International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine.
Nutrition. 2024 Jun;122:112383. doi: 10.1016/j.nut.2024.112383. Epub 2024 Feb 2.
With increasingly prevalent folic acid consumption in early pregnancy, concerns about its potentially negative effect on maternal metabolism have been raised. Recent findings regarding folic acid levels in the first trimester and the risk of gestational diabetes mellitus have been inconclusive. The aim of this study was to investigate the association of folic acid status in early pregnancy with gestational diabetes mellitus as well as examine whether glucose levels can be modulated by folic acid status during the same first trimester.
This was a retrospective cohort study based on 27 128 Chinese pregnant women who registered during their first prenatal visit from January 2015 to December 2019. Serum folic acid and fasting blood glucose concentrations were measured during the 9th to 13th gestational weeks. Binary logistic regression was applied to estimate the odds ratios of gestational diabetes mellitus by using the serum folic acid levels quartiles with adjustment for major confounders. To investigate the potential effect of modifying key risk factors for gestational diabetes mellitus, we established subgroups, in which analyses were stratified by age (<25, 25-29, 30-34, and ≥35 y), parity (nulliparous and parous), prepregnancy body mass index (< 18.5, 18.5-23.9, and ≥ 24 kg/m), and family history of diabetes (yes and no).
The positive association between maternal folate concentrations and fasting blood glucose was observed: the risk for hyperglycemia was higher in those in the middle (Q3) and higher (Q4) quartiles compared with those in Q1 and Q2. A higher risk for gestational diabetes mellitus was found in hyperglycemia of early pregnant women with high folate concentrations (Q3: odds ratio = 5.63; 95% CI, 4.56-6.95, and Q4: odds ratio = 5.57; 95% CI, 4.68-6.64) compared with normal fasting glucose mothers with folate concentrations in Q1 and Q2 after accounting for multiple covariables. Similar patterns were observed for different subgroups. Restricted cubic spline plots had a positive correlation of serum folic acid level with fasting blood glucose concentration as well as risk of gestational diabetes mellitus in a nonlinear pattern, with 32.5 nmol/L as the cutoff point for folic acid level.
Our findings underscore the importance of maintaining an appropriate folic acid concentration for preserving a lower risk of gestational diabetes mellitus, especially in women with relatively higher blood glucose in early pregnancy. Additionally, folic acid concentration > 32.5 nmol/L may be considered a risk factor for gestational diabetes mellitus. This research suggested that folic acid levels should be monitored during the first trimester from the first prenatal checkup to prevent adverse effects of excessive folic acid intake.
随着孕早期叶酸摄入的日益普及，人们对其可能对母体代谢产生负面影响的担忧日益增加。最近关于孕早期叶酸水平与妊娠期糖尿病风险的研究结果尚无定论。本研究旨在探讨孕早期叶酸状况与妊娠期糖尿病的关系，并研究在同一孕早期，血糖水平是否可以通过叶酸状况来调节。
这是一项基于 27128 名中国孕妇的回顾性队列研究，这些孕妇于 2015 年 1 月至 2019 年 12 月在首次产前检查期间登记。在孕 9 至 13 周时测量血清叶酸和空腹血糖浓度。采用二元逻辑回归，在调整主要混杂因素后，使用血清叶酸水平四分位数来估计妊娠期糖尿病的优势比。为了研究对妊娠期糖尿病的潜在关键风险因素的修饰作用，我们建立了亚组，其中按年龄（<25、25-29、30-34 和≥35 岁）、产次（初产妇和经产妇）、孕前体重指数（<18.5、18.5-23.9 和≥24 kg/m）和糖尿病家族史（是和否）进行分层分析。
母亲叶酸浓度与空腹血糖之间存在正相关关系：与 Q1 和 Q2 相比，Q3 和 Q4 中位数的孕妇发生高血糖的风险更高。与 Q1 和 Q2 中位数的正常空腹血糖母亲相比，高叶酸浓度的孕妇（Q3：比值比=5.63；95%CI，4.56-6.95，Q4：比值比=5.57；95%CI，4.68-6.64）在孕早期血糖升高时，发生妊娠期糖尿病的风险更高，考虑到多个协变量后。在不同的亚组中也观察到了类似的模式。限制三次样条图显示，血清叶酸水平与空腹血糖浓度以及妊娠期糖尿病的风险呈非线性正相关，叶酸水平的截断点为 32.5 nmol/L。
我们的研究结果强调了保持适当的叶酸浓度对于降低妊娠期糖尿病风险的重要性，特别是对于孕早期血糖相对较高的妇女。此外，叶酸浓度>32.5 nmol/L 可能是妊娠期糖尿病的一个危险因素。这项研究表明，在首次产前检查时，应在孕早期监测叶酸水平，以防止过量摄入叶酸的不良影响。
