Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
School of Medicine, Boston University, Boston, MA.
Diabetes Care. 2019 Jun;42(6):1034-1041. doi: 10.2337/dc18-2198. Epub 2019 Apr 22.
To identify novel modifiable risk factors of gestational diabetes mellitus (GDM) by examining the association between prepregnancy habitual folate intake and GDM risk.
The study included 14,553 women in the Nurses' Health Study II who reported at least one singleton pregnancy between the 1991 and 2001 questionnaires. Prepregnancy intakes of total folate, supplemental folate, and food folate were assessed using a food frequency questionnaire administered every 4 years. Incident GDM was ascertained from a self-reported physician diagnosis. Relative risks (RRs) of GDM were estimated using log-binomial models, with adjustment for demographic, lifestyle, and dietary factors.
Over the study follow-up, 824 incident GDM cases were reported among 20,199 pregnancies. Women with adequate total folate intake (≥400 μg/day) had an RR of GDM of 0.83 (95% CI 0.72, 0,95, = 0.007) compared with women with inadequate intake (<400 μg/day). This association was entirely driven by supplemental folate intake. The RRs of GDM for 1-399, 400-599, and ≥600 μg/day of supplemental folate intake were 0.83, 0.77, and 0.70, respectively, compared with no supplemental folate intake ( = 0.002). The association between supplemental folate intake and GDM risk largely persisted after additional adjustment for intake of multivitamins and other micronutrients, as well as among women who likely planned for the pregnancy.
Higher habitual intakes of supplemental folate before pregnancy were significantly associated with lower GDM risk. If confirmed, these findings indicate that prepregnancy folic acid supplementation could offer a novel and low-cost avenue to reduce GDM risk.
通过研究孕前习惯性叶酸摄入量与妊娠期糖尿病（GDM）风险之间的关系，确定 GDM 的新的可改变危险因素。
该研究纳入了参加护士健康研究 II 队列的 14553 名女性，她们在 1991 年至 2001 年的问卷中报告了至少一次单胎妊娠。孕前总叶酸、补充叶酸和食物叶酸的摄入量通过每 4 年进行一次的食物频率问卷进行评估。通过自我报告的医生诊断来确定 GDM 的发病情况。使用对数二项式模型估计 GDM 的相对风险（RR），并调整了人口统计学、生活方式和饮食因素。
在研究随访期间，20199 次妊娠中报告了 824 例 GDM 病例。与摄入不足（<400μg/天）的女性相比，总叶酸摄入量充足（≥400μg/天）的女性 GDM 的 RR 为 0.83（95%CI 0.72，0.95， = 0.007）。这种关联完全是由补充叶酸摄入驱动的。与不摄入补充叶酸相比，摄入 1-399μg/天、400-599μg/天和≥600μg/天的补充叶酸的 GDM RR 分别为 0.83、0.77 和 0.70，差异有统计学意义（ = 0.002）。补充叶酸摄入量与 GDM 风险之间的关联在进一步调整了多维元素和其他微量营养素的摄入量以及可能计划怀孕的女性后仍基本存在。
孕前习惯性补充叶酸的摄入量较高与 GDM 风险降低显著相关。如果得到证实，这些发现表明孕前补充叶酸可能为降低 GDM 风险提供一种新的、低成本的途径。
