Association Between Maternal Serum Ferritin Concentration and Risk of Gestational Diabetes Mellitus and Adverse Fetal Outcomes: Maternal Serum Ferritin, GDM, and Adverse Fetal Outcomes

Nadia Naheed; Sadia Majeed; Ayesha Iqbal; Lubna Noor; Bushra Gull; Javaria Majeed; Syed Awais Attique

doi:10.54393/pjhs.v7i8.3579

Authors

Nadia Naheed Department of Obstetrics and Gynecology, Combined Military Hospital, Multan, Pakistan
Sadia Majeed Department of Obstetrics and Gynecology, Combined Military Hospital, Multan, Pakistan
Ayesha Iqbal Department of Obstetrics and Gynecology, District Headquarters Teaching Hospital, Sahiwal, Pakistan
Lubna Noor Department of Obstetrics and Gynecology, Combined Military Hospital, Multan, Pakistan
Bushra Gull Department of Gynecology and Obstetrics, Combined Military Hospital, Multan, Pakistan
Javaria Majeed Department of Obstetrics and Gynecology, Combined Military Hospital, Multan, Pakistan
Syed Awais Attique Department of Biological Sciences, National University of Singapore, Singapore

DOI:

https://doi.org/10.54393/pjhs.v7i8.3579

Keywords:

Gestational Diabetes Mellitus, Serum Ferritin, Pregnancy Outcomes, Macrosomia, Fetal Growth, Iron Supplementation, Maternal Health

Abstract

Gestational diabetes mellitus (GDM) is a common pregnancy-related metabolic disorder linked to serious maternal and fetal complications. Rising evidence indicates that elevated maternal iron stores, especially serum ferritin, may contribute to GDM and adverse neonatal outcomes, yet data from South Asia, particularly Pakistan, are limited. Objectives: To evaluate the association between maternal serum ferritin concentrations at different gestational ages and the risk of GDM and adverse fetal outcomes. Methods: A retrospective cohort study of 146 singleton pregnancies at Combined Military Hospital Multan measured ferritin at 16–18 and 28–32 weeks. Participants were categorized into ferritin quartiles, GDM was diagnosed via a 75-g Oral Glucose Tolerance Test (OGTT), and logistic regression assessed associations after adjusting for key maternal covariates. Results: Higher mid-gestation serum ferritin levels demonstrated a significant relationship with increased risk of GDM (adjusted OR for Q4 vs. Q1: 1.43; p=0.016). Elevated ferritin was also linked to macrosomia (adjusted odds ratio (AOR)=2.01; 95% confidence interval (CI): 1.09–3.67), large for gestational age (LGA) infants (AOR=2.01; 95% CI: 1.09–3.72), and increased neonatal head circumference (AOR=2.70; 95% CI: 1.53–4.77). Although higher ferritin levels were associated with a reduced risk of small for gestational age (SGA) (AOR=0.44; 95% CI: 0.17–1.17), this association was not statistically significant. In late pregnancy, ferritin showed an inverse relationship with macrosomia, suggesting time-dependent effects. Conclusions: Elevated maternal serum ferritin levels during mid-pregnancy are associated with an increased risk of GDM and fetal overgrowth outcomes.

References

Singh J, Jha S, Mahto M. Association of Early Pregnancy Body Iron Stores with the Development of Gestational Diabetes Mellitus: A Hospital-Based Cohort Study. Journal of Family Medicine and Primary Care. 2025 May; 14(5): 2037-2040. doi: 10.4103/jfmpc.jfmpc_1369_24.

Qin Z, Du Y, Wang Z, Qin X, Wu H, Yu X et al. Serum Ferritin Levels in Pregnancy and Their Association with Gestational Diabetes Mellitus: A Prospective Longitudinal Study. Diabetes, Metabolic Syndrome, and Obesity. 2025 Dec: 413-422. doi: 10.2147/DMSO.S480347.

Zhou M, Song L, Huang Y, Chen D. Associations Between Serum Ferritin Levels and Gestational Diabetes Mellitus Among a Non-Anemic Population. BioMed Central Pregnancy and Childbirth. 2025 Mar; 25(1): 288. doi: 10.1186/s12884-025-07391-9.

Pervez SA, Ashraf S, Phulpoto AH, Ramani RK, Channa MA, Aziz A. Association Between Anemia and Prevalence of Gestational Diabetes vs Non-Gestational Diabetes among Pregnant Women: Anemia and Prevalence of Gestational Diabetes Vs Non-Gestational Diabetes. Pakistan Journal of Health Sciences. 2025 Jun: 53-57. doi: 10.54393/pjhs.v6i6.3191.

Adnan M and Aasim M. Prevalence of Gestational Diabetes Mellitus in Pakistan: A Systematic Review and Meta-Analysis. BioMed Central Pregnancy and Childbirth. 2024 Feb; 24(1): 108. doi: 10.1186/s12884-024-06290-9.

Uddin SF, Waheed K, Sheikh S, Noor N, Chohan HU, Mahnoor S, Zain-ul-Abdeen S. Serum Ferritin Level Linked to Male Type-2 Diabetes Mellitus Patients Amongst Residents of Hyderabad, Sindh. In Proceedings. 2024 Apr; 38 (2): 106-110. doi: 10.47489/szmc.v38i2.504.

Zhang Y, Xu S, Zhong C, Li Q, Wu M, Zhang G et al. Periconceptional Iron Supplementation and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Research and Clinical Practice. 2021 Jun; 176: 108853. doi: 10.1016/j.diabres.2021.108853.

Zhang R, Huang X, Li Y, Yu Z, Wu Y, Zha B et al. Serum Ferritin as a Risk Factor for Type 2 Diabetes Mellitus, Regulated by Liver Transferrin Receptor 2. Endocrine Connections. 2021 Dec; 10(12): 1513-1521. doi: 10.1530/EC-21-0316.

Attique SA, Hussain N, Bilal M, Iqbal HM. Enzyme immobilization approaches. InBiocatalyst immobilization. Academic Press. 2023 Jan: 37-54. doi: 10.1016/B978-0-323-91317-1.00007-4.

Zhao Y, Gao Q, Li B, Wang Y, Wang Y. Ferroptosis and its Potential Role in Gestational Diabetes Mellitus: Updated Evidence from Pathogenesis to Therapy. Frontiers in Endocrinology. 2023 Aug; 14: 1177547. doi: 10.3389/fendo.2023.1177547.

Si S, Shen Y, Xin X, Mo M, Shao B, Wang S et al. Hemoglobin Concentration and Iron Supplement During Pregnancy were Associated with an Increased Risk of Gestational Diabetes Mellitus. Journal of Diabetes. 2021 Mar; 13(3): 211-221. doi: 10.1111/1753-0407.13101.

Kim HY, Kim J, Noh E, Ahn KH, Cho GJ, Hong SC et al. Prepregnancy Hemoglobin Levels and Gestational Diabetes Mellitus in Pregnancy. Diabetes Research and Clinical Practice. 2021 Jan; 171: 108608. doi: 10.1016/j.diabres.2020.108608.

Wasim T, Bushra N, Tajammul A, Humayun S, Rasool S, Shahbaz F et al. Ferritin Screening and Iron Treatment for Maternal Anemia and Fetal Growth Restriction Prevention: A Multicenter Randomized Controlled Trial (FAIR Study). Pakistan Journal of Medical Sciences. 2023 Jan; 39(1): 293. doi: 10.12669/pjms.39.1.6686.

Erbağcı MO, Tuna G, Köse S, Dal-Bekar NE, Akış M, Kant M et al. Association Between Early Oxidative DNA Damage and Iron Status in Women with Gestational Diabetes Mellitus. Reproductive Toxicology. 2021 Aug; 103: 171-180. doi: 10.1016/j.reprotox.2021.05.009.

Xie Y, Dai S, Chen Q, Shan D, Pan X, Hu Y. Serum Ferritin Levels and Risk of Gestational Diabetes Mellitus: A Cohort Study. Scientific Reports. 2025 Mar; 15(1): 7525. doi: 10.1038/s41598-025-91456-4.

Fan X, Wang L, Jiao R, Song W, Liu Y, Yu T. Correlation Between High Serum Ferritin Levels and Adverse Pregnancy Outcomes in Women with Gestational Diabetes Mellitus. Heliyon. 2023 Mar; 9(3): 1-8. doi: 10.1016/j.heliyon.2023.e14285.

Ehsani A, Mehrabi MM, Bashar Awad T, Ghasemi M, Eshraghi A, Asef Agah SA et al. Investigation of the Association Between Maternal Serum Ferritin Levels and Preterm Delivery: A Systematic Review and Meta-Analyses. Archives of Gynecology and Obstetrics. 2026 Feb; 313(1): 77. doi: 10.1007/s00404-026-08336-z.

Gautam S, Alam F, Moin S, Noor N, Arif SH. Role of Ferritin and Oxidative Stress Index in Gestational Diabetes Mellitus. Journal of Diabetes and Metabolic Disorders. 2021 Dec; 20(2): 1615-1619. doi: 10.1007/s40200-021-00911-2.

Zhang X, Wu M, Zhong C, Huang L, Zhang Y, Chen R et al. Association Between Maternal Plasma Ferritin Concentration, Iron Supplement Use, and the Risk of Gestational Diabetes: A Prospective Cohort Study. The American Journal of Clinical Nutrition. 2021 Sep; 114(3): 1100-1106. doi: 10.1093/ajcn/nqab162.

Li T, Zhang J, Li P. Ferritin and Iron Supplements in Gestational Diabetes Mellitus: Less or More? European Journal of Nutrition. 2024 Feb; 63(1): 67-78. doi: 10.1007/s00394-023-03250-5.