Prevalence of Gestational Diabetes Mellitus in Women Presenting with Intrahepatic Cholestasis of Pregnancy

Abstract

Objective: The objective of this study is to evaluate the prevalence and associated factors of GDM in women who present with ICP.

Methodology:  This observational study was conducted retrospectively over a period of three years from January 2021 to December 2023 in Fazaia Postgraduate medical institute Islamabad. Medical records of all the women who diagnosed with ICP during their second or third trimester were reviewed. ICP was diagnosed based on pruritus without rash and elevated serum total bile acids (>10 µmol/L). Women with pre-existing diabetes, chronic liver disease, multiple gestations, or other metabolic disorders were excluded. GDM was diagnosis was made on the basis of International Association of Diabetes and Pregnancy Study Groups criteria using a 75-g oral glucose tolerance test at 24–28 weeks of gestation. Logistic regression analysis was performed to identify independent predictors.

Results: There were 1,370 women with ICP in total. The mean age of the mothers was 29.4 ± 4.7 years. The prevalence of GDM was 22.8% (n=312). GDM was significantly more frequent in women with moderate-to-severe ICP (33.7% vs 17.6%; p<0.001). The mean levels of serum bile acid (48.5 ± 34.7 vs 21.4 ± 15.2 µmol/L; p<0.001) were significantly higher in women with GDM. Elevated bile acids (AOR 2.21), maternal age >30 years (AOR 1.58), and BMI ≥25 kg/m² (AOR 1.83) were independent predictors.

Conclusion: GDM is prevalent in ICP-affected women and has a strong relationship with increased BMI, advanced maternal age, and elevated bile acids. Early screening and targeted management are recommended.

Key Words: Intrahepatic cholestasis of pregnancy, Gestational diabetes mellitus, Serum bile acids, Body mass index.