Intestinal Alkaline Phosphatase Deficiency Increases the Risk of Developing Gestational Diabetes Mellitus

Introduction and Objective: Intestinal alkaline phosphatase (IAP) is an endotoxin-detoxifying anti-inflammatory gut enzyme secreted by enterocytes and excreted with stool. A case-control study conducted in 2015 found that IAP deficiency (IAPD) is associated with type 2 diabetes mellitus (T2DM). Additionally, a 5-year prospective cohort study in 2022 showed that IAPD leads to T2DM, establishing IAP as a predictor biomarker for T2DM. Our objective was to investigate whether IAPD also increases the risk of developing gestational diabetes mellitus (GDM). Methods: We used the stool IAP (STAP) test to measure IAP levels in pregnant women's stools, determined fasting plasma glucose (FPG), and performed a 75-g oral glucose tolerance test (OGTT). We also measured basal metabolic index (BMI) and blood pressure. Results: Compared to participants with no GDM (n=75), the average IAP level was significantly lower in participants with GDM (n=43) (85.5 ± 104.2 vs. 46.8 ± 54.0 U/g stool, mean ± SD respectively). The incidence rate of GDM was greatly higher in women with severe IAPD (IAP level: <18 U/g stool) compared to women with no IAPD (60.6% vs. 17.9%, respectively; Table 1). Women with severe IAPD have a 3.38-fold increased risk of developing GDM (Table 1). Conclusion: IAPD increases the risk of developing GDM, establishing IAP as a predictor biomarker for GDM. STAP test would diagnose IAPD and thus identify women vulnerable to GDM. Oral IAP supplements might prevent GDM. Disclosure: P. Chowdhury: None. T. Tofail: None. M.H. Islam: None. G. Bormon: None. T. Sarker: None. M.S. Malo: None. M.A. Hasanat: None.