Study of serum zonulin level as an early predictor for gestational diabetes in Egyptian females

Background Gestational diabetes mellitus (GDM) is any degree of abnormal glucose tolerance first recognized in the period of pregnancy, and is detected in the second or third trimester of pregnancy. Its incidence has paralleled the epidemic of obesity. It also leads to increasing the risk for glucose intolerance, macrosomia, and development type 2 diabetes mellitus after pregnancy. Many markers were tested for the ability of early diagnosis of GDM. Zonulin is the basic protein that modulates tight junctions to regulate intercellular passage. Zonulin was found to be positively correlated with increased markers of inflammation and with insulin resistance in nonpregnant populations. Objective To assess serum zonulin level in pregnant women and to evaluate whether it could be an early predictor for development of GDM. Patients and methods The study included 80 pregnant females in the first trimester who were recruited from the obstetrics outpatient clinic at Al-Shatby University Hospital, Alexandria University. Basic data, clinical examination, and laboratory analysis were obtained from all the cases. Serum zonulin level was measured using human enzyme-linked immunosorbent assay kits. Results The median level of early serum zonulin level in the females who did not develop GDM was statistically significantly lower than the levels in the females who developed GDM. The best cut-off point to identify the diabetic females in pregnancy was more than 30 ng/ml with 97.22% sensitivity and 100% specificity. There was a highly significant association between the BMI and risk of GDM. Conclusion This study revealed that gestational diabetes is a common complication of pregnancy in the middle-aged females. Increasing BMI is associated with high incidence of GDM and high serum zonulin level in the first trimester. It is a sensitive predictor for development of GDM later during pregnancy.