Association of Elevated Serum Homocysteine Level in Women with Gestational Diabetes Mellitus

Background: In gestational diabetes mellitus (GDM), risk prediction is mostly based on maternal history and clinical risk factors and may not optimally identify high risk pregnancies. Therefore, universal screening is widely recommended. Homocysteine levels during pregnancy in women with GDM have been studied; however, it remains unclear whether hyperhomocysteinemia is a useful predictor of GDM. Objective: To determine the association of serum homocysteine level in women with gestational diabetes mellitus. Methods: Case control study was conducted in the Department of Obstetrics and Gynaecology, Institute of Child and Mother Health (ICMH), Dhaka. Pregnant women in their 24 weeks to 40 weeks of gestation attended for antenatal care diagnosed as GDM was selected as cases. Non- diabetic pregnant women matching with cases by age and gestational age were selected as control in this study. GDM was diagnosed by oral glucose tolerance test (OGTT). The serum homocysteine level of these patients was measured. Descriptive and inferential analysis was carried out using SPSS version 22.0. P-value less than 0.05 will be considered as statistically significant. Results: Among the cases fasting blood sugar (6.13 ± 0.66) and controls (4.60 ± 0.57). Similarly, 2 hours after 75 gm. glucose blood sugar among cases (8.46 ± 0.88) and controls (6.32 ± 0.96). Both results were statistically significant p=0.001. Majority of patients were at third trimester of pregnancy (67.0%). 37.5% were primigravida and 2.5% were multigravida. Mean gestational age of cases (30.25 ± 2.74) and controls (30.02 ± 3.03). Among the cases 62.1% had history of GDM where 37.9% don’t have history of GDM. Among control group only 7.7% had history of GDM. This result statistically significant p=0.001. 6.9% cases had history of macrocosmic child which was not statistically significant p=0.49. There was no history of still birth or other congenital defect. Mean serum homocysteine level among cases (6.50 ± 1.72) and controls (5.20 ± 1.87) which was statistically significant p=0.001. Positive correlation observed between maternal serum homocysteine level and maternal blood sugar (r=0.209, p=0.005) in this study. Respondents with high homocysteine level have 3.94 times more chance to develop GDM (OR=3.94; 95% CI = 1.59-9.77). Conclusion: Finding from the present study suggests that maternal elevated serum homocysteine level in pregnancy is significantly associated with Gestational Diabetes Mellitus.