A Comparison of Serum Magnesium Level in Pregnant Women with and without Gestational Diabetes Mellitus (GDM)

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1 Brief Report J Bbol Univ Med Sci Vol 18, Issu 12; Dec P:71-75 A Comprison of Serum Mgnesium Level in Pregnnt Women with nd without Gesttionl Dibetes Mellitus (GDM) Z. Bouzri (MD) 1, F. Elmi(MD) 2, S. Esmeilzdeh (MD) 3, Sh. Yzdni(MD) 3, M. Neimird(MSc) 4, M.R. Ndimi Brforoush(MSc) 5, Z. Mozzezi(MD) 6, K. Hjin(PhD) 7 1. Cellulr & Moleculr Biology Reserch Center, Helth Reserch Institute, Bbol of University of Medicl Science, Bbol, I.R.Irn 2. Student Committee Reserch, Bbol University of Medicl Sciences, Bbol, I.R.Irn 3. Fteme Zhr Fertility & Infertility Reserch Helth Center, Helth Reserch Institute, Bbol of University of Medicl Science, Bbol, I.R.Irn 4. Clinicl Reserch Development Center, Aytollh Rouhni Hospitl, Bbol University of Medicl Sciences, Bbol, I.R.Irn. 5. Islmic Azd University of Dmghn, Dmghn, I.R.Irn 6. Deprtment of Internl Medicine, Bbol University of Medicl Sciences, Bbol, I.R.Irn 7. Deprtment of Sttistic nd Epidemiology, Bbol University of Medicl Sciences, Bbol, I.R.Irn J Bbol Univ Med Sci; 18(12); Dec 2016; PP: 71-5 Received: Nov 3 th 2015, Revised: Dec 7 th 2015, Accepted: Nov 26 th ABSTRACT BACKGROUND AND OBJECTIVE: Intrcellulr mgnesium is cofctor for severl enzymes in crbohydrte metbolism. The im of this study is to demonstrte the role of mgnesium s n effective nd n underlying fctor in disrupted glucose metbolism mong pregnnt women with nd without gesttionl dibetes mellitus (GDM). METHODS: This cross-sectionl ws conducted mong weeks pregnnt women dmitted to gynecology clinic of Aytollh Rohni Hospitl in Bbol. Ptients were divided into four groups: helthy pregnnt women, pregnnt women with high-risk gesttionl dibetes, pregnnt women with gesttionl dibetes mellitus nd pregnnt women with overt dibetes. The demogrphic informtion ws gthered using questionnire nd the serum level, mgnesium RBC nd the fsting blood sugr were mesured by lbortory methods nd were compred between the four groups. FINDINGS: 399 ptients with men ge of 26.53±5.54 prticipted in this study. Overll, men serum mgnesium level ws 1.71±0.12 mg/dl nd mgnesium level in RBC ws 4.88±0.29 mg/dl. The men serum mgnesium level ws 1.73±0.10 in helthy pregnnt women, 1.73±0.12 in pregnnt women with high-risk gesttionl dibetes, 1.71±0.13 in pregnnt women with gesttionl dibetes mellitus nd 1.64±0.15 in pregnnt women with overt dibetes nd there ws significnt difference between the four groups (p=0.001). The result regrding RBC mgnesium level ws found to be 5.12±0.18, 4.81±0.23, 4.77±0.24 nd 4.66±0.38 in helthy pregnnt women, pregnnt women with high-risk gesttionl dibetes, pregnnt women with gesttionl dibetes mellitus nd pregnnt women with overt dibetes, respectively, which ws significnt (p=0.001). Serum level nd RBC mgnesium in dibetic women ws less thn non-dibetic women. CONCLUSION: Results of the study demonstrted tht mgnesium could be n effective nd n underlying fctor in identifiction of disrupted glucose metbolism in pregnnt women. KEY WORDS: Mgnesium, Dibetes, Pregnncy, Glucose. Plese cite this rticle s follows: Bouzri Z, Elmi F, Esmeilzdeh S, Yzdni Sh, Neimird M, Ndimi Brforoush MR, Mozzezi Z, Hjin K. A Comprison of Serum Mgnesium Level in Pregnnt Women with nd Without Gesttionl Dibetes Mellitus (GDM). J Bbol Univ Med Sci. 2016;18(12):71-5. Corresponding uthor: S. Esmeilzdeh (MD) Address: Fteme Zhr Fertility & Infertility Reserch Helth Center, Bbol of University of Medicl Science, Bbol, I.R.Irn Tel: E-mil: sesmel@yhoo.com

2 72 A Comprison of Serum Mgnesium Level in Pregnnt ; Z. Buzri, et l Introduction Mgnesium is the second bundnt ction fter potssium in living cells. Of g mgnesium tht is present in n dult s body, 99% is present in intrcellulr spce nd only 1% is present in extrcellulr fluid (1). Mgnesium cts s mjor cofctor in most enzymtic processes. On the other hnd, mgnesium plys key role in clcium homeostsis nd clcium plys n importnt role in insulin relese nd glucose metbolism. This ction lso plys n importnt role in the process of glucose uptke by cells nd supplying the oxygen needed for cellulr oxidtion of glucose (2). Intrcellulr mgnesium is criticl cofctor for severl enzymes in crbohydrte metbolism. Lck of mgnesium my disrupt the ctivity of tyrosine kinse in the insulin receptor nd my lso be relted to insulin resistnce nd decresed cellulr glucose consumption (3). The lower the level of bsic mgnesium, the more insulin is required for metbolizing of the sme mount of glucose, which indictes reduced sensitivity to insulin. Insulin resistnce is the expected result in the presence of intrcellulr mgnesium (4). In mny cses, mgnesium increse or hypomgnesemi improvement occurs t the sme time with improvement of glucose metbolism such s the use of hypoglycemic drugs nd glucose- lowering foods (fibers). Insulin nd mgnesium hve complicted reltionship (5). Insulin, which is n effective hormone in glucose metbolism, increses permebility of the cell in exposure to mgnesium nd thus increses intrcellulr mgnesium. This bility of insulin to increse intrcellulr mgnesium is impired in people with dibetes nd increse in mgnesium increses the effect of insulin in glucose uptke nd intrcellulr oxidtion (4, 5). In conditions ssocited with hypomgnesemi, impired secretion or insulin resistnce is observed nd long-term dministrtion of mgnesium is ssocited with improvement of this disorder in insulin nd thus effective reduction of glucose. This effect of mgnesium cn be used s protective fctor for ptients with dibetes. On the other hnd, the concentrtion of intrcellulr mgnesium hs inverse reltionship with well-known tests of blood sugr control such s glycosylted hemoglobin nd fructosmine s well s the intensity of side effects of dibetes (4, 5). Lin et l. demonstrted tht serum mgnesium level in young dults with dibetes type 1 is significntly lower thn control group (6). Mostfvi et l. demonstrted tht serum mgnesium nd mgnesium RBC in ptients with gesttionl dibetes mellitus decresed significntly compred with the group of helthy pregnnt women nd nonpregnnt women (5). This study ws conducted to clrify the reltionship between this ction nd dibetes during pregnncy nd since gesttionl dibetes mellitus hs incresed in the lst two decdes in Bbol (7), it cn be very useful to know if hypomgnesemi cn independently ct s n effective fctor nd disrupt the glucose metbolism. This cn effectively help us identify people prone to dibetes. Hence, this study ws conducted to demonstrte the role of mgnesium s n effective nd n underlying fctor in disrupted glucose metbolism mong pregnnt women with nd without gesttionl dibetes mellitus (GDM). Methods This cross-sectionl ws conducted mong 399 pregnnt women (24-32 weeks) dmitted to gynecology clinic of Aytollh Rohni Hospitl in Bbol. Ptients were divided into four groups using simple rndom smpling technique ( ). Ptients with history of hypertension nd kidney, crdiovsculr nd gstrointestinl diseses were excluded from study. First group: control group including helthy pregnnt women; Second group: pregnnt women t risk for gesttionl dibetes; Third group: pregnnt women with gesttionl dibetes mellitus nd Fourth group: pregnnt women with overt dibetes. The highrisk ptients were those with fmily history of gesttionl dibetes in first degree reltives, history of previous gesttionl dibetes or hd fetl mcrosomi, obesity nd glycosuri (8). After getting permission from the ethics committee of Bbol University of Medicl Sciences nd obtining written informed consent, the prticipnts were sked to complete questionnire bout their physicl condition. This questionnire included pregnncy informtion, history of chronic disese, history of dibetes mellitus, history of bortion, gesttionl ge nd history of high-risk lbor nd weight nd height t the beginning of pregnncy. Pregnnt women without history of

3 J Bbol Univ Med Sci; 18(12); Dec dibetes underwent GCT test (50 g orl glucose) t 24-28th week nd one hour lter, blood smples were tken to check blood sugr. 130 mg/dl blood sugr in GCT ws considered s the threshold limit nd blood sugr t higher or lower level ws considered positive result (5). Women with positive GCT, were followed with 100 g orl glucose (fter three dys of diet without crbohydrte limittion) while doing 3-hour OGTT test. Crpenter nd Coustn criteri were used to detect gesttionl dibetes (5). FBS, serum mgnesium nd mgnesium RBC were mesured for ll the prticipnts in the fsting stte. The gthered dt were nlyzed using SPSS 18 softwre nd tests of smirnovkolmogorov, Independent Smple T-test, fisher exct test, one-wy ANOVA, post-hoc Tukey nd Chisqure test nd p<0.05 ws considered significnt.. Results This study ws conducted mong 399 ptients with men ge of 26.53±5.54. The men body mss index of the prticipnts ws 27.48±4.90 kg/m 2. Overll, men serum mgnesium level ws 1.71±0.12 mg/dl ( ). Mgnesium level in RBC ws 4.88±0.29 mg/dl (Tble 1). Serum mgnesium level in mothers with overt dibetes ws significntly lower thn other groups (Tble 2). The men serum mgnesium level ws 1.73±0.10 mg/dl in helthy pregnnt women nd 1.71±0.13 mg/dl in pregnnt women with gesttionl dibetes mellitus (p=0.001). Mgnesium RBC level ws 5.12±0.18 mg/dl in helthy women nd 4.77±0.24 mg/dl in pregnnt women with gesttionl dibetes mellitus (p=0.001). The serum mgnesium level ws 1.69±0.14 mg/dl in dibetic groups (gesttionl dibetes nd overt dibetes) nd 1.73±0.11 mg/dl in non-dibetic groups (helthy pregnnt women nd women t risk for gesttionl dibetes) (p=0.001). Mgnesium RBC level ws 4.74±0.29 mg/dl in dibetic groups (gesttionl dibetes nd overt dibetes) nd 4.97±0.26 mg/dl in non-dibetic groups (helthy pregnnt women nd women t risk for gesttionl dibetes) (p=0.001). Tble 1. The demogrphic informtion of helthy pregnnt women, pregnnt women t risk for gesttionl dibetes, pregnnt women with gesttionl dibetes mellitus nd pregnnt women with overt dibetes Vrible Group Helthy N=129 At risk N=121 Gesttionl dibetes mellitus N=99 Overt dibetes N=50 P-vlue Age (yer) Men±SD 26.60± ± ± ± BMI (kg/m 2 )Men±SD 26.70± ± ± ± Grvid Prity History of bortion 1 62 (48.1) 46 (38) 45 (45.5) 23 (46) 2 41 (31.8) 45 (37.2) 39 (39.4) 21 (42) 3 nd more 26 (20.2) 30 (24.8) 15 (15.2) 6 (12) Nullipr 111 (86) 88 (72.7) 77 (77) 42 (84) Multipr 18 (14) 33 (27.3) 22 (22.2) 8 (16) Yes 99 (78) 77 (63.6) 82 (82.8) 41 (82) No 22 (22) 44 (36.4) 17 (17.2) 9 (18) Tble 2. Comprison of serum mgnesium level nd mgnesium RBC level in helthy pregnnt women, pregnnt women t risk for gesttionl dibetes, pregnnt women with gesttionl dibetes mellitus nd pregnnt women with overt dibetes Group Helthy At risk Gesttionl dibetes mellitus Overt dibetes N=129 N=121 N=99 N=50 P-vlue* Vrible Serum mgnesium level(mg/dl) 1.73± ± ± ±0.15 b Mgnesium RBC level(mg/dl) 5.12±0.18 b 4.81± ±0.24 c d 4.66± According to Tukey test, dissimilr letters in ech horizontl low indicte significnt difference between group t p<0.05 level.

4 74 A Comprison of Serum Mgnesium Level in Pregnnt ; Z. Buzri, et l Discussion In this study, serum mgnesium level in women with overt dibetes ws less thn women with gesttionl dibetes, helthy women nd women t risk. In ddition, serum mgnesium level in dibetic groups ws less thn non-dibetic groups. Results of study by Goker Tsdemir et l. demonstrted tht there is significnt difference in serum mgnesium level between the group of women with gesttionl dibetes with bnorml OGTT nd the group of pregnnt women with norml OGTT nd totl nd ionized mgnesium level in pregnnt women with dibetes is significntly lower thn helthy women. In their study, mgnesium level ws 1.9 mg/dl nd 1.8 mg/dl in non-dibetic group nd dibetic group, respectively, which is little higher thn our results (9). However, in our study, serum mgnesium level in women with gesttionl dibetes, overt dibetes, t risk of dibetes reveled significnt difference with helthy mothers. Lin et l. demonstrted tht serum mgnesium level in young dults with dibetes type 1 is significntly lower thn control group (6), which is in line with our results. Since our prticipnts were pregnnt women, serum mgnesium level in our study ws lower thn the study of Lin. Serum mgnesium level generlly declines during pregnncy nd the presence of dibetes ccelertes this process (10). Simmons et l. reported tht hypomgnesemi is ssocited with known dibetes, but in ptients who were newly dignosed with dibetes, the reltionship is not significnt (11), which is in line with the present study. Men nd women (men ge of 53) with dibetes were exmined in the study of Simmons et l. nd it ws shown tht ging lone decreses serum mgnesium level. Study of Mostfvi et l. reveled tht serum mgnesium nd mgnesium RBC in ptients with gesttionl dibetes is significntly lower thn helthy pregnnt nd nonpregnnt women (5), which is not in line with our study. One of the possible cuses of this difference my be relted to different smple size in the two studies. Serum mgnesium level in women with gesttionl dibetes ws similr in both studies. Serum mgnesium level in helthy women ws lso similr. 99 people suffered from gesttionl dibetes in our study, which ws notbly higher thn the study of Mostfvi (5). Jeong et l., investigted serum mgnesium level in 116 pregnnt women with gesttionl dibetes. After delivery, subjects were divided into three groups (OGTT with 75 mg unnturl glucose, predibetes chnges nd nturl OGTT) nd concluded tht serum mgnesium level in impired OGTT group ws the lowest mong these three groups. However, there ws no significnt difference in serum mgnesium level between mothers with nturl OGTT nd the group with predibetes chnges (12). The results of this study were in line with our study, lthough this study ws dedicted to serum mgnesium level fter delivery. In our study, serum RBC level in helthy pregnnt women ws significntly higher thn other women nd this result remined significnt fter seprtion bsed on body mss index. One of the limittions of this study ws ignoring durtion of dibetes nd its reltionship with mgnesium level. This study did not consider the type of dibetes (type 1 or 2) nd its effect on mgnesium level. Other limittions of the study include ignoring mothers diet nd its effect on mgnesium level. Results of this study indicted tht serum mgnesium level nd mgnesium RBC level in women with dibetes is lower thn helthy women. Hence, mgnesium cn be n effective nd underlying fctor in identifiction of disorders in glucose metbolism mong pregnnt women. Acknowledgments Hereby, we express our deepest sense of grtitude nd ineptness to Reserch Deputy of Bbol University of Medicl Sciences, Prs lbortory nd Clinicl Reserch Development Unit of Aytollh Rohni Hospitl in Bbol.

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