Serum ferritin level and its association with gestational diabetes mellitus in pregnancy
Keywords:Gestational diabetes, Serum ferritin, Haemoglobin, Inflammation, Acute phase reactant
Background: Short term as well as long term effects of GDM on both the mother and the child are preventable if screening and diagnosis are done at an early stage. Efforts have been made to try and identify clinical and biochemical markers that could predict GDM. Ferritin, an acute phase reactant is one such protein. This study was undertaken to know if there is an association between serum ferritin level and GDM in pregnancy.
Methods: A prospective study conducted in the Department of OBG, ESIC-MC-PGIMSR from January 2020 to June 2021. 388 gravid women satisfying the inclusion criteria were enrolled for the study after obtaining an informed written consent and maternal serum ferritin was assayed between 24 to 28 weeks of gestation and was statistically analysed.
Results: Both group demographic characters were matched and they were also matched for Hb% thereby eliminating anaemia, a confounding factor for the study. The mean serum ferritin level in GDM group was 46.4 ng/ml and in non-GDM group was 37.3 ng/ml (p<0.001). With ROC (Receiver operator characteristics curve) the cut off value of serum ferritin is 34.7 ng/ml with 95% CI, with sensitivity of 71% and specificity of 63%.
Conclusions: In this study S. ferritin value of >34.7 ng/ml at 24-28 weeks of gestation, there is 63% risk of developing GDM. Thus, we conclude that elevated serum ferritin level could be used as a biochemical marker for prediction of GDM.
Gestational diabetes mellitus. Available at: https://www.who.org. Accessed on 20 February 2023.
Cunningham W. Obstetrics. 24rd ed. USA: Mc-Graw Hill; 2014:1136-8.
Sumathy V, Kong M, Zhong C, Gao Q, Zhou X, Chen R, et al. Association of elevated mid-pregnancy maternal plasma ferritin concentrations and triglyceride concentrations with the risk of gestational diabetes mellitus: A prospective cohort study. Diab Metab Res Rev. 2023;23:e3637.
Poonguzhalai S, Kalyanikutty KP. The relationship between serum ferritin and gestational diabetes mellitus A cross sectional study. IJOG. 2019;6:342-5.
Rawal S, Hinkle SN, Bao W, Zhu Y, Grewal J, Albert PS, et al. A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort. Diabetologia. 2017;60(2):249-57.
Soheilykhah S, Mojibian M, Jannati Moghadam M. Serum ferritin concentration in early pregnancy and risk of subsequent development of gestational diabetes: A prospective study. Int J Reprod Biomed. 2017; 15(3):155-60.
Bowers KA, Olsen SF, Bao W, Halldorsson TI, Strøm M, Zhang C. Plasma Concentrations of Ferritin in Early Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus in Women in the Danish National Birth Cohort. J Nutr. 2016;146(9):1756-61.
Goldenberg RL, Tamura T, DuBard M, Johnston KE, Copper RL, Neggers Y. Plasma ferritin and pregnancy outcome. Am J Obstet Gynecol 1996;175:1356-9.
Scholl TO. High third-trimester ferritin concentration: association with very preterm delivery, infection, and maternal nutritional status. Obstet Gynecol. 1998;92: 161-6.
Entman SS, Richardson LD, Killam AP. Elevated serum ferritin in the altered ferrokinetics of toxemia of pregnancy. Am J Obstet Gynecol. 1982;144:418-22.
Raman L, Pawashe AB, Yasodhara P. Hyperferritinemia in pregnancy-induced hypertension an eclampsia. J Postgrad Med. 1992;38:65-7.
Prasad DKV, Sheela P, Kumar AN, Kumar NL, Deedi MK, Madhulatha D. Iron level increase in serum from gestational diabetes mellitus mother in coastal area of Andra Pradesh: prospective study. J Diab Metab. 2013; 23:32-8.
Lao TT, Chan PL, Tam KF. Gestational diabetes mellitus in the last trimester: a feature of maternal iron excess. Diab Med. 2001;18:218-23.
Johnston KE, Cliver SP, Hickey CA. Serum ferritin- a predictor of early spontaneous preterm delivery. Obstet Gynecol. 1996;87:360-5.
Islam N, Chowdhury SB. Serum ferritin and Gestational diabetes mellitus; A case control study. Ibrahim Card Med J. 2011;1(2):15-9.