School of Medicine, Jiangsu University, Zhenjiang 212013, China.
Department of Pharmacology, School of Medicine, Jiangsu University, Zhenjiang 212013, China.
Nutrients. 2023 Jun 16;15(12):2766. doi: 10.3390/nu15122766.
Maternal folate has been shown to relate to the risk of gestational diabetes mellitus (GDM). However, the existing studies have yielded inconsistent conclusions. The purpose of this study was to systematically review the association between maternal folate status and the risk of GDM. Observational studies up to 31 October 2022 were included. Study characteristics, the means and standard deviations (SDs) of folate levels (serum/red blood cell (RBC)), the odds ratios (ORs) with 95% confidence intervals (CIs) and the time for folate measurement were extracted. Compared with the non-GDM group, serum and RBC folate levels in women with GDM were significantly higher. Our subgroup analysis demonstrated that serum folate levels in the GDM group were significantly higher than in the non-GDM group only in the second trimester. RBC folate levels in the GDM group were significantly higher than in the non-GDM group in the first and second trimesters. Taking serum/RBC folate levels as continuous variables, the adjusted odds ratios of GDM risk showed that increased serum folate concentration rather than RBC folate elevated the risk of GDM. In the descriptive analysis, five studies reported high serum folate levels increased GDM risk, whereas the other five showed no association between serum folate levels and GDM risk. Moreover, the rest three studies pointed out high RBC folate levels increased GDM risk. Altogether we found that the risk of GDM is associated with high serum/plasma and RBC folate levels. Future studies should determine the recommended folic acid cutoff balancing the risk for GDM and fetal malformations.
母体叶酸与妊娠糖尿病（GDM）的风险有关。然而，现有的研究得出了不一致的结论。本研究旨在系统地回顾母体叶酸状况与 GDM 风险之间的关系。纳入截至 2022 年 10 月 31 日的观察性研究。提取研究特征、叶酸水平（血清/红细胞（RBC））的均值和标准差（SD）、比值比（OR）及其 95%置信区间（CI）和叶酸测量时间。与非 GDM 组相比，GDM 妇女的血清和 RBC 叶酸水平明显较高。我们的亚组分析表明，仅在孕中期，GDM 组的血清叶酸水平明显高于非 GDM 组。在孕早期和孕中期，GDM 组的 RBC 叶酸水平明显高于非 GDM 组。以血清/RBC 叶酸水平为连续变量，调整后的 GDM 风险 OR 表明，血清叶酸浓度的增加而不是 RBC 叶酸升高了 GDM 的风险。在描述性分析中，有五项研究报告说高血清叶酸水平增加了 GDM 的风险，而另外五项研究表明血清叶酸水平与 GDM 风险之间没有关联。此外，其余三项研究指出高 RBC 叶酸水平增加了 GDM 的风险。总的来说，我们发现 GDM 的风险与高血清/血浆和 RBC 叶酸水平有关。未来的研究应确定推荐的叶酸截止值，以平衡 GDM 和胎儿畸形的风险。
