title: A study of bone turnover markers in gestational diabetes mellitus.
abstract: BACKGROUND
  Gestational diabetes is defined as carbohydrate intolerance resulting in hyperglycemia of variable severity with the first recognition during pregnancy. Established risk factors for gestational diabetes mellitus (GDM) are maternal age, obesity, family history of diabetes, etc. Vitamin D, parathyroid hormone (PTH), and various other hormones are known for their function in maintaining calcium and phosphorous homeostatic. Furthermore, Vitamin D, PTH serum ionized calcium, and alkaline phosphatase (ALP) have been reported to be altered with glucose homeostasis. The present study compares the bone markers in pregnant women with and without gestational diabetes.
  
  
  METHODS
  This cross-sectional study was conducted at outpatient antenatal check-up clinic and outpatient diabetic clinics at J. N. Medical College and Hospital, Aligarh. One hundred pregnant females, of which fifty with GDM and fifty without GDM, were included in the study from January 2014 to November 2015. Detailed history, physical examination, and anthropometric measurement were done. Bone turnover markers in the form of Vitamin D, parathyroid hormone, serum ionized calcium, and serum ALP were measured in pregnant women who had gestational diabetes which was compared with normal pregnant women.
  
  
  RESULTS
  In our study, the mean age of participate of GDM group was 28.2 ± 3 years, while the mean age group in non-GDM group was 25.44 ± 2.78 years. Ionized calcium in GDM was found to be 4.606 ± 0.354 mEq/L, while in non-GDM, it was 4.548 ± 0.384 mEq/L,P= 0.430. Vitamin D came out to be 21.80 ± 9.48 ng/ml, while it was 32.346 ± 8.37 ng/ml in non-GDM group. Serum PTH in GDM group was 71.436 ± 36.189 pg/ml and 37.168 ± 8.128 pg/ml in nondiabetic gestational group. Serum ALP in GDM group was 9.1 ± 4.56 KA U/dl and 6.98 ± 2.2 KA U/dl in nondiabetic gestational group,P- 0.0038. In GDM group, there was a significant negative linear correlation between PTH and 25-hydroxyvitamin D with research correlation coefficientr= -0.9073,P= 0; there was a significant positive linear correlation coefficient between PTH and ALP with Persian correlation coefficientr= 0.6597,P= 0; there was no statistically significant correlation between PTH and ionized calciumr= 0.1416,P= 0.3267.
  
  
  CONCLUSIONS
  All GDM subjects should ideally be screened for serum calcium, vitamin D, PTH, ALP. If found impaired should immediately be corrected in order to prevent its adverse effects on maternal and fetal outcome. Vitamin D supplementation should ideally be initiated in all GDM females even if the above parameters are not investigated in Indian setup.
authors.affiliation: Rajiv Gandhi Centre for Diabetes and Endocrinology, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India.
authors.forename: Sheelu Shafiq
authors.initials: SS
authors.lastname: Siddiqi
authors.affiliation: Department of Medicine, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India.
authors.forename: Abhijit Girish
authors.initials: AG
authors.lastname: Borse
authors.affiliation: Department of Medicine, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India.
authors.forename: Anjum
authors.initials: A
authors.lastname: Pervez
authors.affiliation: Department of Gynaecology, J. N. Medical College and Hospital, Aligarh, Uttar Pradesh, India.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Anjum
keywords: Alkaline phosphatase; gestational diabetes mellitus; king armstrongs unit