Aasia Kanwal, Ambreen Khalid, Adeela Shahid, Hafiza Hina Pasha, Mehwish Rana, Muhammad Shahid Saeed


Background: Vitamin B12, homocysteine and glutathione peroxidase are the key components of one carbon metabolism, essential for healthy pregnancy. Inconsistency exists as to whether imbalance of these components can contribute to gestational diabetes mellitus (GDM). The current study intended to determine the levels of vitamin B12, homocysteine and glutathione peroxidase in women with gestational diabetes mellitus.

Materials and Methods: This cross-sectional study was conducted at the Department of Physiology, University of Health Sciences, Lahore, from 1st January 2019 to 31st December 2020. The study involved 90 pregnant women, who were divided into two groups: pregnant women with GDM (n=45) and pregnant women without GDM (n=45). Serum glutathione peroxidase (GPX), homocysteine (Hcy), vitamin B12 (Vit B12), and fasting blood glucose (FBG) levels were measured in both groups at 28-32 weeks of gestation using ELISA and glucose oxidase method, respectively. Data analysis was done by using SPSS version 23. p<0.05 was set statistically significant.

Results:  We recorded statistically significant differences between the two groups (GDM vs healthy group) regarding Vit B12 (149.00 pg/mL vs 357.00 pg/mL), Hcy (16.95 μmol/L vs 10.05 μmol/L) and GPX levels (3.15 U/ml vs 5.09 U/ml).

Conclusions: Vitamin B12 insufficiency is associated with elevated homocysteine and lower glutathione peroxidase levels in GDM. This is the first study that reports the interaction of one carbon metabolism and antioxidants in GDM in a local population from Pakistan.


Gestational Diabetes Mellitus; Vitamin B12; Homocysteine; Glutathione Peroxidase; One Carbon Metabolism.

Full Text:



Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab 2018;29(11):743-54.

Callaway LK, McIntyre HD, Barrett HL, Foxcroft K, Tremellen A, Lingwood BE, et al. Probiotics for the prevention of gestational diabetes mellitus in overweight and obese women: findings from the SPRING double-blind randomized controlled trial. Diabetes Care 2019;42(3):364-71.

Venkataraman H, Ram U. Increased fetal adiposity prior to diagnosis of gestational diabetes in South Asians: more evidence for the 'thin-fat'baby. Diabetologia 2017;60(3):399-405.

Mishra J, Tomar A. Trends of folate, vitamin B12, and homocysteine levels in different trimesters of pregnancy and pregnancy outcomes. Am J Hum Biol 2020;32(5): e23388.

Singh MD, Thomas P. Potential role of folate in pre-eclampsia. Nutr Rev 2015;73(10):694-722.

Kouroglou E, Anagnostis P, Daponte A, Bargiota A. Vitamin B12 insufficiency is associated with increased risk of gestational diabetes mellitus: a systematic review and meta-analysis. Endocrine. 2019;66(2):149-56

Lai JS, Pang WW, Cai S, Lee YS, Chan JK, Shek LP et al. High folate and low vitamin B12 status during pregnancy is associated with gestational diabetes mellitus. Clin. Nutr. 2018;37(3):940-7.

Zhang B, Zhang T, Hu S, Sun L. Association of serum lipid peroxidation and glutathione peroxidase 4 levels with clinical outcomes and metabolic abnormalities among patients with gestational diabetes mellitus: a case-control study in the Chinese population. Front Biosci 2022;27(2):68-72.

Goyal A, Gupta Y, Singla R, Kalra S, Tandon N. American Diabetes Association "Standards of Medical Care-2020 for Gestational Diabetes Mellitus": a critical appraisal. Diabetes Ther 2020;11(8):1639-44.

Sukumar N, Rafnsson SB, Kandala NB, Bhopal R, Yajnik CS, Saravanan P. Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis. Am J Clin Nutr 2016;103(5):1232-51.

Valdés-Ramos R, Ana Laura G-L, Beatriz Elina M-C, Alejandra Donaji B-A. Vitamins, and type 2 diabetes mellitus. Endocrine, Metabolic & Immune Disorders. Drug Targets. 2015;15(1):54-63.

Chapman, L., Darling, A, Brown, J. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab. 2016 ;42(5):316-27.

Fatima, S. S., Rehman, R., Alam, F., Madhani, S., Chaudhry, Khan. Gestational diabetes mellitus and the predisposing factors. J Pak Med Assoc. 2017;67(2):261-265.

Seghieri, G., Breschi, M. C., Anichini, R., De Bellis, A., Alviggi, L., Maida, I, et al. Serum homocysteine levels are increased in women with gestational diabetes mellitus. J Nutr Metab 2003 ;52(6):720-3.

Tarim, E., Bagis, T., Kilicdag, E., Erkanli, S., Aslan, E., Sezgin, N. et al. Elevated plasma homocysteine levels in gestational diabetes mellitus. Acta Obstet Gynecol Scand 2004;83(6):543-7.

Begum, S. A., Khalil, I., Mandal, C. K., Hasan, M. M., Kawsar, M. A. Folic acid deficiency related to hyperhomocystinemia has less correlation with Gestational Diabetes Mellitus (GDM). Update Dent Coll J 2016;6(1):1-7.

Gong, T., Wang, J., Yang, M., Shao, Y., Liu, J., Wu, Q., et al. Serum homocysteine level and gestational diabetes mellitus: A meta-analysis. J Diabetes Investig 2016;7(4):622-8.

Satyanarayana, A., Balakrishna, N., Pitla, S., Reddy, P. Y., Mudili, S., Lopamudra, P., et al. Status of B-vitamins and homocysteine in diabetic retinopathy: association with vitamin-B12 deficiency and hyperhomocysteinemia. PloS one 2011;6(11): e26747.

Van De Lagemaat, De Groot, Van Den Heuvel. Vitamin B12 in Relation to Oxidative Stress: A Systematic Review. Nutrients 2019;11(2):482-497.

López-Tinoco, C., Roca, M., García-Valero, A., Murri, M., Tinahones, F. J., Segundo. et al. Oxidative stress and antioxidant status in patients with late-onset gestational diabetes mellitus. Acta diabetologica 2013;50(2):201-8.

Peuchant, E., Brun, J.-L., Rigalleau, V., Dubourg, L., Thomas, M.-J., Daniel, J.-Y. et al. Oxidative and antioxidative status in pregnant women with either gestational or type 1 diabetes. Clin Biochem 2004;37(4):293-8.

Mahmoud, F., Dashti, A., Abul, H, Jumath, O. A. Antioxidant Enzymes in Gestational Diabetes: A Study on a Kuwaiti Population. Bioenerg 2014;3(117):62-67.

Wdowiak, A., Brzozowski, I, Bojar, I. Superoxide dismutase and glutathione peroxidase activity in pregnancy complicated by diabetes. Ann Agric Environ Med 2015;22(2): 1-2.

Atiba, A. S., Olofinbiyi, B. A., Aduloju, O. P., Akindele, R. A., Tolorunju, K., & Adekanle, D. A. Product of Free Radical Injury and Antioxidant Status in Patients with Gestational Diabetes Mellitus (GDM). IJHSR 2018;8(32):32-37.

Furness, D., Fenech, M., Dekker, G., Khong, T. Y., Roberts, C., & Hague, W. Folate, vitamin B12, vitamin B6 and homocysteine: impact on pregnancy outcome. Matern Child Nutr 2013;9(2):155-66.



  • There are currently no refbacks.

Copyright (c) 2023. Aasia Kanwal, Ambreen Khalid, Adeela Shahid, Hafiza Hina Pasha, Mehwish Rana, Muhammad Shahid Saeed

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Gomal Medical College, Daraban Road, Dera Ismail Khan, Pakistan

ISSN: 1819-7973, e-ISSN: 1997-2067


Phone: +92-966-747373

Scimago Journal & Country Rank