Maternal Iron Intake During Pregnancy and Gestational Diabetes Mellitus: A Prospective Cohort Study

Abstract Objectives Concerns relative to excessive iron intake are raised when high iron status exposure has been linked in observational studies to a greater risk of gestational diabetes mellitus (GDM). We aimed to examine the association between iron intake during pregnancy and GDM risk in Chinese women. Methods The study included 2174 pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC), a prospective cohort in Wuhan, China. Iron intakes from food and supplementation prior to GDM diagnosis were assessed using a validated food frequency questionnaire (FFQ) and a detailed supplement questionnaire collected at 13–28 weeks of gestation. GDM was ascertained by an oral glucose tolerance test at 24–28 weeks of gestation. Odd ratios (ORs) of GDM in relation to categories of iron intake (i.e., quartiles of total and food iron intake, categories of supplemental iron intake [0, 0–30, >30 mg/day]) were estimated using logistic regression models, with adjustment for demographic, dietary and lifestyle factors. Results A total of 242 (11.1%) women were diagnosed with GDM. The adjusted ORs (95% CIs) for the risk of GDM associated with the higher quartiles compared with the lowest quartile of total iron intake were 1.44 (0.89, 2.33), 2.03 (1.27, 3.25), and 2.86 (1.84, 4.43), respectively (P for trend < 0.001). This association was entirely driven by supplemental iron intake. Women with supplemental iron intake > 30 mg/day during pregnancy had an OR for GDM of 2.32 (95% CI: 1.60, 3.36). Moreover, the significant positive effect of supplemental iron was mainly attributed to iron supplementation during mid-pregnancy (≥60 vs. 0 mg/day, OR: 1.46, 95% CI: 1.00, 2.13), while no effect of iron supplementation during early pregnancy was observed. No significant association was found between food iron intake and GDM. Conclusions Higher supplemental iron intake during pregnancy was significantly associated with elevated GDM risk. Adverse effect of indiscriminate iron supplementation, especially inappropriate supplementation during mid-pregnancy, would likely outweigh benefits for maternal health. Funding Sources Funding was received from the National Natural Science Foundation of China (NSFC81673159), National Program on Basic Research Project of China (NO.2013FY114200) and the Fundamental Research Funds for the Central Universities (HUST 2019kfyXMPY008) (Nianhong.Yang.).

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The overall plant-based diet index during pregnancy and risk of gestational diabetes mellitus: a prospective cohort study in China

British Journal Of Nutrition ◽

10.1017/s0007114521000234 ◽

2021 ◽

pp. 1-10

Author(s):

Huanzhuo Wang ◽

Li Huang ◽

Lixia Lin ◽

Xi Chen ◽

Chunrong Zhong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Prospective Cohort ◽

Chinese Women ◽

Tolerance Test ◽

Oral Glucose ◽

Food Groups ◽

Logistic Regression Models ◽

Social Demographic

Abstract The high overall plant-based diet index (PDI) is considered to protect against type 2 diabetes in the general population. However, whether the PDI affects gestational diabetes mellitus (GDM) risk among pregnant women is still unclear. We evaluated the association between PDI and GDM risk based on a Chinese large prospective cohort – the Tongji Maternal and Child Health Cohort. Dietary data were collected at 13–28 weeks of pregnancy by a validated semi-quantitative FFQ. The PDI was obtained by assigning plant food groups positive scores while assigning animal food groups reverse scores. GDM was diagnosed by a 75 g 2-h oral glucose tolerance test at 24–28 weeks of gestation. Logistic regression models were fitted to estimate OR of GDM, with associated 95 % CI, comparing women in different PDI quartiles. Among the total 2099 participants, 169 (8·1 %) were diagnosed with GDM. The PDI ranged from 21·0 to 52·0 with a median of 36·0 (interquartile range (IQR) 33·0–39·0). After adjusting for social-demographic characteristics and lifestyle factors etc., the participants with the highest quartile of PDI were associated with 57 % reduced odds of GDM compared with women in the lowest quartile of PDI (adjusted OR 0·43; 95 % CI 0·24, 0·77; Pfor trend = 0·005). An IQR increment in PDI was associated with 29 % decreased odds of GDM (adjusted OR 0·71; 95 % CI 0·56, 0·90). Findings suggest that adopting a plant-based diet during pregnancy could reduce GDM risk among Chinese women, which may be valuable for dietary counselling during pregnancy.

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Valuable predictors of gestational diabetes mellitus in infertile Chinese women with polycystic ovary syndrome: a prospective cohort study

Gynecological Endocrinology ◽

10.1080/09513590.2017.1290074 ◽

2017 ◽

Vol 33 (6) ◽

pp. 448-451 ◽

Cited By ~ 3

Author(s):

Hexia Xia ◽

Ruixiu Zhang ◽

Xiaoli Sun ◽

Lu Wang ◽

Wei Zhang

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Gestational Diabetes ◽

Polycystic Ovary Syndrome ◽

Gestational Diabetes Mellitus ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Chinese Women ◽

Polycystic Ovary ◽

Ovary Syndrome

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Associations of dietary habits, physical activity and cognitive views with gestational diabetes mellitus among Chinese women

Public Health Nutrition ◽

10.1017/s1368980013001882 ◽

2013 ◽

Vol 17 (8) ◽

pp. 1850-1857 ◽

Cited By ~ 5

Author(s):

Qing Li ◽

Ribo Xiong ◽

Liang Wang ◽

Junying Cui ◽

Linna Shi ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Dietary Habits ◽

Chinese Women ◽

Multiple Logistic Regression Analysis ◽

Oral Glucose ◽

Morning Sickness ◽

Increased Risk

AbstractObjectiveTo evaluate the relationship between dietary habits, physical activity and cognitive views and the risk of gestational diabetes mellitus (GDM) in Chinese women.DesignA cross-sectional study to explore the potential risk factors of GMD through the International Physical Activity Questionnaire, an FFQ and a self-designed structured questionnaire, respectively.SettingGuangzhou, Guangdong Province, China.SubjectsChinese pregnant women (n 571) who underwent a 75-g oral glucose tolerance test at their 24th to 28th gestational week.ResultsThirteen per cent of the investigated women were identified as having GDM, and an increased intake of local featured foods and lower physical activity were observed in the GDM-positive group v. the GDM-negative group. Women who regarded early-pregnancy morning sickness as relevant to fetal abnormalities and those with unlimited dietary intake after the ending of morning sickness both had an increased risk for GDM (P = 0·018 and P = 0·038, respectively). After multiple logistic regression analysis, cognitive views for unlimited food intake subsequent to morning sickness, increased consumption of energy-dense snack foods and high-glycaemic-index fruits were strongly associated with the risk of GDM (OR = 1·911, P = 0·032; OR = 1·050, P = 0·001; and OR = 1·002, P = 0·017, respectively).ConclusionsLocal featured foods and incorrect cognitive views on pregnancy-related health were closely related to the risk of GDM in Chinese women. Intensive health education about pregnancy physiology and reasonable dietary and physical exercise behaviours should be strengthened for the control of GDM.

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The Overall Plant-based Diet Index During Pregnancy and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_074 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 574-574

Author(s):

Huanzhuo Wang ◽

Li Huang ◽

Chunrong Zhong ◽

Renjuan Chen ◽

Xuezhen Zhou ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Smoking Status ◽

Basic Research ◽

Food Group ◽

Oral Glucose ◽

Food Groups ◽

Family History Of Diabetes

Abstract Objectives The overall plant-based diet index (PDI) has been demonstrated to be protective against type 2 diabetes (T2D) in the general population. Whether the PDI was linked to gestational diabetes mellitus (GDM) is unclear. We aimed to assess the association of the PDI with GDM incidence in Chinese pregnant women. Methods A total of 2099 pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) were included in the present study. Dietary data were collected at 13–28 wks of pregnancy by using a validated semi-quantitative food frequency questionnaire (FFQ). Food groups including cereals, fruits, vegetables, nuts, beans, vegetable oil, dairy, eggs, meat, and fish, were ranked into quintiles and given positive (1–5 for plant food groups) or reverse (5–1 for animal food groups) scores. The PDI was obtained by summing the 10 food group scores, with a theoretical range of 10 to 50. GDM was diagnosed by the 75-g 2-h oral glucose tolerance test at 24–28 wks. Cubic-restricted spline function and logistic regression analyses were used to examine the association between the PDI during pregnancy and GDM. Results GDM was reported by 8.1% of the 2099 pregnancies. The PDI score ranged from 17 to 43 (theoretical range: 10–50), the mean (SD) was 30.2 (4.4). After adjusting for maternal age, ethnicity, education, income, parity, gravidity, family history of diabetes, total energy intake per day, and other pre-pregnancy information such as body mass index (BMI), smoking status, drinking status, exercise, and sleep quality, a linear association between the PDI and GDM risk was demonstrated by the restricted cubic splines (P for overall association = 0.024, P for nonlinearity = 0.370). Compared to the lowest quartile 1 of PDI, ORs (95% CI) were 0.91 (0.59, 1.42) for quartile 2, 0.91 (0.58, 1.41) for quartile 3, and 0.52 (0.30, 0.89) for quartiles 4 (P for trend = 0.040) in the adjusted model. Conclusions Our study suggests that higher PDI is associated with a substantially lower risk of developing GDM, which indicates that adopt plant-based diets during pregnancy could be an easy avenue to reduce GDM risk. Funding Sources Funding was received from the National Program on Basic Research Project of China (NO.2013FY114200) and the Fundamental Research Funds for the Central Universities (HUST2016YXZD040) for Nianhong Yang.

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C-reactive protein as a screening test for gestational diabetes mellitus in first-trimester of pregnancy: a prospective cohort study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184922 ◽

2018 ◽

Vol 7 (12) ◽

pp. 4798 ◽

Cited By ~ 1

Author(s):

Tarek A. Farghaly ◽

Neveen A. Helmy ◽

Ahmed M. Abbas ◽

Abdel Ghaffar M. Ahmed

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

First Trimester ◽

Oral Glucose ◽

C Reactive Protein ◽

Reactive Protein

Background: The current study aims to determine if increased inflammation identified by increased C-reactive protein (CRP) level is associated with the subsequent development of gestational diabetes mellitus (GDM).Methods: A prospective cohort study conducted at a tertiary University Hospital included 496 booking for their antenatal care visit between 10-12 weeks of gestation. They were tested for presence of CRP in blood. All women without a history of antenatal type 1 or type 2 diabetes undergo routine GDM screening with the 50-g oral glucose-loading test (GLT) between 24 and 28 weeks 'gestation. Women whose 1-h post-loading plasma glucose level >7.8 mmol/l (>140 mg/dl) undergo a diagnostic, fasting, 100-g, 3-h oral glucose tolerance test (OGTT) within 1-2 weeks following the GLT.Results: Among these 496 women, a total of 27 women (5.4%) were diagnosed as GDM and 10 women (2.0%) were diagnosed as IGT at week 24-28. The CRP was positive and higher in the GDM diagnosed group (p=0.000) compared to those who did not develop GDM. CRP was positively correlated with diagnosis of GDM (r=0.438, p=0.012).Conclusions: There is an association between first-trimester inflammation, marked by increased CRP levels and subsequent risk of GDM.

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Reduced GLP-1 Secretion at 30 Minutes After a 75-g Oral Glucose Load Is Observed in Gestational Diabetes Mellitus: A Prospective Cohort Study

Diabetes ◽

10.2337/db18-0254 ◽

2018 ◽

Vol 67 (12) ◽

pp. 2650-2656 ◽

Cited By ~ 4

Author(s):

Nithya Sukumar ◽

Christos Bagias ◽

Ilona Goljan ◽

Yonas Weldeselassie ◽

Seley Gharanei ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Oral Glucose ◽

Oral Glucose Load ◽

Glucose Load

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The Association between Maternal/Fetal Insulin Receptor Substrate 1 Gene Polymorphism rs1801278 and Gestational Diabetes Mellitus in a Chinese Population

Gynecologic and Obstetric Investigation ◽

10.1159/000514971 ◽

2021 ◽

pp. 1-8

Author(s):

Lingling Wu ◽

Changping Fang ◽

Jun Zhang ◽

Yanchou Ye ◽

Haiyan Zhao

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gene Polymorphism ◽

Gestational Diabetes Mellitus ◽

Insulin Receptor ◽

Tolerance Test ◽

Oral Glucose ◽

Insulin Receptor Substrate ◽

Single Center ◽

Insulin Receptor Substrate 1

Objectives: Insulin receptor substrate 1 (IRS1) is a crucial factor in the insulin signaling pathway. IRS1 gene polymorphism rs1801278 in mothers has been reported to be associated with gestational diabetes mellitus (GDM). However, it is not clear whether IRS1 gene polymorphism rs1801278 in fetuses is associated with their mothers’ GDM morbidity. The purpose of this study is to analyze the association between maternal, fetal, or maternal/fetal IRS1 gene polymorphism rs1801278 and GDM risk. Design: The study was a single-center, prospective cohort study. In total, 213 pairs of GDM mothers/fetuses and 191 pairs of control mothers/fetuses were included in this study. They were recruited after they underwent oral glucose tolerance test during 24–28 weeks of gestation and followed up until delivery. All participants received the conventional interventions (diet and exercise), and no special therapy except routine treatment. Methods: A total of 213 pairs of GDM mothers/fetuses and 191 pairs of normal blood glucose pregnant mothers/fetuses were genotyped using PCR and DNA sequencing from January 2015 to September 2016. Maternal/fetal IRS1 gene polymorphism rs1801278 was analyzed and compared between 2 groups. Results: There were no significant differences in the frequency of individual mothers’ or fetuses’ IRS1 rs1801278 polymorphisms between 2 groups; if both the mothers and fetuses carried A allele, significantly lower GDM morbidity was observed in the mothers. Limitations: The sample size was relatively small as a single-center study. Conclusions: Our study suggested that maternal/fetal rs1801278 polymorphism of IRS1 is a modulating factor in GDM; both mothers/fetuses carrying the A allele of rs1801278 may protect the mothers against the development of GDM.

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Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study

Nutrients ◽

10.3390/nu13020408 ◽

2021 ◽

Vol 13 (2) ◽

pp. 408

Author(s):

Sumali S. Hewage ◽

Xin Yu Hazel Koh ◽

Shu E. Soh ◽

Wei Wei Pang ◽

Doris Fok ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Tolerance Test ◽

Diabetes Risk ◽

Breastfeeding Duration ◽

Oral Glucose ◽

Inverse Association ◽

Index Pregnancy

(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.

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