Association between Serum Homocysteine Levels and Gestational Diabetes Mellitus

Background: Gestational diabetes mellitus (GDM) is a prevalent metabolic condition during pregnancy, linked to negative outcomes for both mother and fetus. Homocysteine (Hcy), a sulfur-based amino acid, has been associated with insulin resistance, endothelial impairment, and oxidative stress. Increased maternal homocysteine levels might play a role in the onset of GDM, yet the evidence varies among different populations. Objective: To assess the association between serum homocysteine levels and gestational diabetes mellitus in pregnant women and evaluate its potential as a predictive biomarker. Methods: This case-control study was conducted at the Department of Obstetrics & Gynecology, Sir Salimullah Medical College Mitford Hospital over 12 months. Eighty pregnant women in their second or third trimester were enrolled, comprising 40 GDM cases (Group A) and 40 gestational-age- and BMI-matched controls without GDM (Group B). Serum homocysteine levels were measured using chemiluminescent microparticle immunoassay (CMIA). Statistical analysis included independent samples t-test, chi-square test, Pearson’s correlation, and odds ratio calculation, with p < 0.05 considered significant. Results: Mean serum homocysteine levels were significantly higher in the GDM group compared to controls (11.7 ± 5.2 µmol/L vs. 5.5 ± 1.4 µmol/L, p < 0.001). Women with homocysteine levels >6.38 µmol/L were 2.31 times more likely to develop GDM (95% CI: 1.591–3.351). Serum homocysteine was positively correlated with both fasting (r = 0.610, p < 0.001) and 2-hour postprandial glucose levels (r = 0.632, p < 0.001). Baseline characteristics, including age, trimester, and gravida status, were similar between groups. Conclusion: Elevated serum homocysteine levels are significantly associated with GDM and correlate positively with maternal glucose levels. Hyperhomocysteinemia may serve as an independent risk factor for GDM, and monitoring homocysteine could facilitate early identification and management of at-risk pregnant women, potentially improving maternal and fetal outcomes.