A study on role of biochemical markers in prediction of gestational diabetes mellitusa

Abstract

Introduction: Diabetes mellitus is a disorder of carbohydrate metabolism. It is caused by a combination of hereditary and environmental factors characterized by either inadequate secretion or inadequate action of insulin. Both pre gestational and gestational diabetes pose many risks to the mother and fetus. In addition to traditional risk factors, several biochemical markers like glycated hemoglobin HbA1c, fasting and postprandial blood sugars and inflammatory markers like c reactive protein, cytokines, pregnancy associated plasma protein-A, which are implicated in pathophysiology of GDM and involved in mechanism related to insulin resistance or chronic inflammation have been studied to predict risk of developing GDMearly[16]. Aims: To diagnose GDM in early trimester with the help of certain biochemical markers like Fasting blood sugar, Postprandial blood sugar, glycosylated hemoglobin HbA1C and C Peptide. Methodology: This is a prospective study done in 200 Pregnant women in early trimester who attended OPD in King George Hospital, Visakhapatnam. With informed consent, these pregnant women are subjected to detailed clinical examination and before 20 weeks subjected to fasting blood sugars, postprandial blood sugars, HbA1C,C – peptide estimation &were followed up with regular antenatal checkups and appropriate antenatal care and at about 24 -28 weeks of period of gestation 75 g oral glucose tolerant testwas done according to the standard protocols for testing regarding concentration and amount of glucose,fasting and timing of blood sample collection. Based on the results of this test, included pregnant women are categorized into GDM (cases) and non GDM group (controls) with cutoff value of 75g glucose tolerant test being 140 mg /dl. Results: The mean values of the selected biochemical markers were significantly higher in GDM cases when compared to controls.The mean FBS,PPBS, HBA1C and C-Peptide of first trimester in GDM cases were 86.76mg/dl,122.76mg/dl,5.4g%,3.4647ng/ml respectively. Conclusion: Gestational Diabetes mellitus is a very common global health problem which is significantly increasing universally with changing life style habits.This increasing rate and it’s effect on maternal and fetal health makes the concept of EARLY DIAGNOSIS of GDM, a very crucial part to our health system .Pregnant women with fasting blood glucose more than 86.76 mg/dl, PPBS more than 122.76 mg/dl, HbA1C more than 5.4g%in first trimester, c peptide more than 3.4ng/ml have to be cautious and are at risk of developing GDM in late trimester and hence followed up carefully. The above Reference cut off values of markers included in our study are yet to be established by further studies with larger population.