Evaluation of Changes in Maternal Blood Sugar and Renal Function Tests during Gestational Period

Authors

  • Satyam Prakash Assistant Professor, Janaki Medical College, Tribhuvan University, Nepal. Department of Biochemistry, Singhania University, Rajasthan, India https://orcid.org/0000-0002-3894-7123
  • Dipendra Raj Pandeya Department of Biochemistry and Genetics, Medical University of the Americas, Nevis, West Indies. Department of Biochemistry, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
  • Jitendra Kumar Singh Deparment of Community Medicine and Public Health, Janaki Medical College, Janakpurdham, Nepal
  • Khushbu Yadav Department of Health Science, Mithila Technical Academy, Janakpurdham, Nepal https://orcid.org/0000-0001-5001-3983
  • Basant Kumar Yadav Department of Surgery, Janaki Medical College, Janakpurdham, Nepal

DOI:

https://doi.org/10.5281/zenodo.4840603

Keywords:

Blood Sugar, Creatinine, Pregnancy, Province 2, Terai, Urea

Abstract

Background and Objectives

The direct effects of altered maternal glucose metabolism and renal impairment from early pregnancy onwards with complications on mother as well as fetal growth and the risks of adverse birth outcomes. It is crucial to understand the biochemical changes to appropriately interpret common laboratory tests for evaluating renal disease and hyperglycemia in women during pregnancy. Thus, the study was focused to estimate the variability in blood glucose and renal functions as well as its association with BMI during pregnancy in Southern Terai of Province No. 2, Nepal.

Materials and Methods

Fasting blood glucose was determined by enzymatic (GOD/POD) method, Serum Urea by Urease-Bertholet’s Method, Serum creatinine by Jaffe’s Reaction Method, and Uric acid by Uricase method. All the biochemical parameters were analyzed using semi-automatic biochemical analyzer (Humalyzer 3500). Statistical analysis of the collected data was carried out using SPSS version 20. The p-value < 0.05 was considered statistically significant.

Results

The  mean with standard deviation for  fasting blood glucose (94.01+30.88; 99.71+23.97; 104.77+21.37) urea (23.22+7.89; 18.22+8.98; 20.64+9.09), creatinine (0.68+0.24; 0.65+0.20; 0.58+0.28), uric acid level with (3.14+0.93, 3.74+0.95, 3.95+0.85) was depicted in 1st, 2nd and 3rd trimester of pregnancy.  Glucose and BMI were positively correlated and highly significant (r=0.191; p<0.01). BMI with urea was negatively correlated and was found to be highly significant(r= -0.196; p<0.01). Also, there was a negative correlation between BMI and Creatinine and was found to be significant (r=-0.132; p<0.01).  But, the association of uric acid was positively correlated and statistically insignificant.

Conclusion

Blood glucose and uric acid gradually start increasing trimester-wise with the advancement of the gestational period. But, the mean urea level was decreased in the 2nd trimester as compared to the 1st and 3rd trimester. Also, small variation for creatinine level was found in different trimesters of pregnancy. 

The association of Glucose, uric acid, and BMI were positively correlated and statistically insignificant whereas Urea and BMI was negatively correlated and highly significant. Also, there was a negative correlation between BMI and Creatinine and was found to be significant.

Downloads

Download data is not yet available.

Author Biographies

Satyam Prakash, Assistant Professor, Janaki Medical College, Tribhuvan University, Nepal. Department of Biochemistry, Singhania University, Rajasthan, India

 

 

 

Dipendra Raj Pandeya, Department of Biochemistry and Genetics, Medical University of the Americas, Nevis, West Indies. Department of Biochemistry, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

 

 

 

Jitendra Kumar Singh, Deparment of Community Medicine and Public Health, Janaki Medical College, Janakpurdham, Nepal

 

 

Khushbu Yadav, Department of Health Science, Mithila Technical Academy, Janakpurdham, Nepal

 

 

Basant Kumar Yadav, Department of Surgery, Janaki Medical College, Janakpurdham, Nepal

 

 

References

Murphy HR, Rayman G, Lewis K et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ. 2008; 337:a1680.

Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER. The effect of real-time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care. 2013; 36(7):1877–1883.

Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: a clinical update.World J Diab. 2015; 6:1065–72.

World Health Organization. Diagnostic criteria and classification of hyperglycemia first detected in pregnancy: a World Health Organization Guideline. Diabetes research and clinical practice. 2014; 103:341–363.

Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of pre-existing diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care. 2008; 31:899–904.

Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138:271–81.

Alfadhli EM. Gestational Diabetes Mellitus. Saudi Medical Journal. 2015; 36:399-406.

Catalano PM, McIntyre HD, Cruickshank JK et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012; 35(4): 780–786.

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes. Diabetes Care. 2002; 25:1862–8.

Kelley KW, Carroll DG and Meyer A. A Review of Current Treatment Strategies for Gestational Diabetes Mellitus. Drugs in Context. 2015; 4: Article ID: 212282.

Siega-Riz AM and King JC. American Dietetic Association; American Society of Nutrition. Position of theAmerican Dietetic Association and American Society for Nutrition: obesity, reproduction, and pregnancy outcomes. J Am Diet Assoc. 2009; 109(05):918–927.

Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestationaldiabetesmellitus. Diabetes Care. 2007; 30(08):2070–2076.

Huda SS, Brodie LE, Sattar N. Obesity in pregnancy: prevalence and metabolic consequences. Semin Fetal Neonatal Med. 2010; 15 (02):70–76.

Damm P, Kuhl C, Bertelsen A, Molsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol. 1992; 167:607–16.

Tobias DK, Hu FB, Forman JP, Chavarro J, Zhang C. Increased risk of hypertensionafter gestational diabetes mellitus: findings from a large prospective cohort study. Diabetes Care. 2011; 34:1582– 1584.

O’Higgins AC, O’Dwyer V, O’Connor C, Daly SF, Kinsley BT, Turner MJ. Postpartum dyslipidaemia in women diagnosed with gestational diabetes mellitus. Ir J Med Sci. 2017; 186:403–407.

Heitritter SM, SolomonCG, MitchellGF, Skali-Ounis N, Seely EW. Subclinical inflammation and vascular dysfunction in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab. 2005; 90:3983–3988.

Sullivan SD, Umans JG, Ratner R. Gestational diabetes: implications for cardiovascular health. Curr Diab Rep. 2012; 12:43–52.

Davison JM. Kidney function in pregnant women. Am J Kidney Dis. 1987; 9: 248–252.

Sturgiss SN, Dunlop W, Davison JM. Renal haemodynamics and tubular function in human pregnancy. Clin Obstet Gynaecol. 1994; 8: 209–234

Jungers P, Houillier P, Forget D et al. Specific controversies concerning the natural history of renal disease in pregnancy. Am J Kidney Dis. 1991; 17: 116–122

Wiggins KJ, Johnson DW. The influence of obesity on the development and survival outcomes of chronic kidney disease. Adv Chronic Kidney Dis. 2005; 12: 49-55.

Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kid¬ney Int. 2008; 73: 19-33.

Mathew AV, Okada S, Sharma K. Obesity related kidney disease. Curr Di¬abetes Rev. 2011; 7: 41-9.

Imbasciati E, Gregorini G, Cabiddu G et al. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis. 2007; 49:753–762.

Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J kidneyDis.1999;33:235–252.

Bar J, Orvieto R, Shalev Y et al. Pregnancy outcome in women with primary renal disease. Isr Med Assoc J. 2000; 2: 178–181

Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med. 1996; 335: 226–232

Sanders CL, Lucas MJ: Renal disease in pregnancy. Obstet Gynecol Clin North Am. 2001; 28: 593–600.

JD Newman, PC Price. In: CA Burtis, ER Ashwood (Eds.), Tietz Fundamentals of Clinical Chemistry, 5th ed., W.B. Saunders Company, Philadelphia, 2001, pp. 419 – 707.

Alper AB, Webber LS, Pridjian G, Mumuney AA, Saade G, Morgan J, Nuwayhid B et al. Estimation of glomerular filtration rate in preeclamptic patients. Am J Prenatal. 2007; 24: 569– 574

Imbasciati EGG, Cabiddu G, Gammaro L, Ambroso G, DelGiudice A and Ravani P. Pregnancy in CKD stages 3 to 5: Fetal and maternal outcomes. Am J Kidney. 2007; 49: 753–762.

Lippi G, Albiero A, Montagnana M, Salvagno GL, Scevarolli S, Franchi M, Guidi GC. Lipid and lipoprotein profile in physiological pregnancy. Clin Lab. 2007; 53(3–4):173–7.

Anjum R, Zahra N, Rehman K, Alam R, Parveen A, Akash M. Comparative analysis of serum lipid profile between normotensive and hypertensive Pakistani pregnant women. J Mol Genet Med. 2013; 7(64):1-5.

Alavian SM, Esmaillzadeh A, Adibi P, Azadbakht L. Dietary quality indices and biochemical parameters among patients with non alcoholic fatty liver disease (NAFLD). Hepat Mon. 2013; 13(7):e10943.

Prakash S and Pandeya RD. Biochemical analysis of Liver Function Test in different trimesters of Pregnancy. International Journal of Biomedical Res. 2019; 10(11): 1-12.

Katharine LC and Richard AL. Renal Physiology of Pregnancy. Adv Chronic Kidney Dis. 2013; 20(3): 209–214.

Matthews A, Haas DM, O'Mathúna DP, Dowswell T. Interventions for nausea and vomiting in early pregnancy (Review). Cochrane Database of Systematic Reviews. 2015(9): Art. No.: CD007575

ADA. 2005. Available at: http://www.diabetes.org/

IOM. Weight Gain during Pregnancy: Re-examining the Guidelines. Institute of Medicine (US) and National Research Council (US) and Committee to Reexamine IOM Pregnancy Weight Guidelines, 2009.

Akinloye O, Obikoya OM, Jegede AI, Oparinde DP and Arowojolu AO. Cortisol plays central role in biochemical changes during pregnancy. Int Journal of Med and Biomed Res. 2013(2)1: 3-12.

Agbecha A, Anwana UI. Serum Uric Acid and Plasma Glucose Levels in Normal Pregnancy. American Journal of Laboratory Med. 2019; 4(1): 24-30.

Zannat MR , Nessa A, Hossain MM, Das RK, Asrin M, Sufrin S, Islam MT, Tajkia T, Nasreen S. Serum Glucose Level in First and Third Trimester of Pregnancy. Mymensingh Med J. 2016; 25(2):211-4.

Seabra G, Saunders C, Padilha CP, Zajdenverg L et al. Association between maternal glucose levels during pregnancy and gestational diabetes mellitus: an analytical cross-sectional study. Diabetology & Metabolic Syndrome. 2015; 7(17):1-7.

Bako IG, Isa AI, Hassan A, Abdulrauf AR, Madugu N. Hauwa Random Blood Glucose Levels Among Pregnant Women Attending Ante-Natal Clinic in Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria. IOSR Journal of Dental and Medical Sciences. 2014; 13(1): 59-63.

Romero J and Spinedi E. Two-hour insulinemia after oral glucose overload and women at risk of pregnancy-induced hypertensive disorders. Hypertension in Pregnancy. 2013; 32(4):355–366.

Feig DS, Shah BR, Lipscombe LL et al. Preeclampsia as a risk factor for diabetes: a population-based cohort study. PLoS Medicine. 2013; 10(4): Article IDe1001425.

Catalano PM. Focus Review on obesity, insulin resistance and pregnancy outcome. Journal of Reproduction. 2010; 140: 365-371.

Nwaoguikpe RN and Uwakwe AA. Blood glucose levels of pregnant women at different gestation periods in Aba area of Abia State of Nigeria. Scientific Research and Essays. 2008; 3(8):373-375.

Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA. Longitudinal changes in insulin release and insulin resistance in non-obese pregnant women. American Journal of Obstetrics and Gynecology. 1991; 165:1667–1672.

Baeyens L, Hindi S, Sorenson LR, and German SM.. β-Cell Adaptation in Pregnancy. Diabetes Obes Metab 2016; 18(Suppl 1):63–70.

Galvan A, Natali A, Baldi S, Frascerra S, Sanna G, Ciociaro D, Ferrannini E. Effect of insulin on uric acid excretion in humans. Am J Physiol. 1995; 268:E1–E5.

Dunlop W. Serial changes in renal hemodynamics during normal human pregnancy. BJOG. 1981; 88:1.

Macdonald HN, Good W. Changes in Plasma Total Protein, Albumine, Urea, and á aminonitrogen Concentration in Pregnancy and the Puerperium. J Obset Gynecol Br Common Wealth. 1971; 78: 912-917.

Korda AR, Horvath JS. Renal Physiology, 2nd ed., London, Black Well Scientific Publication. 1979; 376-409.

Smith HW. The kidney: structure and function in health and disease, Oxford University press, New York, USA 1991; pp. 336.

Brochner-Mortensen J. Current status on assessment and measurement of glomerular filtration rate. Clin Physiol. 1985; 5: 1-17.

Patricia OO, Christiana AB, and Raphael JO. Evaluation of changes in renal functions of pregnant women attending antenatal clinic in Vom Plateau State, North- Central Nigeria Scholars Research Library. Archives of Applied Science Research. 2013; 5 (4):111-116.

Mitchell HR and Kline W. Core curriculum in nephrology, Renal Function Testing. Am J Kidney Dis. 2006; 47:174–183.

Branten AJ, Vervoort G, Wetzels J. Serum creatinine is a poor marker of GFR in nephrotic syndrome. Nephrol Dial Transplant. 2005; 20:707–711.

Dennen FR, Joel MO, Karasik SK, Egan LV, Paredes NR, Diaz FAO. Comparison of hemodynamic, biochemical and hematological parameters of healthy pregnant women in the third trimester of pregnancy and the active labor phase. BioMed Central Pregnancy and Childbirth. 2011; 16(4):234-37.

Asif N, Hassan K, Mahumud S, Zaheer HA, Naseem L, Zafer T, Shams R. Comparison of serum ferritin level in three trimesters of pregnancy and their correlation with increasing gravidity. International Journal of Pathol. 2007; 5(1): 26-30.

Al-Tawil RS. Biochemical and hematological profile of normal pregnant women in Gaza Governorate, Gaza strip. Dissertation Master of biological sciences. Medical Technology. 2013; Page 1-69.

Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ. 2008; 26; 336(7637): 211–215.

Conrad KP. Maternal vasodilation in pregnancy: the emerging role of relaxin. Am J Physiol Regul Integr Comp Physiol. 2011; 301(2): R267–R275.

Ogueh O, Clough A, Hancock M, Johnson MR. A longitudinal study of the control of renal and uterine hemodynamic changes of pregnancy. Hypertens Pregnancy. 2011 30(3):243–259.

Lafayette RA, Hladunewich MA, Derby G, Blouch K, Druzin ML, Myers BD. Serum relaxin levels and kidney function in late pregnancy with or without preeclampsia. Clin Nephrol. 2011; 75(3):226–232.

Downloads

Published

2021-05-08

How to Cite

Satyam Prakash, Pandeya, D. R., Singh, J. K., Yadav, K., & Yadav, B. K. (2021). Evaluation of Changes in Maternal Blood Sugar and Renal Function Tests during Gestational Period. South East Asia Journal of Medical Sciences, 5(1), 1–8. https://doi.org/10.5281/zenodo.4840603

Issue

Section

Original research