A CROSS-SECTIONAL STUDY OF BONE TURNOVER MARKERS IN GESTATIONAL DIABETES MELLITUS
Main Article Content
Keywords
Gestational diabetes mellitus, Bone turnover biomarker, Bone metabolism
Abstract
Background and Aim: Bone turnover markers (BTMs) can be used to monitor bone formation and bone resorption activity. Maternal age, Vitamin D, obesity, parathyroid hormone (PTH), and prior history of diabetes mellitus are various risk factors for gestational diabetes mellitus (GDM). The objective of the current study aimed to explore the bone turnover markers in gestational diabetes mellitus.
Patients and Methods: This cross-sectional study investigated 102 gestational diabetes mellitus patients in the departments of Endocrine and Gynecology, Fatima Memorial Hospital, Lahore from January 2023 to December 2023. All the pregnant females aged 18-45 years having 24 weeks gestational age with no prior history of diabetes mellitus were included. Patients were classified into two groups; Group-I (Pregnant female with GDM) and Group-II or Control group (Pregnant female without GDM). All the patients underwent detailed history, physical examination, and bone turnover markers in terms of Vitamin D, serum ALP, parathyroid hormone, and serum-ionized calcium were measured and compared with the control group. Data analysis was done using SPSS version 27.
Results: The number of patients in Group-I and Group-II was 60 (58.8%) and 42 (41.2%), respectively. The overall mean age in Group-I and Group-II was 27.8 ± 2.8 years and 26.32 ± 2.86, respectively. The mean BMI, Ionized calcium, Vitamin D, and Serum PTH in both groups were as follows; (25.86 ± 3.51 kg/m2 vs. 23.98 ± 2.62 kg/m2, 4.58 ± 0.379 m-Eq/L vs. 4.59 ± 0.349 m-Eq/L, 31.256 ± 8.41 ng/ml vs. 20.98 ± 9.52 ng/ml, and 36.28 ± 8.13 pg/ml vs. 70.391 ± 35.192 pg/ml, respectively). Serum ALP in Group-I and Group-II was 8.9 ± 4.61 KA U/dl and 6.99 ± 2.1 KA U/dl, respectively.
Conclusion: The present study observed that pregnant female with gestational diabetes mellitus (GDM) are more susceptible to obesity, lower parathyroid hormone, and lower vitamin D levels as compared to control group. This provide a justification for the assessment of bone turnover markers at early stages for better positive and health outcome.
References
2. Siddiqi SS, Borse AG, Pervez A, Anjum S. A study of bone turnover markers in gestational diabetes mellitus. Indian J Endocr Metab 2017;21:38‑44.
3. Dall TM, Yang W, Gillespie K, Mocarski M, Byrne E, Cintina I, et al. The Economic Burden of Elevated Blood Glucose Levels in 2017:Diagnosed and Undiagnosed Diabetes, Gestational Diabetes Mellitus, and Prediabetes. Diabetes Care. 2019;42(9):1661–1668. doi:10.2337/dc18-1226.
4. Dwarkanath P, Vinotha P, Thomas T, Joseph S, Thomas A, Shirley G, et al. Relationship of Early Vitamin-D Concentrations and Gestational Diabetes Mellitus in Indian Pregnant Women. Front Nutr. 2019;6:116. doi:10.3389/fnut.2019.00116.
5. Chen YH, Fu L, Hao JH, Yu Z, Zhu P, Wang H, et al. Maternal Vitamin-D deficiency during pregnancy elevates the risks of small for gestational age and low birth weight infants in Chinese population. J Clin Endocrinol Metab. 2015;100(5):1912–1919. doi:10.1210/jc.2014-4407.
6. Ahmadi M, Mirbagheri E. Designing Data Elements and Minimum Data Set (MDS) for Creating the Registry of Patients with Gestational Diabetes Mellitus. J Med Life. 2019;12(2):160–167. doi:10.25122/jml-2019-0011.
7. Abreu LRS, Shirley MK, Castro NP, Euclydes VV, Bergamaschi DP, Luzia LA, et al. Gestational diabetes mellitus, pre-pregnancy body mass index, and gestational weight gain as risk factors for increased fat mass in Brazilian newborns. PLoS One. 2019;14(8):e0221971. doi:10.1371/journal.pone.0221971.
8. Deischinger C, Bastian M, Leitner K, Bancher-Todesca D, Kiss H, Baumgartner-Parzer S, Kautzky-Willer A, Harreiter J. Gremlin-1 in pregnancy and postpartum: relation to the fatty liver index, markers of bone health, glucose metabolism and gestational diabetes mellitus status. Acta Diabetologica. 2023 Dec;60(12):1699-707.
9. Lu B, Zhang L. Association of a history of gestational diabetes mellitus with osteoporosis, bone mineral density, and trabecular bone score in postmenopausal women. Diabetology & Metabolic Syndrome. 2023 Oct 27;15(1):215.
10. Wang Q, Wang C. Comparison of the expression levels of TNF-α, IL-6, hsCRP and sICAM-1 inflammatory factors, bone mineral density and nutritional status between diabetic and normal pregnant women. Cell Mol Biol. 2020;66:132–7.
11. Luo LM, Wu N, Zhang J, Yang D. Maternal vitamin D levels correlate with fetal weight and bone metabolism during pregnancy: a materno-neonatal analysis of bone metabolism parameters. Journal of Perinatal Medicine. 2023 May 25;51(4):538-45.
12. Chen Y, Zeng G, Lu X, Zeng T, Miao Y, Li P, Luo S, Zeng L, Lu R. Association of novel inflammatory markers with gestational diabetes mellitus in a representative US sample: evidence from NHANES 2007-2018.
13. Kubihal S, Gupta Y, Goyal A, Kalaivani M, Tandon N. Bone microarchitecture, bone mineral density and bone turnover in association with glycemia and insulin action in women with prior gestational diabetes. Clinical Endocrinology. 2022 Apr;96(4):531-8.
14. Luo C, Li Z, Lu Y, Wei F, Suo D, Lan S, Ren Z, Jiang R, Huang F, Chen A, Jiang L. Association of serum vitamin D status with gestational diabetes mellitus and other laboratory parameters in early pregnant women. BMC Pregnancy and Childbirth. 2022 May 11;22(1):400.
15. Fan H, Hui L, Yan X, et al. Serum 25 hydroxyvitamin D levels and affecting factors among preconception fertile women. BMC Womens Health. 2020;20:146.
16. Milajerdi A, Abbasi F, Mousavi SM, et al. Maternal vitamin D status and risk of gestational diabetes mellitus: A systematic review and meta-analysis of prospective cohort studies. Clin Nutr. 2021;40(5):2576–86.
17. Yin WJ, Tao RX, Hu HL, et al. The association of vitamin D status and supplementation during pregnancy with gestational diabetes mellitus: a Chinese prospective birth cohort study. Am J Clin Nutr. 2020;111(1):122–30. https://doi.org/10.1093/ajcn/nqz260 PMID: 31625576.
18. Lee YY, Kim HB, Lee JW, Lee GM, Kim SY, Hur JA, et al. The Association between Urine Albumin to Creatinine Ratio and Osteoporosis in Postmenopausal Women with Type 2 Diabetes. J Bone Metab. 2016;23(1):1–7. doi:10.11005/jbm.2016.23.1.1.
19. Arnold DL, Enquobahrie DA, Qiu C, et al. Early pregnancy maternal VD concentrations and risk of gestational diabetes mellitus. Paediatr Perinat Epidemiol. 2015;29:200–10.
20. McIntyre HD, Catalano P, Zhang C, et al. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019;5:47.
21. Damm P, Houshmand-Oeregaard A, Kelstrup L, et al. Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia. 2016;59:1396–9.
22. Corcoy R, Mendoza LC, Simmons D, et al. The DALI VD randomized controlled trial for gestational diabetes mellitus prevention: No major benefit shown besides VD sufficiency. Clin Nutr. 2020;39:976–84.
23. Kramer CK, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, et al. The Relationship Between Parathyroid Hormone and 25-HydroxyVitamin-D During and After Pregnancy. J Clin Endocrinol Metab. 2016;101(4):1729–1736. doi:10.1210/jc.2015-4060.
24. Wang M, Chen Z, Hu Y, et al. The effects of VD supplementation on glycemic control and maternal-neonatal outcomes in women with established gestational diabetes mellitus: A systematic review and meta-analysis. Clin Nutr. 2020;S0261–5614(20):30691–9. https://doi.org/10.1016/j.clnu.2020.12.016.
25. Curtis EM, Parsons C, Maslin K, D’Angelo S, Moon RJ, Crozier SR, Gossiel F, Bishop NJ, Kennedy SH, Papageorghiou AT, Fraser R. Bone turnover in pregnancy, measured by urinary CTX, is influenced by vitamin D supplementation and is associated with maternal bone health: findings from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial. The American Journal of Clinical Nutrition. 2021 Nov 1;114(5):1600-11.
26. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018;19(11):3342. doi:10.3390/ijms19113342.
27. Serra MC, Ryan AS. Influence of Vitamin-D and Parathyroid Hormone on Bone and Metabolic Risk in Women with Previous Gestational Diabetes. Horm Metab Res. 2016;48(8):497–502. doi:10.1055/s-0042-101550.
28. Karamali M, Bahramimoghadam S, Sharifzadeh F, Asemi Z. Magnesium-zinc-calcium-Vitamin-D co-supplementation improves glycemic control and markers of cardiometabolic risk in gestational diabetes:a randomized, double-blind, placebo-controlled trial. Appl Physiol Nutr Metab. 2018;43(6):565–570. doi:10.1139/apnm-2017-0521.
29. Sirico A, Dell'Aquila M, Tartaglione L, Moresi S, Fari G, Pitocco D, et al. PTH-rP and PTH-R1 Expression in Placentas from Pregnancies Complicated by Gestational Diabetes:New Insights into the Pathophysiology of Hyperglycemia in Pregnancy. Diagnostics (Basel) 2021;11(8):1356. doi:10.3390/diagnostics11081356.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Qamar Sajad
Fellow Endocrinology, Endocrine Department, Fatima Memorial Hospital, Lahore, Pakistan
Saira Iqbal
Senior Registrar Obs & Gynae, Lahore General Hospital, Lahore, Pakistan
Sara Khan Niazi
Senior Registrar, Lahore General Hospital, Lahore, Pakistan
Namrah Ahmad
Accidents and Emergency Department, DHQ Hospital, Chiniot, Pakistan
Akashnath Kivalur Ganeshanath
Royal College of Surgeons Ireland- Medical University of Bahrain
Muhammad Awais
Medicine Department, Saidu Teaching Hospital, Swat, Pakistan
Hosam Alazazzi
Royal College of Surgeons in Ireland - Bahrain
Kamel J. K. Walwil
Royal College of Surgeons in Ireland - Bahrain
Jumana Abdelrahman Diab
Royal College of Surgeons in Ireland - Bahrain