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Evaluating the Association of Maternal Anthropometrics and Alkaline Phosphatase (ALP) Levels for Gestational Diabetes Mellitus (GDM) at 24–28 Weeks: A Multivariable Analysis

Abstract

Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder of pregnancy associated with adverse maternal and neonatal outcomes, yet early risk stratification remains limited in many clinical settings. This study aimed to evaluate the predictive utility of maternal anthropometric measures and serum alkaline phosphatase (ALP) levels for GDM diagnosed at 24–28 weeks of gestation using a 2-hour oral glucose tolerance test (OGTT) threshold of greater than 140 mg/dL. A cross-sectional analytical study was conducted among 200 pregnant women between 24 and 28 weeks of gestation recruited through purposive sampling in a city in Bulacan, Philippines. Maternal age, gestational age, body mass index (BMI), waist-to-hip ratio (WHR), and serum ALP levels were collected, and multiple logistic regression was used to examine their association with GDM status defined by 2-hour OGTT results. Among the participants, 26.5% (n = 53) were diagnosed with GDM. The multivariable model was statistically significant (χ²(5) = 80.52, p < .001), with ALP emerging as the only significant predictor of GDM (B = 0.083, p < .001; OR = 1.09; 95% CI [1.06, 1.11]), while maternal age, gestational age, BMI, and WHR were not significantly associated with GDM. These findings suggest that higher maternal ALP levels at 24–28 weeks of gestation are independently associated with increased odds of GDM, whereas conventional anthropometric and demographic factors did not significantly predict GDM in this cohort due to a possible effect on the changes in the placenta of a pregnant woman. Incorporating ALP into screening strategies may enhance early stratification for a better prognosis of women at elevated risk, particularly in resource-limited settings, and supports further research on liver-related biomarkers in GDM risk prediction. Keywords: Gestational diabetes mellitus; maternal anthropometrics; alkaline phosphatase; logistic regression; enzyme biomarkers