First trimester Serum Uric Acid levels in predicting Gestational Diabetes Mellitus: A hospital based longitudinal follow-up study

Abstract

Background: Elevated serum uric acid levels have been associated with insulin resistance, hypertension, and metabolic syndrome, conditions that share common pathophysiological mechanisms with gestational diabetes mellitus (GDM).

Objectives: To determine the diagnostic accuracy of first trimester serum uric acid levels in predicting Gestational Diabetes Mellitus.

Methods: This was a longitudinal follow-up study conducted in the Department of Biochemistry and Obstetrics & Gynaecology, of a tertiary teaching healthcare facility in South India.

Results: The study enrolled 400 women with single live intrauterine pregnancy up to 14 weeks of gestation; 74.5% were between 21 and 30 years of age. Nearly two third patients were multigravida (62.5%); 36.7% were overweight, and 14.5% were obese. The mean (SD) levels of uric acid was 3.3 (0.9); 47.7% had serum uric acid levels >3.2 mg/dl. Serum uric acid levels were significantly (p<0.05) elevated among overweight and obese women. Of the 400 women, 149 women (37.3%) had GDM on follow-up. Patients with gestational diabetes mellitus (GDM) had significantly higher mean uric acid levels (3.8 mg/dl) compared to those without GDM (2.9 mg/dl). 65.8% of GDM patients had uric acid levels ≥3.2 mg/dl, versus 37.1% without GDM, a statistically significant difference. Serum uric acid levels showed a mild to moderate positive correlation with fasting, one-hour, and two-hour postprandial blood glucose in both first and second OGTT. First-trimester serum uric acid levels predicted GDM with 68.4% sensitivity, 74.2% specificity, 53.5% positive predictive value, 84.4% negative predictive value, and 72.4% overall diagnostic accuracy at a cutoff of ≥3.2 mg/dl.

Conclusion: Early pregnancy serum uric acid levels could potentially serve as a valuable biomarker for identifying women at higher risk for GDM, thereby allowing for earlier interventions and improved management of pregnancy outcomes.