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Joint effect of maternal pre-pregnancy body mass index and folic acid supplements on gestational diabetes mellitus risk: a prospective cohort study
BMC Pregnancy and Childbirth ( IF 3.1 ) Pub Date : 2023-03-23 , DOI: 10.1186/s12884-023-05510-y
Minyu Li 1 , Lijiang Wang 2 , Zhanhui Du 2 , Qianqian Shen 3 , Lu Jiang 2 , Lun Sui 2 , Nan Zhang 2 , Hong Wang 1 , Guoju Li 2, 4
Affiliation  

The joint effect of folic acid (FA) supplements and maternal pre-pregnancy body mass index (BMI) on gestational diabetes mellitus (GDM) has not been fully addressed. This study aimed to examine the joint effect of FA supplements and pre-pregnancy BMI on GDM. Pregnant women at 4 to 14 weeks of gestation (n = 3186) were recruited during their first prenatal visit in Qingdao from May 1, 2019, to June 27, 2021. The main outcome was GDM at 24–28 weeks’ gestation. Screening was based on 75 g 2-hour oral glucose tolerance (OGTT), a fasting glucose ≥ 5.1 mmol/L, or a 1-hour result ≥ 10.0 mmol/L, or a 2-hour result ≥ 8.5 mmol/L. The interactive effect of FA supplements and pre-pregnancy BMI on GDM was examined using logistic regression analysis and ratio of odds ratios (ROR) was used to compare subgroup differences. Overall, 2,095 pregnant women were included in the analysis, and GDM incidence was 17.76%. Compared with women with pre-pregnancy BMI lower than 25.0 kg/m2 and FA-Sufficient supplements ≥ 400 µg/day (FA-S) population, the adjusted odds ratios (aORs) of FA-S and FA-Deficiency supplements < 400 µg/d (FA-D) were 3.57 (95% confidence interval [CI]: 2.02–6.34) and 10.82 (95% CI: 1.69–69.45) for the obese women (BMI ≥ 30.0 kg/m2), and the aORs of FA-S and FA-D were 2.17 (95% CI: 1.60–2.95) and 3.27 (95% CI: 1.55–6.92) for overweight women (25.0 kg/m2 ≤ BMI < 30.0 kg/m2). However, the risk of GDM did not differ significantly between the FA-D and the FA-S group in pre-pregnancy obese women (ROR = 2.70, 95%CI: 0.47–2.30), or overweight women (ROR = 0.66, 95%CI: 0.30–1.49). After further stratification of FA supplementation time, F-D and FA-S in obese women showed an interaction when FA supplement intake time < 3 months. However, there was no significant difference between subgroups (ROR = 1.63, 95% CI: 0.37–7.04). Maternal pre-pregnancy BMI was associated with the incidence of GDM, the dose of FA supplementation from pre-pregnancy to early pregnancy was not found to be related to the incidence of GDM. The dosage of FA supplement was not associated with GDM irrespective of maternal pre-pregnancy BMI.

中文翻译:

母亲孕前体重指数和叶酸补充剂对妊娠糖尿病风险的联合影响:一项前瞻性队列研究

叶酸 (FA) 补充剂和孕妇孕前体重指数 (BMI) 对妊娠糖尿病 (GDM) 的联合影响尚未得到充分解决。本研究旨在检查 FA 补充剂和孕前 BMI 对 GDM 的联合影响。在 2019 年 5 月 1 日至 2021 年 6 月 27 日期间在青岛进行第一次产前检查期间招募了妊娠 4 至 14 周的孕妇(n = 3186)。主要结果是妊娠 24-28 周时的 GDM。筛选基于 75 g 2 小时口服葡萄糖耐量 (OGTT)、空腹血糖 ≥ 5.1 mmol/L,或 1 小时结果 ≥ 10.0 mmol/L,或 2 小时结果 ≥ 8.5 mmol/L。使用逻辑回归分析检查 FA 补充剂和孕前 BMI 对 GDM 的交互作用,并使用比值比 (ROR) 的比率来比较亚组差异。总的来说,2,095名孕妇纳入分析,GDM发生率为17.76%。与孕前 BMI 低于 25.0 kg/m2 且 FA 充足补充剂 ≥ 400 µg/天 (FA-S) 的女性相比,FA-S 和 FA 缺乏补充剂 < 400 µg 的调整后比值比 (aOR) /d (FA-D) 对于肥胖女性 (BMI ≥ 30.0 kg/m2) 分别为 3.57(95% 置信区间 [CI]:2.02-6.34)和 10.82(95% CI:1.69-69.45),aOR 为对于超重女性(25.0 kg/m2 ≤ BMI < 30.0 kg/m2),FA-S 和 FA-D 分别为 2.17(95% CI:1.60-2.95)和 3.27(95% CI:1.55-6.92)。然而,在孕前肥胖女性(ROR = 2.70, 95%CI: 0.47–2.30)或超重女性(ROR = 0.66, 95 %CI:0.30–1.49)。FA补充时间进一步分层后,当 FA 补充摄入时间 < 3 个月时,肥胖女性的 FD 和 FA-S 表现出相互作用。然而,亚组之间没有显着差异(ROR = 1.63,95% CI:0.37–7.04)。孕妇孕前BMI与GDM的发生率相关,未发现从孕前至早孕的FA补充剂量与GDM的发生率相关。FA 补充剂的剂量与 GDM 无关,与孕妇孕前 BMI 无关。
更新日期:2023-03-23
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