Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Obstetrics and Gynaecology, Hubei Maternal and Child Health Hospital, Wuhan, Hubei, China.
Diabetes Res Clin Pract. 2021 Jun;176:108853. doi: 10.1016/j.diabres.2021.108853. Epub 2021 May 5.
Iron supplementation has been recommended for healthy pregnancy, but concerns have been raised regarding the potential adverse effects. We sought to examine the impact of periconceptional iron supplement use on subsequent gestational diabetes mellitus (GDM) risk.
Participants (N = 5101) with information on periconceptional micronutrient supplementation and diagnosis of GDM were involved. Information on iron supplementation and general characteristics were collected at enrollment and follow-up visits. GDM was diagnosed by oral glucose tolerance tests (OGTT) conducted at 24-28 weeks of gestation. Robust Poisson regression model was used to estimate the relative risks (RRs) and 95% confidence intervals (CI) for the effect of iron supplement use on GDM.
10.5% of the participants were diagnosed with GDM and the incidence was significantly higher in users with iron >30 mg/d for more than 3 months (Iron >30-L) than in nonusers. Adjusted RRs (95% CI) were 1.53 (1.21, 1.93) in Iron >30-L group, 1.14 (0.80, 1.61) in users with iron >30 mg/d for<3 months (Iron > 30-S) and 1.15 (0.86, 1.54) in users with iron ≤30 mg/d for any duration (Iron ≤30) respectively, compared to nonusers. This link in Iron >30-L group was even stronger (adjusted RR: 1.70, 95% CI: 1.25, 2.31) when restricting the analysis among primiparous and iron-replete participants without family history of diabetes. There were no significant differences in birth outcomes among groups.
Periconceptional iron supplementation >30 mg/d for long-term was associated with increased GDM risk. The need and safety of prophylactic iron supplement in iron-replete pregnant women should be reconsidered.
铁补充剂已被推荐用于健康妊娠，但人们对其潜在的不良影响表示担忧。我们旨在研究围孕期铁补充剂的使用对随后发生妊娠期糖尿病（GDM）风险的影响。
研究纳入了 5101 名参与者，这些参与者的围孕期微量营养素补充信息和 GDM 诊断信息齐全。在入组和随访时收集了关于铁补充剂和一般特征的信息。GDM 通过 24-28 孕周的口服葡萄糖耐量试验（OGTT）进行诊断。采用稳健泊松回归模型来估计铁补充剂使用对 GDM 的影响的相对风险（RR）和 95%置信区间（CI）。
10.5%的参与者被诊断患有 GDM，在铁补充剂使用量>30mg/d 且超过 3 个月（铁>30-L 组）的使用者中，GDM 的发生率明显高于未使用者。铁>30-L 组的校正 RR（95%CI）为 1.53（1.21，1.93），铁补充剂使用量>30mg/d 且<3 个月（铁>30-S 组）的校正 RR 为 1.14（0.80，1.61），铁补充剂使用量≤30mg/d 且任何时长（铁≤30 组）的校正 RR 为 1.15（0.86，1.54），与未使用者相比。当限制分析仅包括无糖尿病家族史的初产妇和铁充足的参与者时，铁>30-L 组的这种关联更为强烈（校正 RR：1.70，95%CI：1.25，2.31）。各组之间的出生结局没有显著差异。
围孕期铁补充剂>30mg/d 且长期使用与 GDM 风险增加相关。对于铁充足的孕妇，预防性铁补充的必要性和安全性应重新考虑。
