Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 550 Hunan RD, Shanghai201204, People's Republic of China.
Department of Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Public Health Nutr. 2023 May;26(5):1014-1021. doi: 10.1017/S136898002200194X. Epub 2022 Sep 12.
To investigate the association between folate levels and the risk of gestational diabetes mellitus (GDM) risk during the whole pregnancy.
In this retrospective cohort study of pregnant women, serum folate levels were measured before 24 gestational weeks (GW). GDM was diagnosed between 24th and 28th GW based on the criteria of the International Association of Diabetes and Pregnancy Study Groups. General linear models were performed to examine the association of serum folate with plasma glucose (i.e. linear regressions) and risk of GDM (i.e. log-binomial regressions) after controlling for confounders. Restricted cubic spline regression was conducted to test the dosage-response relationship between serum folate and the risk of GDM.
A sigle, urban hospital in Shanghai, China.
A total of 42 478 women who received antenatal care from April 2013 to March 2017 were included.
Consistent positive associations were observed between serum folate and plasma glucose levels (fasting, 1-h, 2-h). The adjusted relative risks (RR) and 95 % CI of GDM across serum folate quartiles were 1·00 (reference), 1·15 (95 % CI (1·04, 1·26)), 1·40 (95 % CI (1·27, 1·54)) and 1·54 (95 % CI (1·40, 1·69)), respectively (-for-trend < 0·001). The positive association between serum folate and GDM remained when stratified by vitamin B (adequate . deficient groups) and the GW of serum folate measurement (≤13 GW . >13 GWs).
The findings of this study may provide important evidence for the public health and clinical guidelines of pregnancy folate supplementation in terms of GDM prevention.
研究妊娠全程叶酸水平与妊娠期糖尿病（GDM）风险的关系。
本研究为回顾性队列研究，纳入了在妊娠 24 周（GW）前检测血清叶酸水平的孕妇。GDM 诊断依据国际妊娠糖尿病研究组（IADPSG）标准，在 24 至 28 GW 之间进行。采用一般线性模型，在校正混杂因素后，检验血清叶酸与血浆葡萄糖（即线性回归）和 GDM 风险（即对数二项式回归）之间的关系。采用受限立方样条回归检验血清叶酸与 GDM 风险之间的剂量-反应关系。
中国上海的一家单一城市医院。
共纳入 2013 年 4 月至 2017 年 3 月期间接受产前保健的 42478 名妇女。
血清叶酸与血浆葡萄糖水平（空腹、1 小时、2 小时）呈一致正相关。血清叶酸四分位数的 GDM 调整相对风险（RR）和 95 % CI 分别为 1·00（参考）、1·15（95 % CI（1·04，1·26））、1·40（95 % CI（1·27，1·54））和 1·54（95 % CI（1·40，1·69））（趋势检验 P<0·001）。血清叶酸与 GDM 之间的正相关关系在按维生素 B（充足、缺乏组）和血清叶酸测量的 GW（≤13 GW、>13 GWs）分层时仍然存在。
本研究结果可能为妊娠叶酸补充预防 GDM 的公共卫生和临床指南提供重要依据。
