Serum and cord blood neutrophil gelatinase associated lipocalin levels in pregnant women with gestational diabetes mellitus and its association with tumor necrosis factor-alpha

Objectives: To examine the significance of neutrophil gelatinase-associated lipocalin (NGAL) and tumor necrosis factor-alpha (TNF-alpha) in women with gestational diabetes mellitus (GDM) and their correlation with insulin resistance and metabolic markers. Methods: Blood samples from maternal and cord sources were obtained from 289 pregnant women, divided into GDM, prediabetic, and normal pregnancy groups. Serum levels of NGAL, TNF-alpha, insulin, fasting blood sugar (FBS), homeostasis model assessment-estimated insulin resistance (HOMA-IR), triglycerides, cholesterol, and so on were measured. Statistical analyses, including the Kruskal-Wallis test and Mann-Whitney U test, were used to compare NGAL levels across patient groups and ethnicities. Results: Women with GDM showed significantly higher serum NGAL and TNF-alpha levels compared to prediabetic and normal pregnancy groups. The NGAL levels positively correlated with key metabolic markers such as FBS, insulin, HOMA-IR, triglycerides, and cholesterol, suggesting a link between elevated NGAL and insulin resistance. In the GDM group, there was also a positive association (r=0.366) between NGAL and TNF-alpha values. No significant variation in NGAL levels was observed between non-tribal and tribal women. Conclusion: Elevated levels of NGAL and TNF-alpha in women with GDM are linked to increased insulin resistance, excessive gestational weight gain, and higher neonatal morbidity risk. These findings underscore the possible involvement of these inflammatory markers in the development of GDM, emphasizing the need for targeted management of both gestational weight gain and inflammation in GDM patients.