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Association of High Serum Ferritin Level in Early Pregnancy with Development of Gestational Diabetes Mellitus- A Prospective Observational Study

Introduction: Gestational Diabetes Mellitus (GDM) has a negative impact on maternal and perinatal outcome and several long-term complications. The evidence from different experimental studies have shown that high serum ferritin concentration can lead to pancreatic β-cell dysfunction and impaired glucose metabolism leading to GDM. Aim: To determine the association of increased serum ferritin level in first trimester and GDM in course of pregnancy. Materials and Methods: A prospective observational study was conducted in 204 women in Institute of Post Graduate Medical Education and Research and SSKM Hospital, West Bengal, India, during the period from January 2015 to December 2015. The blood samples were collected and screened for GDM by Oral Glucose Tolerance Test (OGTT) at the beginning of the study and then assayed for serum ferritin level who were screened negative. The women were divided into four groups by quartiles of serum ferritin levels (Q1 to Q4). Then they were followed-up with OGTT at 24-28 weeks and again at 32-34 weeks. Statistical analysis was done by using paired t-test, Chi-square test and Fisher’s- exact test. Results: The participants had an average serum ferritin concentration of 77.44 ng/mL. GDM prevalence within each serum ferritin quartile was 7.84%, 11.76%, 19.61% and 23.53% respectively (p-value=0.016). The odds ratio for GDM in the ferritin Q2-Q4 was 1.57 (CI=0.41-5.92), 2.87 (CI=0.84-9.83) and 3.62 (CI=1.08-12.11) compared with Q1, respectively. In addition, primigravida and women with high Haemoglobin (Hb) level (>13 gm%) have an increased risk of developing GDM. Conclusion: Elevated serum ferritin level is associated with increased incidence of GDM irrespective of other risk factors. Iron supplementation should therefore be individualised based on serum ferritin in early pregnancy to minimise the risk of GDM.