Association away from Maternal Folate and Supplement B12 at the beginning of Pregnancy That have Gestational All forms of diabetes Mellitus: A potential Cohort Analysis

Xiaotian Chen, Yi Zhang, Hongyan Chen, Yuan Jiang, Yin Wang, Dingmei Wang, Mengru Li, Yalan Dou, Xupeng Sun, Guoying Huang, Weili Yan; Association of Maternal Folate and Vitamin B₁₂ in Early Pregnancy With Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care ; 44 (1): 217–223.

The data of this study were from a subcohort within the Shanghai Preconception Cohort Study. We included pregnancies with red blood cell (RBC) folate and vitamin B₁₂ measurements at recruitment (between 9 and 13 gestational weeks) and those with three samples available for glucose measurements under an oral glucose tolerance test. GDM was diagnosed between 24 and 28 weeks’ gestation. Odds ratio (OR) and 95% CI of having GDM was used to quantify the association.

A total of 1,058 pregnant women were included, and GDM occurred in 180 (%). RBC folate and vitamin B₁₂ were significantly higher in pregnancies with GDM than those without GDM (P values were 0.045 and 0.002, respectively) and positively correlated with 1-h and 2-h serum glucose. Daily folic acid supplementation in early pregnancy increases the risk of GDM; OR (95% CI) was 1.73 (1.19–2.53) (P = 0.004)pared with RBC folate <400 ng/mL, pregnancies with RBC folate ?600 ng/mL were associated with ?1.60-fold higher odds of GDM; the adjusted OR (95% CI) was 1.58 (1.03–2.41) (P = 0.033). A significant development of risk effect on GDM risk across categories of RBC folate was observed (P_trend = 0.021). Vitamin B₁₂ was significantly associated with GDM risk (OR 1.14 per 100 pg/mL; P = 0.002). No significant association of serum folate and percentile ratio of RBC folate/vitamin B₁₂ with GDM was observed.

Higher maternal RBC folate and vitamin B₁₂ levels in early pregnancy are significantly associated with GDM risk, while the balance of folate/vitamin B₁₂ is not significantly associated with GDM.

Introduction

As among the popular pregnancy complications, gestational all forms of diabetes mellitus (GDM) influences ?17% of pregnancies internationally (1). Into the China, ?dos.9 mil expectant mothers have problems with this condition (2). GDM have enough time-term adverse effects in both mothers and you may children (3). Even with the major difficulties, brand new analysis off GDM isn’t performed till the late 2nd otherwise very early third trimester (4). Examining convertible risk activities at the beginning of maternity stage would much more significantly subscribe early avoidance out-of GDM.

Folate and vitamin B₁₂, metabolically entwined during one-carbon metabolism, are both key nutrients in early pregnancy and involved in the DNA methylation and cell metabolism (5–7). Folic acid supplementation (FAS) of 0.4 mg/day is conventionally recommended for women of the childbearing age before and during the first trimester of pregnancy for the essential role of folate in the prevention of neural tube defects (NTDs) (8,9). The mandatory folic acid fortification aimed to alleviate micronutrient deficiencies has been implemented by >50 countries (10). Nevertheless, the relationship between folate and GDM risk with inconsistent findings has emerged as a field of interest. The Nurses’ Health Study II including 14,533 women has observed that FAS before pregnancy is associated with a lower risk of GDM (11); in contrast, another cohort study gave opposite conclusions that daily folic acid intake in early pregnancy increased the risk of GDM (12), reminding us that the association of folate with GDM is still equivocal.

In contrast to solution folate, yellow bloodstream cell (RBC) folate reacts much slower in order to changes in folate consumption and you may signifies the new long-title folate status, due to the fact erythrocytes possess a 120-time life time and only gather folate throughout the erythropoiesis (13). Just like the solution folate try a sign of the latest folate consumption and are considerably influenced by FAS, such situation-handle scientific studies are at the mercy of prejudice produced from weight loss folic acid (13). As such, investigating the newest association of RBC folate having GDM are certainly more helpful to elucidate new much time-title coverage out-of folate and you may GDM risk. A great 15-seasons national cohort noticed higher RBC folate is in the an enthusiastic enhanced danger of death one of people which have diabetes (14). Xie mais aussi al. (15) discovered maternal RBC folate concentrations in the 2nd trimester notably when you look at the association which have an increased chance of GDM, which is recognized in the same period of pregnancy. Whether maternal RBC folate publicity during the early maternity from the occurrence of GDM has not been investigated.