Elevated first trimester serum ferritin concentrations is associated with subsequent gestational diabetes. — The Association Specialists
  1. Schedule
  2. Biomarkers in Clinical Medicine
  3. Elevated first trimester serum ferritin concentrations is associated with subsequent gestational diabetes.

Elevated first trimester serum ferritin concentrations is associated with subsequent gestational diabetes. (430)

Amina Z. Khambalia 1 , Christine L. Roberts 1 , Aidan McElduff 2 , Antonia W. Shand 1 2 3 , Vitomir Tasevski 4 , Natasha Nassar 1
  1. Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
  2. Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia
  3. Department of Obstetrics and Gynaecology , Royal Hospital for Women, Randwick, NSW, Australia
  4. Fetal Maternal Medicine , Royal North Shore Hospital, Sydney, NSW, Australia

Background: High serum ferritin (SF) levels in pregnancy have been associated with gestational diabetes (GDM) (1); however it is uncertain whether elevated SF reflects increased body iron or an inflammatory response to prevent invading pathogens from ingesting iron (2).

Aim: To determine whether first trimester SF is associated with subsequent GDM in the absence of overt inflammation.

Methods:  Serum samples for women with first trimester Down syndrome screening in 2007 at a state laboratory were linked to birth and hospital discharge records, NSW. Gestational age and body weight (kg) at testing were derived from laboratory data, age, parity, country of birth, multiple pregnancy and smoking from birth records and GDM diagnosis from hospital data. Blood was analysed for iron stores (SF; µg/L), tissue iron (transferrin receptor, TfR; nmol/L),  inflammation (C-reactive protein, CRP; mg/L) and vitamin D (25(OH)D; nmol/L). Women with CRP >5 or Type 1 or 2 diabetes were excluded. Odds ratios (OR) for GDM were adjusted for age, parity, country of birth, multiple pregnancy, smoking, gestational age, body weight and 25(OH)D concentrations. Receiver operating characteristic (ROC) analysis was used to examine the performance of SF as a predictor for GDM.

Results: Of 2,765 pregnancies, 103 (3.7%) developed GDM. Compared to no GDM, GDM pregnancies had significantly higher median SF (26.3 vs. 34.0, p= 0.0004); but not TfR (14.9 vs. 15.5, p=0.22) concentrations.  The likelihood of developing GDM was statistically significant for SF (OR: 1.60; 95% CI: 1.18, 2.18), adjusting for all available factors.  The area under the curve for SF was 0.61.

Conclusions: In absence of overt inflammation, elevated iron stores were associated with GDM; however ferritin has poor accuracy as a diagnostic test for GDM.  Better understanding of why SF levels are elevated may be important for identifying high-risk pregnancies for GDM.

  1. Chen X, Scholl TO, Stein TP. Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: The Camden study. Diabetes Care 2006 5:1077-82.
  2. Cairo G, Recalcati S, Mantovani A, Locati M. Iron trafficking and metabolism in macrophages: contribution to the polarized phenotype. Trends Immunol. 2011 32: 241-7.