Serum Uric Acid Levels in the First Trimester of Pregnancy and the Development of Gestational Diabetes Mellitus: A Prospective Cohort Study.

INTRODUCTION: Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy associated with adverse maternal and fetal outcomes; early identification of at-risk women is essential for timely intervention. Serum uric acid (SUA) has emerged as a potential biomarker for predicting glucose intolerance during pregnancy. This study aimed to evaluate the association between first-trimester SUA levels and the subsequent development of GDM. MATERIALS AND METHODS: A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care teaching hospital from January 2024 to December 2025. A total of 212 non-diabetic antenatal women in their first trimester were enrolled using consecutive sampling. Baseline clinical assessment, anthropometric measurements, and SUA estimation were performed at enrolment using a fully automated biochemical analyzer (Dimension RXL Max, Siemens Healthineers, Erlangen, Germany). Participants were followed until 24-28 weeks of gestation and screened for GDM using the Diabetes in Pregnancy Study Group of India (DIPSI) criteria following a 75 g oral glucose challenge. Statistical analysis was performed using SPSS v25.0 (IBM Corp., Armonk, NY). Independent t-test, chi-square test, Pearson correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analyses were used. RESULTS: Of the 212 participants, 44 (20.8%) developed GDM. Women who developed GDM had significantly higher first-trimester SUA levels (5.4 ± 0.9 mg/dL vs. 3.8 ± 0.8 mg/dL; p < 0.001). SUA showed a positive correlation with second-trimester post-glucose blood sugar (r = 0.52, p < 0.001). The unadjusted odds ratio for GDM with SUA >4 mg/dL was 12.0 (95% CI: 4.8-30.0; p < 0.001). On multivariate logistic regression, elevated SUA (adjusted odds ratio [AOR] = 3.6, 95% CI: 1.8-7.1, p < 0.001), BMI ≥25 kg/m² (AOR = 2.9), and positive family history of diabetes (AOR = 2.4) were independent predictors. ROC analysis demonstrated an area under the curve (AUC) of 0.87 at a cut-off of 4.1 mg/dL (sensitivity 80%, specificity 70%). CONCLUSIONS: Elevated first-trimester SUA levels are significantly associated with, and independently predict, GDM. SUA may serve as a simple, inexpensive, and widely available biomarker for early identification of women at increased risk of GDM. Large-scale multicenter studies are warranted to validate these findings and establish ethnicity-specific thresholds.