1):10-5.

Davison JM, Dunlop W. Renal hemodynamics and tubular function normal human pregnancy. Kidney Int. 1980;18:152-61.

Lind T, Godfrey KA, Otun H, Philips PR. Changes in serum uric acid concentrations during normal pregnancy. Br J Obstet Gynaecol. 1984;91:128-32.

Kappaganuthu A, Jyothisachan, Shailaja G. Hyperuricemia in early pregnancy: a marker for gestational diabetes mellitus. IOSR Journal Dent Med Sci. 2014;13(12):51-4.

Nader A, AboHassan, Rezk AY, Salama KM. Early detection of gestational diabetes via measurement of first trimester maternal serum uric acid. Med J Cairo Univ. 2016;84(2):151-8.

Rasika C, Samal S, Ghose S. Association of elevated first trimester serum uric acid levels with development of GDM. J Clin Diagno Res. 2014;8(12):OC01-OC05.

Ratnakaran R, Connelly PW, Sermer M, Zinman B, Hanley AJG. The impact of family history of diabetes on risk factors for gestational diabetes. Cln Endocrinol. 2007;67:754-60.

El-Gharib M, Mahfouz AE, Morad MA. Prediction of gestational diabetes by measuring first trimester maternal serum uric acid concentration. J Basic Clin Reproduct Sci.2013;2:27-31.

Rao CN, Uthraraj K. Elevated 1st trimester serum uric acid - a risk for gestational diabetes mellitus among South-Indians: a prospective observational, longitudinal study. Int J Reprod Contracept Obstet Gynecol. 2017;6:4923-7.