Department of Medical Laboratory, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Diabetes Metab Res Rev. 2023 Sep;39(6):e3637. doi: 10.1002/dmrr.3637. Epub 2023 Apr 13.
Ferritin levels are well known to be associated with gestational diabetes mellitus (GDM). However, the association of the combination of ferritin and triglyceride (TG) levels in early mid-pregnancy with GDM has not been studied in depth. We investigated the independent and combined relationships of plasma ferritin and TG concentrations with the risk of GDM as well as the mediation effect of TG on ferritin.
We analysed 2071 pregnant women from the Tongji Maternal and Child Health Cohort who had their plasma ferritin and TG concentrations measured at 11-20 weeks of gestation. Associations between ferritin and TG concentrations and GDM risk were estimated using multivariable logistic regression models. Youden's index was calculated to find the cut-off values of ferritin and TG by ROC curve analysis. The mediation effect of the TG concentration on the ferritin level with GDM risk was explored by a mediation analysis.
A total of 264 (12.3%) participants developed GDM. The median and IQR of ferritin was 53.9 (30.5-92.7) ng/mL. After adjusting for potential confounders, the relative risks (RRs) and 95% confidence intervals of GDM were 2.19 (1.42, 3.39) for ferritin and 2.02 (1.37, 2.97) for TG. The adjusted RR for combination was 2.40 (1.62, 3.55). Moreover, we found that the TG concentration mediated 15.0% of the total effect of the ferritin concentration on the risk of GDM.
Women with a combination of both high plasma ferritin (˃55.7 ng/mL) and high TG (˃1.9 mmoL/L) were at the highest risk of GDM. Additionally, we have revealed for the first time that an elevated maternal TG concentration in early pregnancy mediates the relationship between ferritin concentration and GDM risk.
This trial is registered at https://ClinicalTrials.gov as NCT03099837.
铁蛋白水平与妊娠糖尿病（GDM）密切相关。然而，早中期妊娠时铁蛋白与甘油三酯（TG）水平的联合与 GDM 的关系尚未得到深入研究。我们调查了血浆铁蛋白和 TG 浓度与 GDM 风险的独立和联合关系，以及 TG 对铁蛋白的中介作用。
我们分析了来自同济母婴队列的 2071 名孕妇，这些孕妇在妊娠 11-20 周时测量了血浆铁蛋白和 TG 浓度。使用多变量 logistic 回归模型估计铁蛋白和 TG 浓度与 GDM 风险之间的关联。通过 ROC 曲线分析计算 Youden 指数，以找到铁蛋白和 TG 的截断值。通过中介分析探讨了 TG 浓度对铁蛋白水平与 GDM 风险的中介作用。
共有 264 名（12.3%）参与者发生 GDM。铁蛋白的中位数和 IQR 为 53.9（30.5-92.7）ng/ml。在调整了潜在混杂因素后，铁蛋白的相对风险（RR）和 95%置信区间（CI）为 GDM 2.19（1.42，3.39），TG 为 2.02（1.37，2.97）。组合的调整 RR 为 2.40（1.62，3.55）。此外，我们发现 TG 浓度介导了铁蛋白浓度对 GDM 风险的总效应的 15.0%。
铁蛋白（˃55.7ng/ml）和 TG（˃1.9mmol/L）水平均升高的女性患 GDM 的风险最高。此外，我们首次发现，妊娠早期母体 TG 浓度升高可介导铁蛋白浓度与 GDM 风险之间的关系。
本试验在 https://ClinicalTrials.gov 注册为 NCT03099837。
