Association of Maternal Serum Gamma-Glutamyltransfetase Level at First Trimester as a Predictive Biomaker of Gestational Diabetes Mellitus

Abstract

Introduction: The prevalence of GDM is increasing globally. GDM is associated with many maternal and fetal complications. Hence identifying and treating maternal hyperglycemia is beneficial for both mother and baby. Proper monitoring of women is necessary during pre-conceptional and early pregnancy period to prevent GDM and its complication. Objective: To assess the level of maternal serum Gamma-glutamyltransferase (GGT) as predictor of Gestational Diabetes Mellitus (GDM). Methods: A Prospective cohort study was carried out at Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka from January 2021 to December 2021. Total sample size was 144. Pregnant women attending Obstetric OPD, DMCH at her 1st trimester (8 -12 weeks) without the evidence of GDM, DM, or any comorbid condition and drugs that affects blood glucose level. Data regarding demographic profile, medical and family history (history of chronic hypertension, diabetes mellitus, autoimmune disease, and CKD) were recorded. Obstetric history regarding gravity, parity, past obstetric history was documented. Then a complete physical examination of the subjects including height, weight, blood pressure level was carried out with an appropriate procedure. Period of the gestation was confirmed by recording CRL in early USG. Patient’s fasting blood sugar and 2hrs after 75- gram glucose at first trimester was measured. Results: In the current study 144 pregnant women, at their first trimester (8-12 week) were included, but during follow up about 12 patients were dropped out due to mid trimester abortion, migration to another place and so on. Most of them were primi (56.1%) housewife (75%), had completed their secondary education (59.1%), and about 61.4% belong to middle class family. The clinical parameter like BMI 25.80±4.56kg/m2, gestational age at delivery 38.09±1.28 weeks. The mean ±SD BMI 27.52±4.72 kg/m in GDM group 25.40±4.46 kg/m in Non GDM group. The mean ± SD birth weight was 3.07±0.37 kg in GDM group and 2.86±0.33 in Non GDM group. The difference was statistically non- significant (p>0.05) between two groups. Among 45.45% subjects had GGT level <10 U/L,34.09% had 11-20 U/L and 20.45% had GGT >20 U/L. Among total 132 respondents 25 respondents (18.94%) developed GDM. The total population divided in two groups, Group I (GDM) and Group II (non GDM). Shows that in group A (GGT ≥12.5 U/L) total respondents were 61, GDM developed in 29.50% (n=18), GDM not developed in 70.49% (n=43). On the Other hand in Group B (GGT <12.5 U/L) total respondents were 71, GDM developed in 9.85% (n=07) and GDM not developed in 90.14% (n=64) and p value was 0.004. Conclusion: The result of our study indicated that pregnant women with high GGT (>12.5 U/L) at booking visit had greater risk of developing GDM (72%).Sensitivity, Specificity, PPV ,NPV of this diagnostic test was 72% , 59.81%, 29.50%, 90.14% respectively and accuracy is 94.69%. Among these 132 respondents, those having GGT>12.5IU/L relative risk (RR) of development of GDM is 3.01. As measurement of GGT is easy, inexpensive and easy to carry out, it can be used as a predictive biomarker who are at increased risk for the subsequent development of GDM.