Department of Epidemiology Shanxi Medical University School of Public Health, Taiyuan, China.
Center of Clinical Epidemiology and Evidence Based Medicine Shanxi Medical University, Taiyuan, China.
J Diabetes Res. 2024 Jul 13;2024:1298122. doi: 10.1155/2024/1298122. eCollection 2024.
Exposure to heavy metals has been suggested to increase the risk of gestational diabetes mellitus (GDM) through the oxidative stress pathway. The study is aimed at examining whether vitamin C could modify the association between exposure to heavy metals and risk of GDM. We conducted a case-control study in Taiyuan, China, with 776 GDM cases and 776 controls. Data on vitamin C intake from diet and supplements were collected through questionnaires. Concentrations of metals in participants' blood were measured using inductively coupled plasma-mass spectrometry (ICP-MS). Unconditional logistic regression models were applied to estimate effect modification of vitamin C on the association between heavy metals and GDM. Women with higher blood levels of mercury (Hg) (odds ratio (OR) = 2.36, 95% confidence interval (CI): 1.43, 3.92 and 2.04, 95% CI: 1.20, 3.46 for the second and third vs. the first tertile) and arsenic (As) (OR = 2.46, 95% CI: 1.37, 4.43 and 2.16, 95% CI: 1.12, 4.17 for the second and third vs. the first tertile) exposure were associated with increased risk of GDM among women without vitamin C supplement use and having dietary vitamin C intake < 85 mg/day. We found no significant association with metals among women who took vitamin C supplements and/or dietary vitamin C ≥ 85 mg/day. Significant interactions were observed between vitamin C and exposures to metals (i.e., Hg and As) on the risk of GDM ( = 0.048 and 0.045, respectively). Our study, for the first time, suggests that vitamin C supplement use or higher dietary vitamin C intake during preconception and early pregnancy could alleviate the risk of GDM associated with exposure to As and Hg. The results warrant further investigation.
重金属暴露通过氧化应激途径被认为会增加妊娠糖尿病（GDM）的风险。本研究旨在检验维生素 C 是否可以改变重金属暴露与 GDM 风险之间的关联。
我们在中国太原进行了一项病例对照研究，共纳入 776 例 GDM 病例和 776 例对照。通过问卷收集了来自饮食和补充剂的维生素 C 摄入量数据。使用电感耦合等离子体质谱法（ICP-MS）测量了参与者血液中的金属浓度。应用非条件 logistic 回归模型来估计维生素 C 对重金属与 GDM 之间关联的修饰作用。
在没有使用维生素 C 补充剂且膳食维生素 C 摄入量<85mg/天的女性中，较高的血液汞（Hg）水平（比值比（OR）=2.36，95%置信区间（CI）：1.43，3.92 和 2.04，95% CI：1.20，3.46 对于第二和第三 tertile 与第一 tertile 相比）和砷（As）（OR=2.46，95% CI：1.37，4.43 和 2.16，95% CI：1.12，4.17 对于第二和第三 tertile 与第一 tertile 相比）暴露与 GDM 风险增加相关。而在服用维生素 C 补充剂和/或膳食维生素 C≥85mg/天的女性中，与金属之间没有发现显著的关联。在 GDM 风险方面，观察到维生素 C 与金属（即 Hg 和 As）暴露之间存在显著的交互作用（ = 0.048 和 0.045）。
本研究首次表明，在孕前和孕早期补充维生素 C 或增加膳食维生素 C 摄入量可以减轻与 Hg 和 As 暴露相关的 GDM 风险。这些结果值得进一步研究。
