ASSOCIATION OF GESTATIONAL DIABETES MELLITUS WITH FIRST TRIMESTER URIC ACID LEVEL- AMONG PREGNANT MOTHERS

Abstract

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy and is associated with adverse maternal and neonatal outcomes. Early identification of women at increased risk is essential to facilitate timely intervention. Serum uric acid has emerged as a potential early biomarker because of its association with insulin resistance and metabolic dysfunction. Methods: A hospital-based prospective observational study was conducted among 100 pregnant women attending the Department of Obstetrics and Gynaecology, Sree Balaji Medical College and Hospital, Chennai, between August 2023 and January 2025. Eligible women with singleton pregnancies at ≤13+6 weeks of gestation underwent estimation of first trimester serum uric acid using the uricase–peroxidase enzymatic method. Maternal demographic and clinical characteristics were recorded. Participants underwent a 75-g oral glucose tolerance test (OGTT) at 24–28 weeks according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Women with normal OGTT results underwent repeat testing at 32–34 weeks to identify late-onset GDM. Statistical analysis included Chi-square test, Student's t-test, odds ratio estimation and receiver operating characteristic (ROC) curve analysis. Results: Among the 100 participants, 25 (25.0%) developed early GDM and 15 (15.0%) developed late GDM. Women with GDM were significantly older, had higher body mass index, and more frequently reported a family history of diabetes mellitus. The mean first-trimester serum uric acid level was 3.8 ± 0.8 mg/dL in normoglycaemic women, 5.9 ± 0.9 mg/dL in women with early GDM, and 5.2 ± 0.7 mg/dL in those with late GDM. Hyperuricaemia was associated with higher odds of early GDM (OR: 2.05) and late GDM (OR: 3.25). ROC analysis demonstrated moderate predictive performance for early GDM with a serum uric acid cut-off of ≥4.5 mg/dL, sensitivity of 74%, specificity of 62%, and an area under the curve of 0.72. Conclusion: Elevated first-trimester serum uric acid levels were associated with an increased risk of gestational diabetes mellitus and demonstrated moderate diagnostic accuracy for predicting early GDM. Serum uric acid estimation is inexpensive, readily available, and may serve as a useful adjunctive biomarker for early risk stratification when combined with established maternal risk factors. Larger multicentric studies are required to validate its role in routine antenatal screening.