DOI: http://dx.doi.org/10.18203/2349-3933.ijam20193296

A comparative and correlative study of serum homocysteine level in gestational diabetes mellitus and normal pregnancy

Manoharan S., Sharmila R., Natesh Prabhu M.

Abstract


Background: An alarming increase in Gestational diabetes mellitus (GDM) cases worldwide elevates concern regarding the consequences including fetal macrosomia, preeclampsia and many more. Plasma homocysteine levels which has direct impact on to endothelial function of blood vessels. The relationship of homocysteine and GDM is yet to be clarified.

Methods: This single centre prospective observational study was conducted in Department of Obstetrics and Gynaecology of Thanjavur medical college hospital among 50 pregnant primi and multi gravida patients with normal pregnancy and gestational diabetes mellitus to assess the association and comparison of serum homocysteine levels in both groups.

Results: The mean value of homocysteine in control group was 3.8 ± 0.95 and in gestational diabetes patients was 16.30±6.09. On comparison, found that there was hyperhomocysteinemia among GDM patients with normal pregnancy and results were statistically significant (T= -9.024 Df=48.000 <0.05).

Conclusions: In this comparative and correlative study, we found that patients with gestational diabetes mellitus have higher serum homocysteine levels in comparison with normal pregnant women. Hyperhomocysteinemia is found to be an independent risk factor for gestational diabetes mellitus patients. Further investigations are needed to follow up for these patients in the postpartum period and later in their life.


Keywords


Gestational diabetes mellitus, Glucose challenge test, Homocysteine, Hyperhomocysteinemia, Multigravida, Primigravida

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References


Management of Diabetes in Pregnancy. Diab Care. 2015;38(1):S77-9.

Bairwa M, Yadav V, Misra P, Kant S. Gupta S. Prevalence of gestational diabetes mellitus in india: a systematic review and meta-analysis (oral presentation). 21st IEA World Congress of Epidemiology. 2017;1-28.

Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diab Res Clin Pract. 2014;103(2):176-85.

Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-9.

Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA, Thangaratinam S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetol. 2016;59(7):1403-11.

Melchior H, Kurch-Bek D, Mund M. The Prevalence of Gestational Diabetes. Dtsch Arztebl Int. 2017;114(24):412-8.

Steegers-Theunissen RP, Boers GH, Trijbels FJ, Eskes TK. Neural-tube defects and derangement of homocysteine metabolism. N Engl J Med. 1991;324(3):199-200.

Ueland PM, Vollset SE. Homocysteine and Folate in Pregnancy. Clin Chemistry. 2004;50(8):1293-95.

Ganguly P, Alam SF. Role of homocysteine in the development of cardiovascular disease. Nutr J. 2015;14(1):6.

Stamler JS, Osborne JA, Jaraki O, Rabbani LE, Mullins M, Singel D, et al. Adverse vascular effects of homocysteine are modulated by endo-thelium-derived relaxing factor and related oxides of nitrogen. J Clin Invest. 1993;91(1):308-18.

Wustmann K, Klaey M, Burow A, Shaw SG, Hess OM, Allemann Y. Additive effect of homocysteine- and choles-terol-lowering therapy on endothelium-dependent vasodilation in patients with cardiovascular disease. Cardiovasc Ther. 2012;30(5):277-86.

Meigs JB, Jacques PF, Selhub J, Singer DE, Nathan DM, Rifai N, et al. Fasting plasma homocysteine levels in the insulin resistance syndrome: Framingham Offspring Study. Diab Care. 2001;24(8):1403-10.

Walker MC, Smith GN, Perkins SL, Kelly EJ, Garner PR. Changes in homocysteine levels during normal pregnancy. Am J Obst Gyn. 1999;180(3):660-4.

Gong T, Wang J, Yang M, Shao Y, Liu J, Wu Q, et al. Serum homocysteine level and gestational diabetes mellitus: a meta-analysis. J Diab Investig. 2016;7(4):622-8.

Seghieri G, Breschi MC, Anichini R, De Bellis A, Alviggi L, Maida I, et al. Serum homocysteine levels are increased in women with gestational diabetes mellitus. Metab. 2003;52(6):720-3.

Schlaich MP, John S, Jacobi J, Lackner KJ, Schmieder RE. Mildly elevated homocysteine concentrations impair endothelium dependent vasodilation in hypercholesterolemic patients. Atherosclerosis. 2000 Dec;153(2):383-9.

Guven MA, Kilinc M, Batukan C et al. Elevated second trimester serum homocysteine levelsin women with gestational diabetes mellitus. Arch Gynecol Obstet. 2006;12:333-7.

Seghieri G, Breschi MC, Anichini R, De Bellis A, Alviggi L, Maida I, et al. Serum homocysteine levels are increased in women with gestational diabetes mellitus. Metab. 2003;52(6):720-3.

Tarim E, Bagis T, Kilicdag E, Erkanli S, Aslan E, Sezgin N, et al. Elevated plasmahomocysteine levels ingestational diabetes mellitus. Acta Obstet Gynecol Scand. 2004:83(6);543-7.

Daly C, Fitzgerald AP, O'callaghan P, Collins P, Cooney MT, Graham IM, et al. Homocysteine increases the risk associated with hyperlipidaemia. Eur J Cardiovasc Prev Rehabil. 2009;16(2):150-5.

Asare-Anane H, Bawah AT, Osa-Andrews B, Adanu R, Ofori EK, Tagoe SB et al. Lipid Profile In Ghanaian Women With Gestational Diabetes Mellitus. Int J Sci Tech Res. 2013;2(4):168-75.

Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: a systematic review and meta-analysis. BJOG. Int J Obstet Gynaecol. 2015;122(5):643-51.