Association Between Gestational Diabetes Mellitus and Maternal Bone Metabolism: A Cross-Sectional Study
Gestational Diabetes Mellitus and Maternal Bone Metabolism
DOI:
https://doi.org/10.54393/pbmj.v9i1.1323Keywords:
Osteocalcin, Gestational Diabetes Mellitus, Bone-Specific Alkaline Phosphatase, BiomarkersAbstract
Gestational diabetes mellitus (GDM) is a prevalent metabolic condition complicated by pregnancy that relates to poor maternal and infant outcomes. The connection between glucose intolerance and a shift in the bone metabolism in pregnant women is a developing field whose applicability of bone turnover measurements in GDM is yet to be determined. Objectives: To determine the relationship between GDM and maternal bone turnover indices and GDM predictors. Methods: The groups of pregnant women with GDM and those without diabetes were 120 and 60, respectively, in the second trimester of this cross-sectional study. Serum osteocalcin, a cross-linked C-telopeptide of type I collagen (CTX), and bone-specific alkaline phosphatase (B-ALP) were measured. It comprised a series of clinical, biochemical, and obstetric data, such as the body mass index (BMI) and insulin resistance, which was determined using the homeostasis model assessment (HOMA-IR). ROC curve analysis and logistic regression analysis were carried out. Results: GDM women were significantly older women with much higher BMI and HOMA-IR compared to controls (p<0.001). B-ALP level of the GDM group was substantially low (p<0.05), and CTX did not change. The results of the logistic regression analysis identified the independent predictors of GDM as osteocalcin, BMI, and HOMA-IR (OR: 0.565; 0.442-0.722; OR: 1.309; 1.062-1.614; OR: 2.289; 1.090-4.805). The discriminative power (AUC = 0.905; p<0.001) was found to be powerful. Conclusions: GDM is also related to bone metabolism, osteocalcin, BMI, and HOMA-IR are independent predictors.
References
Sweeting A, Wong J, Murphy HR, Ross GP. A Clinical Update on Gestational Diabetes Mellitus. Endocrine Reviews. 2022 Oct; 43(5): 763-793. doi: 10.1210/endrev/bnac003. DOI: https://doi.org/10.1210/endrev/bnac003
Williams R, Karuranga S, Malanda B, Saeedi P, Basit A, Besançon S et al. Global and Regional Estimates and Projections of Diabetes-Related Health Expenditure: Results from The International Diabetes Federation Diabetes Atlas. Diabetes Research and Clinical Practice. 2020 Apr; 162: 1-6. doi: 10.1016/j.diabres.2020.108072. DOI: https://doi.org/10.1016/j.diabres.2020.108072
Gao C, Sun X, Lu L, Liu F, Yuan J. Prevalence of Gestational Diabetes Mellitus in Mainland China: A Systematic Review and Meta‐Analysis. Journal of Diabetes Investigation. 2019 Jan; 10(1): 154-62. doi: 10.1111/jdi.12854. DOI: https://doi.org/10.1111/jdi.12854
He Y, Ching Wan Ma R, McIntyre HD, Sacks DA, Lowe J et al. Comparing IADPSG and NICE Diagnostic Criteria for Gestational Diabetes Mellitus in Predicting Adverse Pregnancy Outcomes. Diabetes Care. 2022 Sep; 45(9): 2046-2054. doi: 10.2337/dc22-0579. DOI: https://doi.org/10.2337/dc22-0579
Cui L, Gao Y, Sun R, Li Z, Zhang Z, Ji L et al. Mediating Effect of Osteocalcin Underlying the Link Between Insulin-Like Growth Factor-I And Gestational Diabetes Mellitus. BioMed Central Pregnancy and Childbirth. 2025 May; 25(1): 579. doi: 10.1186/s12884-025-07689-8. DOI: https://doi.org/10.1186/s12884-025-07689-8
Karsenty G. Osteocalcin: A Multifaceted Bone-Derived Hormone. Annual Review of Nutrition. 2023 Aug; 43(1): 55-71. doi: 10.1146/annurev-nutr-061121-091348. DOI: https://doi.org/10.1146/annurev-nutr-061121-091348
Fernandes TA, Gonçalves LM, Brito JA. Relationships Between Bone Turnover and Energy Metabolism. Journal of Diabetes Research. 2017 Jun; 2017(1): 1-11. doi: 10.1155/2017/9021314. DOI: https://doi.org/10.1155/2017/9021314
Zanatta LC, Boguszewski CL, Borba VZ, Kulak CA. Osteocalcin, Energy, and Glucose Metabolism. Arquivos Brasileiros de Endocrinologia e Metabologia. 2014 Jul; 58: 444-451. doi: 10.1590/0004-2730000003333. DOI: https://doi.org/10.1590/0004-2730000003333
Schini M, Vilaca T, Gossiel F, Salam S, Eastell R. Bone Turnover Markers: Basic Biology to Clinical Applications. Endocrine Reviews. 2023 Jun; 44(3): 417-473. doi: 10.1210/endrev/bnac031. DOI: https://doi.org/10.1210/endrev/bnac031
Brescia V, Lovero R, Fontana A, Zerlotin R, Colucci SC, Grano M et al. Reference Intervals of the Bone Turnover Markers in Children and Adolescents: A Proposal for Effective Use. Biomedicines. 2024 Dec; 13(1): 34. doi: 10.3390/biomedicines13010034. DOI: https://doi.org/10.3390/biomedicines13010034
Gong Y, Li N, Lai M, Fang F, Yang J, Kang M et al. Consistently Low Levels of Osteocalcin from Late Pregnancy to Postpartum are Related to Postpartum Abnormal Glucose Metabolism in Gestational Diabetes Mellitus Patients. Frontiers In Endocrinology. 2022 Mar; 13: 1-7. doi: 10.3389/fendo.2022.803624. DOI: https://doi.org/10.3389/fendo.2022.803624
Usman TO, Chhetri G, Yeh H, Dong HH. Beta-Cell Compensation and Gestational Diabetes. Journal of Biological Chemistry. 2023 Dec; 299(12): 1-10. doi: 10.1016/j.jbc.2023.105405. DOI: https://doi.org/10.1016/j.jbc.2023.105405
Nowicki JK and Jakubowska-Pietkiewicz E. Osteocalcin: Beyond Bones. Endocrinology and Metabolism. 2024 Jun; 39(3): 399-406. doi: 10.3803/EnM.2023.1895. DOI: https://doi.org/10.3803/EnM.2023.1895
Tiwari R, Singh S, Bajpai M, Verma N, Verma S. Impact of Osteocalcin on Glycemic Regulation and Insulin Sensitivity in Type 2 Diabetes Mellitus Patients. Cureus. 2024 Oct; 16(10): 1-8. doi: 10.7759/cureus.71675. DOI: https://doi.org/10.7759/cureus.71675
Nishiura M, Watanabe H, Nakanishi-Kimura A, Hoshi-Numahata M, Nishimoto S, Ueno F et al. Bone Metabolic Changes and Osteoporosis During Pregnancy and Lactation: A View from Dental Medicine. International Journal of Molecular Sciences. 2025 Oct; 26(21): 1-15. doi: 10.3390/ijms262110476. DOI: https://doi.org/10.3390/ijms262110476
Riquelme-Gallego B, García-Molina L, Cano-Ibáñez N, Sánchez-Delgado G, Andújar-Vera F, García-Fontana C et al. Circulating Undercarboxylated Osteocalcin as an Estimator of Cardiovascular and Type 2 Diabetes Risk in Metabolic Syndrome Patients. Scientific Reports. 2020 Feb; 10(1): 1840. doi: 10.1038/s41598-020-58760-7. DOI: https://doi.org/10.1038/s41598-020-58760-7
Lin X, Brennan-Speranza TC, Levinger I, Yeap BB. Undercarboxylated Osteocalcin: Experimental and Human Evidence for a Role in Glucose Homeostasis and Muscle Regulation of Insulin Sensitivity. Nutrients. 2018 Jun; 10(7): 847. doi: 10.3390/nu10070847. DOI: https://doi.org/10.3390/nu10070847
Wongdee K and Charoenphandhu N. Osteoporosis in Diabetes Mellitus: Possible Cellular and Molecular Mechanisms. World Journal of Diabetes. 2011 Mar; 2(3): 41. doi: 10.4239/wjd.v2.i3.41. DOI: https://doi.org/10.4239/wjd.v2.i3.41
Yang J, Zhang Y, Liu X, Chen B, Lei L. Effect of Type 2 Diabetes on Biochemical Markers of Bone Metabolism: A Meta-Analysis. Frontiers in Physiology. 2024 Jul; 15: 1-12. doi: 10.3389/fphys.2024.1330171. DOI: https://doi.org/10.3389/fphys.2024.1330171
Hwang YC, Jeong IK, Ahn KJ, Chung HY. Circulating Osteocalcin Level is Associated with Improved Glucose Tolerance, Insulin Secretion, and Sensitivity Independent of the Plasma Adiponectin Level. Osteoporosis International. 2012 Apr; 23(4): 1337-1342. doi: 10.1007/ DOI: https://doi.org/10.1007/s00198-011-1679-x
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