Sulhariza Husni Zain, Zalilah Mohd Shariff, Geeta Appannah
Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
Institute of Public Health, National Institute of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.
Front Nutr. 2023 Jun 15;10:1197485. doi: 10.3389/fnut.2023.1197485. eCollection 2023.
The accrual of iron that is reflected in high maternal hemoglobin (Hb) status is increasingly recognized as a risk factor for gestational diabetes mellitus (GDM). Changes in maternal Hb level could also implicate glycemic status in pregnancy. This study aimed to determine the associations between maternal Hb levels and their changes with GDM.
In this retrospective cohort study, a total of 1,315 antenatal records of mothers with singleton pregnancies from eight health clinics of a district in the northern region of Peninsular Malaysia who delivered between 1st January 2016-31st December 2017 were analyzed. Data extracted from the records were socio-demographic, anthropometric, obstetrical, and clinical data. Hb levels were extracted at booking (<14 weeks) and second trimester (14-28 weeks). Change in Hb was determined by subtracting the Hb level in the second trimester from the booking Hb level and was categorized as decreased, unchanged, and increased Hb. The associations between maternal Hb levels and their changes with GDM risk were analyzed using multiple regression, adjusting for covariates in four different models. Model 1: maternal age and height. Model 2: covariates of Model 1 added with parity, history of GDM, and family history of diabetes. Model 3: covariates of Model 2 added with iron supplementation at booking. Model 4: covariates of Model 3 added with Hb level at booking.
Unchanged Hb level from booking to second trimester was significantly associated with GDM risk in Model 1 (AOR: 2.55; 95% CI: 1.20, 5.44; < 0.05), Model 2 (AOR: 2.45, 95% CI: 1.13, 5.34; < 0.05) Model 3 (AOR: 2.42; 95% CI: 1.11, 5.27; < 0.05), and Model 4 (AOR: 2.51; 95% CI: 1.15, 5.49; p < 0.05). No significant associations were observed between maternal Hb levels and GDM in the study.
Unchanged Hb levels from the booking (<14 weeks of gestation) to the second trimester (14-28 weeks) increased GDM risk. Further investigation is warranted to evaluate the associations between changes in maternal Hb and GDM risk and to identify potential factors influencing this relationship.
孕期母体血红蛋白（Hb）水平升高所反映的铁蓄积日益被认为是妊娠期糖尿病（GDM）的一个危险因素。母体Hb水平的变化也可能与孕期血糖状况有关。本研究旨在确定母体Hb水平及其变化与GDM之间的关联。
在这项回顾性队列研究中，分析了马来西亚半岛北部一个地区八家健康诊所的1315例单胎妊娠母亲的产前记录，这些母亲在2016年1月1日至2017年12月31日期间分娩。从记录中提取的数据包括社会人口统计学、人体测量学、产科和临床数据。在孕早期（<14周）和孕中期（14 - 28周）提取Hb水平。Hb变化通过用孕早期Hb水平减去孕中期Hb水平来确定，并分为Hb降低、不变和升高。使用多元回归分析母体Hb水平及其变化与GDM风险之间的关联，并在四个不同模型中对协变量进行调整。模型1：母体年龄和身高。模型2：在模型1的协变量基础上增加产次、GDM病史和糖尿病家族史。模型3：在模型2的协变量基础上增加孕早期补铁情况。模型4：在模型3的协变量基础上增加孕早期Hb水平。
在模型1（比值比[AOR]：2.55；95%置信区间[CI]：1.20，5.44；P<0.05）、模型2（AOR：2.45，95%CI：1.13，5.34；P<0.05）、模型3（AOR：2.42；95%CI：1.11，5.27；P<0.05）和模型4（AOR：2.51；95%CI：1.15，5.49；P<0.05）中，从孕早期到孕中期Hb水平不变与GDM风险显著相关。在本研究中，未观察到母体Hb水平与GDM之间存在显著关联。
从孕早期（妊娠<14周）到孕中期（14 - 28周）Hb水平不变会增加GDM风险。有必要进一步研究以评估母体Hb变化与GDM风险之间的关联，并确定影响这种关系的潜在因素。
