TO STUDY ELEVATED FIRST TRIMESTER SERUM URIC ACID LEVELS AS A PREDICTOR OF GESTATIONAL DIABETES MELLITUS

Dr. BHARTI SHARMA; Dr. DEEPALI JAIN; Dr. AJAY SHARMA

Volume : VIII, Issue : IV, April - 2019

TO STUDY ELEVATED FIRST TRIMESTER SERUM URIC ACID LEVELS AS A PREDICTOR OF GESTATIONAL DIABETES MELLITUS

Dr. Bharti Sharma, Dr. Deepali Jain, Dr. Ajay Sharma

Abstract :

Introduction: Gestational diabetes mellitus is one of the most important complications during pregnancy which is associated with both maternal and fetal morbidity and mortality1. WHO / American diabetes association define GDM as any degree of Glucose intolerance with onset or 1st recognition during pregnancy irrespective of the treatment with diet or insulin2. Serum Uric acid is associated with insulin resistance in non–pregnant women3. Uric acid is an independent risk factor for developing type 2 diabetes within 10 years in non–pregnant adults, in pregnancy uric acid is correlated with insulin resistance in women with gestational hypertension10 and higher at 24–28 weeks gestation in women diagnosed with GDM compared to women without diabetes4. Method: This prospective study was conducted on 154 antenatal women, with singleton pregnancy of gestational age < 15 weeks in first trimester at Rajkiya Mahila Chikitsalaya, JLN Medical College, Ajmer, during Oct 2017 to Sep 2018 after considering all exclusion and inclusion criteria. Obstetric history, family history, and personal history was obtained from patients. Per abdomen examination and USG was done to calculate the gestational age of every patient. Venous blood sample was withdrawn from antenatal women for serum uric acid levels. All antenatal mothers was followed for around 24–28 weeks for routine GDM screening. Association between elevated serum uric acid level in first trimester and GDM was calculated with statistical methods of analysis. Results: Among the total 154 antenatal patients under study in first trimester, 119 patients (77%) had normal uric acid level and 35 patients (23%) had elevated uric acid level. Out of 35 patients who had elevated serum uric acid level in first trimester, 15(42.85%) had serum uric acid in 1st quartile, 11(31.42%) had serum uric acid in 2nd quartile, 9(25.71%) had serum uric acid level in 3rd quartile. Serum uric acid level of patients under study at 24–28 weeks of gestation, out of 154 patients, 46 (29.87%) had elevated uric acid level and 108 (70.12%) had normal level of uric acid. Out of 154 patients, GCT was negative in 110 (71%) patients, and GGT was positive in 44 (29%) patients. Out of 154 patients, 13 patients (8.5%) had DIPSI positive and 141 patients (91.5%) were negative. DIPSI test is confirmatory test for GDM in patients under study. Out of 13 patients diagnosed GDM 8(61.53%) had family history of GDM and 5(38.46%) had no family history of GDM. Out of 13 patients who had GDM, 10 patients had elevated serum uric acid level, out of them 2(20%) patients had serum uric acid level in 1st quartile, 2(20%) in 2nd quartile and 6(60%) in 3rd quartile. Conclusion: Hyperuricemia has been demonstrated to be a risk factor for developing type 2 diabetes. In our study, we found that uric acid ≥ 6.5 mg/dl early in pregnancy is associated with increased risk of developing gestational diabetes. Our study demonstrated a striking association between first trimester uric acid and risk of developing gestational diabetes, more than half of the women with uric acid in the highest quartile actually developed the disease. Thus we postulate that elevated 1st trimester serum uric acid helps in the prediction of gestational diabetes mellitus and also identification those at risk of developing type II Diabetes mellitus of follow up.