Early intercession and appropriate intervention in patients with GDM or at increased hazard for developing of GDM will helpful in forestalling the inauspicious maternal and foetal result and besides protect them from long term complications. GDM induces similar biochemical alterations that are produced by DM outside gestation. Hyperuricemia has been used as a marker in the anticipation of type 2 DM. Several surveies have shown the association of hyperuricemia with GDM.
This survey conducted in Mahatma Gandhi Medical Collage and Research Institute, Pondicherry, a third attention centre between November 2010 and May 2012, was undertaken to happen out the association of elevated first trimester uric acid with development of GDM. A sum of 70 pregnant adult females were included and assorted parametric quantities were studied.
The maternal age in this survey ranged between 18 and 35 old ages. The average age was 25.33±4.47. Majority ( 48.6 % ) of them were between 21 to 25 old ages of age. There was no statistical significance between age of the pregnant adult females studied and their serum uric acerb degree at & A ; lt ; 15 hebdomads of gestation ( P = 0.704 ) . There was no important correlativity between the age group and GDM ( P = 0.643 ) .
The incidence of GDM with relation to age was low in this survey population as bulk of the topics were in the low hazard age group for the development of GDM. Lao TT et Al and Khatun N et Als have shown that advanced maternal age is a known hazard factor for the gestation complications including preterm bringing, low birth weight, perinatal decease, GDM, gestational high blood pressure, placenta previa, intra-uterine growing deceleration ( IUGR ) etc.80, 81Yet another ground for lower incidence of GDM may be due to the smaller survey population.
In this survey 51.4 % were primigravida and 48.6 % were multigravida. There was no difference between the para and serum uric acid degrees at & A ; lt ; 15 hebdomads of gestation ( P=0.538 ) . The same has been shown by Dunlop W et Al in 2005 in their survey ; ( Effect of nephritic handling of uric acid in gestation ) that there was no difference detected in the alterations seen in serum uric acid degrees between gravida I and multigravida. A Survey by Nagalakshmi C.S et Al has shown an increased hazard of developing GDM among primigravida.77 Al-Rowaily MA et Als have shown in their survey that multiparous adult females were 8.29 times more likely to hold GDM than nulliparous women.78 However, after accommodation for maternal age and history of abortion, nulliparous adult females were 2.95 times more likely to develop GDM than parous adult females. In this survey there was no difference in the incidence of GDM in relation to the para of the population studied ( P = 0.870 ) , the hazard of development of GDM is about equal in both primi and multiparous adult females. This may be attributed to the lesser population of pregnant adult females studied and the diagnostic trial used for testing ( one measure trial as per DIPSI ) .
80 % of pregnant adult females studied were non corpulent ( BMI & A ; lt ; 30kg/m2 ) and bulk of them had their serum uric acid degree in the 2nd and 3rd quartile. 20 % were corpulent with their serum uric acid degree in the 3rd quartile followed by 2nd quartile. This distribution has shown that there is a relative addition in the serum uric acid with addition in the BMI but non statistically important. There has besides been noted a important correlativity between BMI and hazard of development of GDM ( P = 0.001 ) .
In this survey those topics who had a normal BMI had elevated degrees of uric acid at & A ; lt ; 15 hebdomad of gestation which was associated with increased degrees of blood glucose degree at 24 to 28 hebdomads of gestation. These findings suggested though BMI is significantly associated with development of GDM, the association between elevated uric acid degrees at early trimester and hazard of development of GDM was independent of BMI. Similar statement was given by Laughon. KS et Al that although uric acid was strongly associated with organic structure mass index, the hazard of gestational diabetes was increased among adult females with elevated first trimester uric acerb independent of BMI.14
Majority of the topics had no important household history of DM though they had higher degrees blood glucose at 24 to 28 hebdomads. There was a moderate significance noted between the household history of DM and one measure trial ( P =0.048 ) . Similar findings were noted in yet another survey by Ratnakaran R et Al where they have shown that established hazard factors for GDM were relevant in adult females with household history of DM but may non be the chief determiners of gestational hyperglycemia in adult females without important household history.79 The serum uric acid degrees at & A ; lt ; 15 hebdomads of gestation were non related to the household history of DM ( p = 0.236 ) though the serum uric acid degrees of 50 % of those with important household history were in the 3rd quartile.
The topics with uric acid in the first quartile had a normal one measure trial value ( & A ; lt ; 120mg/dl ) . In the 2nd quartile 27.1 % had gestational glucose intolerance i.e. one measure trial of 120 to 140 mg/dl and 5.4 % had GDM ( & A ; gt ; 140mg./dl ) . In the 3rd quartile 81.3 % had gestation glucose intolerance and 12.5 % had GDM. This distribution has revealed that higher degree of serum uric acid in the first trimester were strongly associated with increased degrees of one measure trial ( 120 to 140mg/dl ) i.e Gestational Glucose Intolerance ( GGI ) ( P= & A ; lt ; 0.001 ) though merely 5.7 % were diagnosed to hold GDM.
The same was stated by Langhon KS et Al foremost spare hyperuricemia is associated with increased hazard for development of GDM.14Wolak T EL Al besides have shown that UA degrees in the highest quartile of the normal scope during the first 20 hebdomads of gestation are associated with higher hazard for the development of GDM and mild preeclampsia.75 Zhou J et Al showed in their survey measured lipoids and uric acid concentrations in 1000 healthy nulliparous adult females at 20 hebdomads of gestation and showed that hyperuricemic adult females experienced a 1.99-fold hazard for pre-eclampsia and a 2.34-fold hazard for GDM.76
Our findings are consistent with the association of uric acid with insulin opposition in the non-pregnant population10 and besides the early gestation uric acid concentrations in our survey were similar to those reported by others.
There was a important correlativity between the uric acid degrees at & A ; lt ; 15 hebdomads and at 24 to 28 hebdomads ( P= & A ; lt ; 0.001 ) .Majority of the topics did non hold any alterations between serum uric acid degrees at & A ; lt ; 15 hebdomads and at 24 to 28 hebdomads of gestation. They either had same degrees or little addition in the degree. This could hold been due do the normal alterations that occur in uric acid degrees in gestation as stated by Boyle JA et Al that the uric acid degree autumn during the early and mid-trimester rises to normal values in late pregnancy.73
There was no important correlativity between uric acid degrees at 24 to 28 hebdomads and hazard of development of GDM ( P=0.094 ) . Though there is a important correlativity between serum uric acid at & A ; lt ; 15 hebdomads and at 24 to 28 hebdomads, serum uric acid at & A ; lt ; 15 hebdomads of gestation is a better forecaster of GGI and GDM than uric acid degrees at 24 to 28 hebdomads of gestation ( Pearson ‘s correlativity = 0.735 ) . This is due to the fact that serum uric acid degrees usually falls in early trimester and mid-trimester and rises to normal values in late gestation. Elevated or higher normal degrees of serum uric acid in the first trimester may be associated with a preexistent metabolic mental unsoundness which leads to hapless maternal physiological versions and predisposes the pregnant adult females to development of gestation complications like GDM, pre eclampsia etc.
The sample size of this survey was less due to the limited survey period. In this survey bulk of topics with high first trimester uric acid had one measure trial value of 120 to 140mg/dl ( GGI ) . Follow up of these patients after 28 hebdomads of gestation was non done to happen out whether they developed GDM subsequently in the gestation.