TO MEASURE THE FREQUENCY OF GESTATIONAL DIABETES MELLITUS IN PATIENTS WITH RAISED SERUM URIC ACID LEVEL IN FIRST TRIMESTER OF PREGNANCY.
Keywords: Frequency, Gestational diabetes, Hyperuricemia, Low birth weight.
In pregnancy, uric acid is correlated with insulin resistance. Serum uric acid is higher in first trimester in women diagnosed with GDM as compared to women without GDM1. Gestational diabetes mellitus is an illness distinct as any type of glucose intolerance which is developed for the first time in pregnant women. GDM is characterized by higher level of insulin resistance and abnormality in secretion of insulin. Essentially, pregnancy acts as metabolic stress test and bares the causal insulin resistance and dysfunctionality of beta cell. GDM is also linked with multiple complications (Maternal and fetal), mainly macrosomia2,3. Studies have indicated that there is an increase in propensity for higher and unbalanced free radical production, which can cause to trigger membrane harm in patients with GDM and other side effects related to oxidative imbalance.
Altered prostaglandin biosynthesis is believed to be the main effect of increased presence of Reactive oxygen species in GDM. Abnormal biosynthesis of prostaglandin may be the main cause in development of GDM related embryopathy4-6. Hyperuricemia in first trimester was linked with higher possibility of developing GDM. The possibility of having GDM was 3.25 times greater if uric acid levels in first trimester remain in 4th quartile. Although, there is a strong relation of raised uric acid levels in the body with the body mass index, the possibility of having GDM remained elevated among pregnant women with raised level of uric acid in 1st trimester independent of BMI. The rationale of our study was to determine frequency of GDM in pregnant population with high serum uric acid level in first trimester of pregnancy7.
MATERIAL AND METHODS
It is a descriptive case series study conducted at: Pak Emirates Military Hospital Rawalpindi from: 11th Jul 2015 to 11th Jan 2016. All 140 pregnant women in their first trimester with increased serum uric acid level (cut off value >4mg/dl) were included in the study according to inclusion criteria (Antenatal woman's with gestational amenorrhea of less than 13 weeks, Age 20 to 40 year, Parity 0 to 8) and exclusion criteria (Pregestational diabetes, Hypertension, Renal disease, Liver disease, Multiple gestations, Gout, Drugs which increases uric acid excretion, Past history of gestational diabetes mellitus, History of good size baby in previous pregnancies). Sampled Patients were followed up in OPD, at 24 weeks of gestation, 75g OGTT was performed to diagnose GDM with cut of f value: fasting blood sugar level of >92 mg/dl, 1 hour after breakfast> 180mg/dl, 2 hours after breakfast >155mg.
All data was entered and analyzed using SPSS version 17. Descriptive statistics were calculated for both qualitative and quantitative variables. For qualitative variables like gestational diabetes mellitus, frequency and percentage were calculated. For quantitative variables like age, parity, gestational age, uric acid levels and blood glucose levels mean and standard deviation will be calculated. Qualitative variables were presented through tables and charts. Effect modifiers like age, gestational age, parity were controlled by stratification. Post stratification Chi-square test was applied. A p-value 4mg/dl developed GDM.
Katherine et al11 showed uric acid levels >3.6 mg/dl are linked with 3-fold higher possibility of developing GDM. Yoo et al, also reported about connection between raised uric acid and insulin resistance among non-pregnant women and blamed hyperuricemia as an element of risk for type 2 diabetes mellitus12. Hyperuricemia being the independent indicator of cardiovascular disease13, is closely linked with insulin resistance. The data obtained from cross sectional as well as cohort studies have confirmed that raised uric acid levels being the independent risk factor DM14,15. In another study, it was observed that multiparous were 8.29 fold more expected to develop GDM than nulliparous. The chances for a parous woman for developing GDM inflate from 2% to 21% when age changes from 20 years to 40. Maternal age confounding effect may be attributed to higher incidence of GDM among grand multiparous women16. 44.3% of multiparous women with raised levels of uric acid in serum, have GDM.
Wolak et al, observed that levels of uric acid at the highest quartile in initial 20 weeks during pregnancy are linked with GDM development and mild preeclampsia17. Usually, levels of uric acid in early pregnancy and in mid-trimester fall below normal levels and in late pregnancy, uric acid levels are restored to normal levels. If there are some preexisting metabolic imbalances in pregnancy where women have hyperuricemia, they may have poor physiological adaptations. It may predispose the pregnant women to problems like GDM and preeclampsia18. The present study is important in the aspect that it sets a cut-off serum uric acid level in pregnant women of 4 mg/dl responsible for GDM development. Therefore, it is strongly recommended to monitor the levels of uric acid in serum during first trimester of pregnancy so early diagnosis may be possible and treatment could be started in time. As, early diagnosis and management is important in avoiding adverse fetal and maternal complications.
High uric acid correlates in assessing pregnant women in first trimester to predict gestational diabetes mellitus development. Frequency of GDM is significantly increased in patients with first trimester hyperuricemia and with high number of parity as well. Certain parameter of biochemical origin such as uric acid levels in serum may be helpful in determining and predicting complications like GDM. Early diagnosis is important in changing the outcome of complications and it may also help clinicians to better understand the condition and in proper management of condition like GDM. Timely diagnosis will help in improving health of quality of life of GDM women and offspring. Therefore, it is highly recommended to monitor serum uric acid levels in first antenatal care visit.
CONFLICT OF INTEREST
This study has no conflict of interest to be declared by any author.
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|Publication:||Pakistan Armed Forces Medical Journal|
|Date:||Jun 30, 2019|
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