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Long BY, Liang X. Dietary management of gestational diabetes: A review. Medicine (Baltimore) 2024; 103:e38715. [PMID: 38996126 PMCID: PMC11245252 DOI: 10.1097/md.0000000000038715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/06/2024] [Indexed: 07/14/2024] Open
Abstract
Gestational diabetes mellitus (GDM) is a common condition in pregnant women that can affect the health of both the mother and the fetus. A healthy diet reduces the risk of GDM, while on the contrary, an unhealthy diet can increase the risk of developing GDM. Dietary interventions remain an important way to control GDM at this time. However, real-life diets are complex and varied, and the effect of these diets on gestational diabetes is unknown. This article summarizes research related to dietary control of GDM. Hopefully, this will help with dietary interventions for people with GDM.
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Affiliation(s)
- Bin-Yang Long
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Liang
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Reproductive Maternity and Childhood Hospital Affiliated to Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Ramijinni RR, Mahajan A, Sapehia D, Singh P, Suri V, Kaur J. Association of Altered Ratio of Maternal Folic Acid and Vitamin B12 during Pregnancy with Newborn Birth Weight, Head Circumference, and Chest Circumference. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:452-463. [PMID: 38289269 DOI: 10.1080/27697061.2024.2307980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/16/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE This study evaluated the effect of an altered ratio of maternal RBC folate (MRF) to serum vitamin B12 (MB12) on pregnancy and newborn outcomes. METHODS Blood samples were collected from pregnant women and the umbilical cord at the time of delivery. Estimations of RBC folate and serum vitamin B12 from maternal and cord blood samples and total homocysteine (HCY) were performed. Maternal and newborn anthropometric parameters like placental weight (PW), head circumference (HC), chest circumference (CC), and body weight (BW) were measured in offsprings after birth. We stratified the pregnant women into six groups (a) vitamin B12 normal and folic acid normal (BNFN)-control group, (b) vitamin B12 normal and folic acid elevated (BNFE), (c) vitamin B12 normal and folic acid deficient (BNFD), (d) vitamin B12 deficient and folic acid normal (BDFN), (e) vitamin B12 deficient and folic acid elevated (BDFE) and (f) vitamin B12 deficient and folic acid deficient (BDFD) based on their levels of RBC folate (MRF) and vitamin B12 (MB12). The expression of the one-carbon metabolism genes (methionine synthase (MS), glycine N-methyltransferase (GNMT), and cystathionine β-synthase (CBS) was also studied in placental tissue by using real-time PCR. RESULTS Cord blood RBC folate was significantly reduced in groups BDFE and BDFD as compared to the control group (BNFN). The cord blood vitamin B12 levels were also reduced in the BDFE group as compared to the BDFD. All the newborn parameters viz. PW, HC, CC, and BW, were reduced in the altered MRF/MB12 ratio (low & high vs. normal ratio). Total HCY was significantly elevated in the groups with (BDFE & BDFN) an imbalance of maternal RBC folate and serum vitamin B12 as compared to the control group. Downregulation of one-carbon metabolism genes like MS (p < 0.001), GNMT (p < 0.05), and CBS (p < 0.01) in placental tissue was observed in the high MRF/MB12 ratio group as compared to the normal ratio group. A strong positive correlation was also observed between MRF, MB12, and newborn parameters. CONCLUSIONS The altered ratio of folate to vitamin B12 in the maternal blood is associated with adverse growth and development of the newborn.
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Affiliation(s)
- Ramji Rao Ramijinni
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aatish Mahajan
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divika Sapehia
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parampal Singh
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyotdeep Kaur
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Zhang C, Liu Z, Sun K, Zhao J, Huang H, Zhang C. Association of serum folic acid levels in response to fasting blood glucose in early pregnancy with the risk of gestational diabetes mellitus: A retrospective cohort study. Nutrition 2024; 122:112383. [PMID: 38422754 DOI: 10.1016/j.nut.2024.112383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE 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. METHODS 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/m2), and family history of diabetes (yes and no). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Chenjie Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaonan Liu
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine
| | - Kuan Sun
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine
| | - Junfei Zhao
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hefeng Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Institute of Reproduction and Development, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Chen Zhang
- Institute of Reproduction and Development, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Duan X, Hu H, Wang L, Chen L. Aldehyde dehydrogenase 1 family: A potential molecule target for diseases. Cell Biol Int 2024. [PMID: 38800962 DOI: 10.1002/cbin.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/22/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
Aldehyde dehydrogenase 1 (ALDH1), a crucial aldehyde metabolizing enzyme, has six family members. The ALDH1 family is expressed in various tissues, with a significant presence in the liver. It plays a momentous role in several pathophysiological processes, including aldehyde detoxification, oxidative stress, and lipid peroxidation. Acetaldehyde detoxification is the fundamental function of the ALDH1 family in participating in vital pathological mechanisms. The ALDH1 family can catalyze retinal to retinoic acid (RA) that is a hormone-signaling molecule and plays a vital role in the development and adult tissues. Furthermore, there is a need for further and broader research on the role of the ALDH1 family as a signaling molecule. The ALDH1 family is widely recognized as a cancer stem cell (CSC) marker and plays a significant role in the proliferation, invasion, metastasis, prognosis, and drug resistance of cancer. The ALDH1 family also participates in other human diseases, such as neurodegenerative diseases, osteoarthritis, diabetes, and atherosclerosis. It can inhibit disease progression by inhibiting/promoting the expression/activity of the ALDH1 family. In this review, we comprehensively analyze the tissue distribution, and functions of the ALDH1 family. Additionally, we review the involvement of the ALDH1 family in diseases, focusing on the underlying pathological mechanisms and briefly talk about the current status and development of ALDH1 family inhibitors. The ALDH1 family presents new possibilities for treating diseases, with both its upstream and downstream pathways serving as promising targets for therapeutic intervention. This offers fresh perspectives for drug development in the field of disease research.
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Affiliation(s)
- Xiangning Duan
- Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, Hengyang Medical School, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Institute of Pharmacy and Pharmacology, University of South China, Hengyang, Hunan, China
| | - Haoliang Hu
- Changde Research Centre for Artificial Intelligence and Biomedicine, Zoology Key Laboratory of Hunan Higher Education, College of Life and Environmental Sciences, Hunan University of Arts and Science, Changde, Hunan, China
| | - Lingzhi Wang
- Department of Pharmacy, The First Affiliated Hospital of Jishou University, Jishou, Hunan, China
| | - Linxi Chen
- Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, Hengyang Medical School, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Institute of Pharmacy and Pharmacology, University of South China, Hengyang, Hunan, China
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Guo G, Chen X, Zhang J, Meng X, Jia A, Xing X, Huang F, Zhang X, Liu J, Li S, Zhang Q. Serum Folate and Vitamin B 12 Modify the Associations of N6AMT1 Genetic Variants with Gestational Diabetes Mellitus: A Cross-Sectional Study in Chinese Pregnant Women. Diabetes Metab Syndr Obes 2024; 17:1781-1791. [PMID: 38645658 PMCID: PMC11032668 DOI: 10.2147/dmso.s451045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose This study aimed to explore the association between N-6 adenine-specific DNA methyltransferase 1 (N6AMT1) single nucleotide polymorphisms (SNPs) and gestational diabetes mellitus (GDM) and the modification of the relationship by folate and vitamin B12. Methods A cross-sectional study involving 1303 pregnant women (262 GDM and 1041 non-GDM) was performed in Tianjin, China. Nine SNPs in N6AMT1 were genotyped, and serum folate, vitamin B12, and homocysteine (Hcy) levels were measured. The logistic regression models determined the odds ratios (ORs) for SNPs in N6AMT1 and the gene-nutrition interactions on GDM. Results N6AMT1 rs7282280, rs1048546, and rs1997605 were related to GDM under the dominant model after adjusting for multiple covariates. Individuals carrying the N6AMT1 rs7282280 TC/TT genotypes had a lower risk of developing GDM, regardless of serum folate and vitamin B12 levels. However, rs1048546 TG/GG genotypes were associated with lower GDM risk when serum folate ≥ 6.0 ng/mL. Pregnancies with the risk genotypes in N6AMT1 and higher serum folate or lower vitamin B12 are more prone to GDM. The study also showed a statistically significant additive interaction between N6AMT1 rs1997605 GG genotypes and lower vitamin B12 (RERI: 2.54; 95% CI: 0.17, 4.92). Conclusion SNPs in N6AMT1 were found to be associated with GDM, and serum folate and vitamin B12 levels can modify their associations.
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Affiliation(s)
- Guanshuai Guo
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Xi Chen
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Jingran Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Xiangmin Meng
- Department of Endocrinology, Tianjin Xiqing Hospital, Tianjin, People’s Republic of China
| | - Aifeng Jia
- Department of Obstetrics and Gynecology, Tianjin Xiqing Hospital, Tianjin, People’s Republic of China
| | - Xinli Xing
- Department of Obstetrics and Gynecology, Women’s and Children’s Health Center of Dongchangfu District, Liaocheng, People’s Republic of China
| | - Fenglei Huang
- Department of Reproductive Health, Women’s and Children’s Health Center of Dongchangfu District, Liaocheng, People’s Republic of China
| | - Xumei Zhang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Juan Liu
- Department of Biomedical Information and Library, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Shuying Li
- Department of Endocrinology, Tianjin Xiqing Hospital, Tianjin, People’s Republic of China
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Qiang Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, People’s Republic of China
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Bunga PK, Balaga VS, Raju R, Suvvari TK, Sivaraj N, Narayan G, Ramadugu R, Arigapudi N, Kande MB, Panchanani A. Association of MTHFD1 G1958A Polymorphism with Gestational Diabetes Mellitus. Cureus 2024; 16:e53287. [PMID: 38435941 PMCID: PMC10905650 DOI: 10.7759/cureus.53287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The MTHFD1 G1958A polymorphism is a common variation in the gene encoding methylenetetrahydrofolate dehydrogenase 1 (MTHFD1), an enzyme crucial for folate metabolism. This study investigated the association between the MTHFD1 G1958A polymorphism, which is involved in folate metabolism, and gestational diabetes mellitus (GDM) risk. Methods A case-control study was conducted and 304 pregnant women (152 with gestational diabetes as cases and 152 healthy pregnant as controls) participated in the study. The polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) techniques were used to determine the MTHFD1 1958G>A polymorphism genotypes. Results Analysis of genotype frequencies revealed a statistically significant difference (p-value < 0.05) between the GDM group and the control group, suggesting a potential association between this gene variant and the development of GDM. Interestingly, while allele frequencies alone did not show a significant association with GDM risk, analysis in a recessive model (both severe and mild forms) demonstrated a strong link between the homozygous AA genotype and increased susceptibility to GDM. Conclusion This study provides the first evidence linking the MTHFD1 G1958A polymorphism and GDM risk in an Indian setting. These findings warrant further investigation into the functional impact of the MTHFD1 G1958A polymorphism and its potential role in the pathogenesis of GDM.
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Affiliation(s)
- Papa Kusuma Bunga
- Research and Development, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Vijaya Sirisha Balaga
- Obstetrics and Gynaecology, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Riya Raju
- Internal Medicine, Maharajah Institute of Medical Sciences, Vizianagaram, IND
| | - Tarun Kumar Suvvari
- General Medicine, Rangaraya Medical College, Kakinada, IND
- Research, Squad Medicine and Research (SMR), Visakhapatnam, IND
| | - Nagarjuna Sivaraj
- Research and Development, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Gaurang Narayan
- Obstetrics and Gynecology, Indira Gandhi Government Medical College & Hospital, Nagpur, IND
| | - Rithika Ramadugu
- Surgery, Kamineni Academy of Medical Science And Research Centre, Hyderabad, IND
| | - Nithya Arigapudi
- Genetics, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, IND
| | - Mahesh Babu Kande
- Internal Medicine, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Arun Panchanani
- Internal Medicine, Great Eastern Medical School & Hospital, Srikakulam, IND
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Dey M, Dhume P, Sharma SK, Goel S, Chawla S, Shah A, Madhumidha G, Rawal R. Folic acid: The key to a healthy pregnancy - A prospective study on fetomaternal outcome. Tzu Chi Med J 2024; 36:98-102. [PMID: 38406574 PMCID: PMC10887341 DOI: 10.4103/tcmj.tcmj_110_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/17/2023] [Accepted: 09/14/2023] [Indexed: 02/27/2024] Open
Abstract
Objectives The objective of the study is to study the fetomaternal outcome associated with folic acid deficiency in pregnancy. Materials and Methods This hospital-based observational study was conducted in the Department of Obstetrics and Gynaecology at Base Hospital, Delhi Cantt, and a total of 351 participants were enrolled who were fulfilling the inclusion criteria. The plasma folic acid level of the selected patients was measured in the booking visit by automated chemiluminescence assay. The cutoff levels of folic acid were taken at 8.6 ng/mL. Based on these values, the study population was divided into two groups, one with folic acid values <8.6 ng/mL and the other with values ≥8.6 ng/mL. Plasma Vitamin B12 levels were measured to check for any concurrent deficiencies. Obstetric outcomes included first- and second-trimester miscarriages, development of anemia, gestational hypertension/preeclampsia, gestational diabetes mellitus, hypothyroidism, placental abruption, and intrauterine fetal growth restriction (FGR). Furthermore, the period of gestation at delivery, fetal weights, APGAR scores at 5 min were documented. The study also considered fetal neural tube defects, intrauterine fetal demise for data collection. Collected data were analyzed statistically to find the association of the above-mentioned outcomes with levels of folic acid. Results The rate of preterm deliveries was significantly higher in the folic acid group with levels <8.6 ng/mL (16.94%). The incidence of small for gestational age/FGR was higher in the folic acid group with levels <8.6 ng/mL (27.11%) compared to the high folic acid group with levels ≥8.6 ng/mL (13.38%). The differences in the incidence of anemia, gestational hypertension, gestational diabetes, and preeclampsia between the two groups were not statistically significant and no cases of intrauterine fetal demise or placental abruption were observed in either group. Moreover, there was no significant difference in the relative risk of low Apgar scores at 5 min between the two groups. Conclusion The present study suggests that low folic acid levels during pregnancy are associated with a higher risk of adverse pregnancy outcomes such as anemia, miscarriages, preterm delivery, and FGR. Therefore, adherence to nutritional recommendation of folic acid supplementation during pregnancy is essential to prevent these adverse outcomes.
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Affiliation(s)
- Madhusudan Dey
- Department of Obstetrics and Gynaecology, Base Hospital Delhi Cantt, Delhi, India
| | - Pranjali Dhume
- Department of Obstetrics and Gynaecology, Base Hospital Delhi Cantt, Delhi, India
| | - Sanjay K Sharma
- Department of Obstetrics and Gynaecology, AFMC, Pune, Maharashtra, India
| | - Suyash Goel
- Department of Obstetrics and Gynaecology, Base Hospital Delhi Cantt, Delhi, India
| | - Sunil Chawla
- Department of Obstetrics and Gynaecology, Base Hospital Delhi Cantt, Delhi, India
| | - Ankur Shah
- Department of Obstetrics and Gynaecology, Base Hospital Delhi Cantt, Delhi, India
| | - G Madhumidha
- Department of Obstetrics and Gynaecology, Base Hospital Delhi Cantt, Delhi, India
| | - Reshu Rawal
- Department of Obstetrics and Gynaecology, Base Hospital Delhi Cantt, Delhi, India
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Qin XY, Ha SY, Chen L, Zhang T, Li MQ. Recent Advances in Folates and Autoantibodies against Folate Receptors in Early Pregnancy and Miscarriage. Nutrients 2023; 15:4882. [PMID: 38068740 PMCID: PMC10708193 DOI: 10.3390/nu15234882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
Though firstly identified in cerebral folate deficiency, autoantibodies against folate receptors (FRAbs) have been implicated in pregnancy complications such as miscarriage; however, the underlying mechanism needs to be further elaborated. FRAbs can be produced via sensitization mediated by folate-binding protein as well as gene mutation, aberrant modulation, or degradation of folate receptors (FRs). FRAbs may interfere with folate internalization and metabolism through blocking or binding with FRs. Interestingly, different types of FRs are expressed on trophoblast cells, decidual epithelium or stroma, and macrophages at the maternal-fetal interface, implying FRAbs may be involved in the critical events necessary for a successful pregnancy. Thus, we propose that FRAbs may disturb pregnancy establishment and maintenance by modulating trophoblastic biofunctions, placental development, decidualization, and decidua homeostasis as well as the functions of FOLR2+ macrophages. In light of these findings, FRAbs may be a critical factor in pathological pregnancy, and deserve careful consideration in therapies involving folic acid supplementation for pregnancy complications.
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Affiliation(s)
- Xue-Yun Qin
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China; (X.-Y.Q.); (S.-Y.H.)
| | - Si-Yao Ha
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China; (X.-Y.Q.); (S.-Y.H.)
| | - Lu Chen
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Tao Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Ming-Qing Li
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China; (X.-Y.Q.); (S.-Y.H.)
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China
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Fardous AM, Heydari AR. Uncovering the Hidden Dangers and Molecular Mechanisms of Excess Folate: A Narrative Review. Nutrients 2023; 15:4699. [PMID: 37960352 PMCID: PMC10648405 DOI: 10.3390/nu15214699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
This review delves into the intricate relationship between excess folate (vitamin B9) intake, especially its synthetic form, namely, folic acid, and its implications on health and disease. While folate plays a pivotal role in the one-carbon cycle, which is essential for DNA synthesis, repair, and methylation, concerns arise about its excessive intake. The literature underscores potential deleterious effects, such as an increased risk of carcinogenesis; disruption in DNA methylation; and impacts on embryogenesis, pregnancy outcomes, neurodevelopment, and disease risk. Notably, these consequences stretch beyond the immediate effects, potentially influencing future generations through epigenetic reprogramming. The molecular mechanisms underlying these effects were examined, including altered one-carbon metabolism, the accumulation of unmetabolized folic acid, vitamin-B12-dependent mechanisms, altered methylation patterns, and interactions with critical receptors and signaling pathways. Furthermore, differences in the effects and mechanisms mediated by folic acid compared with natural folate are highlighted. Given the widespread folic acid supplementation, it is imperative to further research its optimal intake levels and the molecular pathways impacted by its excessive intake, ensuring the health and well-being of the global population.
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Affiliation(s)
- Ali M. Fardous
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ahmad R. Heydari
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI 48202, USA
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Mussai EX, Lofft ZA, Vanderkruk B, Boonpattrawong N, Miller JW, Smith A, Bottiglieri T, Devlin AM. Folic acid supplementation in a mouse model of diabetes in pregnancy alters insulin sensitivity in female mice and beta cell mass in offspring. FASEB J 2023; 37:e23200. [PMID: 37773756 DOI: 10.1096/fj.202301491r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
Epidemiological studies have reported discrepant findings on the relationship between folic acid intake during pregnancy and risk for gestational diabetes mellitus (GDM). To begin to understand how folic acid impacts metabolic health during pregnancy, we determined the effects of excess folic acid supplementation (5× recommendation) on maternal and fetal offspring metabolic health. Using a mouse (female C57BL/6J) model of diet-induced diabetes in pregnancy (western diet) and control mice, we show that folic acid supplementation improved insulin sensitivity in the female mice fed the western diet and worsened insulin sensitivity in control mice. We found no unmetabolized folic acid in liver from supplemented mice suggesting the metabolic effects of folic acid supplementation are not due to unmetabolized folic acid. Male fetal (gestational day 18.5) offspring from folic acid supplemented dams (western and control) had greater beta cell mass and density than those from unsupplemented dams; this was not observed in female offspring. Differential sex-specific hepatic gene expression profiles were observed in the fetal offspring from supplemented dams but this differed between western and controls. Our findings suggest that folic acid supplementation affects insulin sensitivity in female mice, but is dependent on their metabolic phenotype and has sex-specific effects on offspring pancreas and liver.
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Affiliation(s)
- Ei-Xia Mussai
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Zoe A Lofft
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben Vanderkruk
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicha Boonpattrawong
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua W Miller
- Department of Nutritional Sciences, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Andre Smith
- Department of Nutritional Sciences, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| | | | - Angela M Devlin
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
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11
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Wang Y, Wang Y, Sun Y, Zhang N, Liang X, Luo S, Dai L, Sun C, Yang Y, Li S, Zhang X, Zhang Q. Serum folate mediates the associations of MTHFR rs1801133 polymorphism with blood glucose levels and gestational diabetes mellitus in Chinese Han pregnant women. Br J Nutr 2023; 130:1329-1337. [PMID: 36756752 DOI: 10.1017/s0007114523000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This study aimed to explore the mediation effects of one-carbon metabolism (OCM) related nutrients on the association between MTHFR rs1801133 polymorphism and gestational diabetes mellitus (GDM). Folate, vitamin B12 and homocysteine (Hcy) were measured in the serum of 1254 pregnant women. Linear and logistic regressions were used to estimate the associations of OCM nutrients and MTHFR rs1801133 polymorphism with blood glucose levels and GDM risk. Mediation analysis was applied to test the mediation effects of folate, vitamin B12 and Hcy on the association of MTHFR rs1801133 polymorphism with blood glucose concentrations and GDM. Pregnant women with MTHFR rs1801133 CC genotype had higher serum folate (10·75 v. 8·90 and 9·40 ng/ml) and lower serum Hcy (4·84 v. 4·93 and 5·20 μmol/l) than those with CT and TT genotypes. Folate concentrations were positively associated with fasting plasma glucose (FPG), 1-h plasma glucose (1-h PG), 2-h plasma glucose (2-h PG) and GDM risk. Vitamin B12 levels were negatively correlated with FPG and GDM. Although no direct association was found between MTHFR rs1801133 genotypes and GDM, there were significant indirect effects of MTHFR rs1801133 CC genotype on FPG (β: 0·005; 95 % CI: 0·001, 0·013), 1-h PG (β: 0·006; 95 % CI: 0·001, 0·014), 2-h PG (β: 0·007; 95 % CI: 0·001, 0·015) and GDM (β: 0·006; 95 % CI: 0·001, 0·014) via folate. In conclusion, serum folate mediates the effect of MTHFR rs1801133 on blood glucose levels and GDM. Our findings potentially provide a feasible GDM prevention strategy via individualised folate supplementation according to the MTHFR genotypes.
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Affiliation(s)
- Yunguo Wang
- Department of Orthopedics Surgery, Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin300211, People's Republic of China
| | - Yiyun Wang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
| | - Yao Sun
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
| | - Naijian Zhang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
| | - Xiaoshan Liang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
| | - Suhui Luo
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
| | - Lirong Dai
- Community Health Service Center of Yangliuqing Town, Tianjin300380, People's Republic of China
| | - Chao Sun
- Community Health Service Center of Yangliuqing Town, Tianjin300380, People's Republic of China
| | - Yungui Yang
- Community Health Service Center of Zhangjiawo Town, Tianjin300393, People's Republic of China
| | - Shuying Li
- Department of Endocrinology, Tianjin Xiqing Hospital, Tianjin300380, People's Republic of China
| | - Xumei Zhang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
| | - Qiang Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin300070, People's Republic of China
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12
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Liu PJ, Ma L, Li R, Liu Y. The Association Between the Imbalance of Single-Carbon Nutrients in Early Pregnancy and Gestational Diabetes Mellitus Risk is Influenced by Serum Selenium Status: A Cohort Study. Diabetes Metab Syndr Obes 2023; 16:3275-3283. [PMID: 37881350 PMCID: PMC10596188 DOI: 10.2147/dmso.s428286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose The role of imbalanced one-carbon nutrients in gestational diabetes mellitus (GDM) risk has garnered significant interest, yet existing studies yield inconsistent results. Our objective was to assess whether the association between an unbalanced ratio of folate to vitamin B12 and GDM risk is influenced by the status of other micronutrients. Methods This cohort study included 366 singleton-pregnancy Han women enrolled at the Shunyi District Maternal and Child Health Hospital in Beijing, China. During the first trimester of pregnancy, we measured red blood cell (RBC) folate, serum levels of vitamin B12, vitamin D, and selenium. We examined the association between the imbalanced status of RBC folate and vitamin B12 and GDM risk using logistic regression, stratified by serum selenium or vitamin D status. Results Among the 366 women, 67 (18.3%) were diagnosed with GDM, 201 (54.9%) had vitamin D deficiency, and 245 (66.9%) had selenium deficiency. Overall, women with higher RBC folate/vitamin B12 ratios did not exhibit a significantly higher risk of GDM compared to those in reference tertile (all P > 0.05). Subsequently, we divided women into deficient and non-deficient groups based on serum selenium or vitamin D levels. In women with selenium deficiency, those in the highest tertile of the RBC folate/vitamin B12 ratio had the highest odds of GDM [OR: 3.40 (1.16-9.97), P=0.026] after adjusting for covariates. However, similar findings were not observed in pregnancies with normal selenium status. Irrespective of vitamin D status, women with higher RBC folate/vitamin B12 ratios did not exhibit a significantly increased risk of GDM. Conclusion Micronutrient deficiencies are common in early pregnancy. Women with a higher folate/vitamin B12 ratio coupled with selenium deficiency in early pregnancy have a higher GDM risk. These findings underscore the importance of micronutrient assessment in early pregnancy and subsequent interventions for micronutrient deficiencies.
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Affiliation(s)
- Peng Ju Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Liangkun Ma
- Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Rui Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yanping Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
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13
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Watanabe M, Eguchi A, Sakurai K, Yamamoto M, Mori C. Prediction of gestational diabetes mellitus using machine learning from birth cohort data of the Japan Environment and Children's Study. Sci Rep 2023; 13:17419. [PMID: 37833313 PMCID: PMC10575866 DOI: 10.1038/s41598-023-44313-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Recently, prediction of gestational diabetes mellitus (GDM) using artificial intelligence (AI) from medical records has been reported. We aimed to evaluate GDM-predictive AI-based models using birth cohort data with a wide range of information and to explore factors contributing to GDM development. This investigation was conducted as a part of the Japan Environment and Children's Study. In total, 82,698 pregnant mothers who provided data on lifestyle, anthropometry, and socioeconomic status before pregnancy and the first trimester were included in the study. We employed machine learning methods as AI algorithms, such as random forest (RF), gradient boosting decision tree (GBDT), and support vector machine (SVM), along with logistic regression (LR) as a reference. GBDT displayed the highest accuracy, followed by LR, RF, and SVM. Exploratory analysis of the JECS data revealed that health-related quality of life in early pregnancy and maternal birthweight, which were rarely reported to be associated with GDM, were found along with variables that were reported to be associated with GDM. The results of decision tree-based algorithms, such as GBDT, have shown high accuracy, interpretability, and superiority for predicting GDM using birth cohort data.
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Affiliation(s)
- Masahiro Watanabe
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba, 263-8522, Japan.
| | - Akifumi Eguchi
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba, 263-8522, Japan
| | - Kenichi Sakurai
- Department of Nutrition and Metabolic Medicine, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Midori Yamamoto
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba, 263-8522, Japan
| | - Chisato Mori
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba, 263-8522, Japan
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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14
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Wang XM, Wang QY, Huang J. Anemia status of infants and young children aged six to thirty-six months in Ma'anshan City: A retrospective study. World J Clin Cases 2023; 11:6744-6753. [PMID: 37901006 PMCID: PMC10600847 DOI: 10.12998/wjcc.v11.i28.6744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Anemia in infants and young children can have long-term effects on cognitive and physical development. In Ma'anshan City, China, there has been growing concern about the prevalence of anemia among children aged 6 to 36 mo. Understanding the factors influencing this condition is crucial for targeted interventions and improving overall child health in the region. AIM To analyze the anemia status and influencing factors of infants and young children aged 6 to 36 mo in Ma'anshan City, China. Providing scientific evidence for reducing the incidence of anemia and improving the health level of children in this age group. METHODS The study encompassed 37698 infants and young children, aged from 6 to 36 mo, who underwent health examinations at the Ma'anshan Maternal and Child Health Hospital from January 2018 to October 2022 were included in the study. Basic information, physical examination, and hemoglobin detection data were collected. Descriptive analysis was used to analyze the prevalence of anemia in children in the region, and univariate analysis was used to analyze the influencing factors of anemia. RESULTS The mean hemoglobin level of infants and young children aged 9 to 36 mo increased with age, and the anemia detection rate decreased with age. The anemia detection rate in rural infants aged 6, 9, and 12 mo was higher than that in urban infants. Although the anemia detection rate was higher in 6-mo-old boys than girls, it was higher in 24-mo-old girls than boys. There were statistically significant differences in the anemia detection rates among 9-mo-old and 12-mo-old infants with different nutritional statuses (emaciation, overweight, obese, and normal). Moreover, there were no statistically significant differences in anemia detection rates among infants and young children with different nutritional statuses at other ages. Besides, the anemia detection rates in obese infants aged 9 and 12 mo were higher than those in normal and overweight infants, with statistically significant differences. Finally, there were no statistically significant differences in the anemia detection rates between emaciation infants and those with other nutritional statuses. CONCLUSION The anemia situation among infants and young children aged 6 to 36 mo in Ma'anshan City, China, is relatively prominent and influenced by various factors. Our result shown that attention should be paid to the anemic infant and young child population, with strengthened education and targeted prevention and dietary guidance to help them establish good living habits, improve nutritional status, and reduce the occurrence of anemia to improve children's health levels.
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Affiliation(s)
- Xue-Mei Wang
- Department of Pediatric, Ma’anshan Maternal and Child Health Center, Ma’anshan 243011, Anhui Province, China
| | - Qiong-Yao Wang
- Department of Pediatric, Ma’anshan Maternal and Child Health Center, Ma’anshan 243011, Anhui Province, China
| | - Jie Huang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
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15
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Cristodoro M, Dell’Avanzo M, Ghio M, Lalatta F, Vena W, Lania A, Sacchi L, Bravo M, Bulfoni A, Di Simone N, Inversetti A. Before Is Better: Innovative Multidisciplinary Preconception Care in Different Clinical Contexts. J Clin Med 2023; 12:6352. [PMID: 37834996 PMCID: PMC10573412 DOI: 10.3390/jcm12196352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
CONTEXT Implementation of pre-conception care units is still very limited in Italy. Nowadays, the population's awareness of the reproductive risks that can be reduced or prevented is very low. Purpose and main findings: We presented a new personalized multidisciplinary model of preconception care aimed at identifying and possibly reducing adverse reproductive events. We analyzed three cohorts of population: couples from the general population, infertile or subfertile couples, and couples with a previous history of adverse reproductive events. The proposal involves a deep investigation regarding family history, the personal histories of both partners, and reproductive history. PRINCIPAL CONCLUSIONS Preconception care is still neglected in Italy and under-evaluated by clinicians involved in natural or in vitro reproduction. Adequate preconception counseling will improve maternal and fetal obstetrical outcomes.
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Affiliation(s)
- Martina Cristodoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Division of Obstetrics and Gynecology, Humanitas San Pio X Hospital, 20159 Milan, Italy
- Diabetes Center, Humanitas Gavazzeni Institute, Via M. Gavazzeni 21, 24100 Bergamo, Italy
| | - Marinella Dell’Avanzo
- Division of Obstetrics and Gynecology, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Matilda Ghio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Faustina Lalatta
- Division of Obstetrics and Gynecology, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Walter Vena
- Diabetes Center, Humanitas Gavazzeni Institute, Via M. Gavazzeni 21, 24100 Bergamo, Italy
| | - Andrea Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
| | - Laura Sacchi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Maria Bravo
- Division of Obstetrics and Gynecology, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Alessandro Bulfoni
- Division of Obstetrics and Gynecology, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Division of Obstetrics and Gynecology, Humanitas San Pio X Hospital, 20159 Milan, Italy
- Diabetes Center, Humanitas Gavazzeni Institute, Via M. Gavazzeni 21, 24100 Bergamo, Italy
| | - Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Division of Obstetrics and Gynecology, Humanitas San Pio X Hospital, 20159 Milan, Italy
- Diabetes Center, Humanitas Gavazzeni Institute, Via M. Gavazzeni 21, 24100 Bergamo, Italy
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16
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Chen Y, Xiang L, Luo L, Qin H, Tong S. Correlation of Nonalcoholic Fatty Liver Disease with Dietary Folate and Serum Folate in U.S. Adults: Cross-Sectional Analyses from National Health and Nutrition Examination Survey 2009-2018. Metab Syndr Relat Disord 2023; 21:389-396. [PMID: 37733056 DOI: 10.1089/met.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is a global health problem, and dietary intervention is still considered one of the primary interventions. This study aimed to examine cross-sectional associations between dietary and serum levels of folate and NAFLD. Methods: We conducted a study of 7543 adults who participated in the National Health and Nutrition Examination Survey, 2009-2018. NAFLD status was determined by a fatty liver index (FLI) value ≥60. Multivariable logistic regression models were used to estimate associations between folate and NAFLD. Results: Almost half (45%) of the patients were classified as having NAFLD based on the FLI. In the fully adjusted model, participants in the highest quartile of dietary total folate and food folate were found to have a lower prevalence of NAFLD than those in the lowest quartile [odds ratio (OR)quartile 4 versus 1 = 0.582; 95% confidence interval (CI) = 0.350-0.968; and ORquartile 4 versus 1 = 0.737; 95% CI = 0.611-0.888, respectively], and the fourth quartile values of serum total folate and 5-methyl-tetrahydrofolate were significantly negatively associated with NAFLD prevalence (ORquartile 4 versus 1 = 0.664; 95% CI = 0.495-0.891; and ORquartile 4 versus 1 = 0.712; 95% CI = 0.532-0.954, respectively). Subgroup analyses revealed that this beneficial association was more significant in women (ORquartile 4 versus 1 = 0.526; 95% CI = 0.329-0.843; pinteraction < 0.001) than in men (ORquartile 4 versus 1 = 0.805; 95% CI = 0.546-1.186). Conclusions: Higher dietary folate intake and serum folate levels are associated with a lower NAFLD prevalence among U.S. adults and the trend is more pronounced among women, indicating opportunities for dietary NAFLD interventions.
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Affiliation(s)
- Yushi Chen
- Department of Clinical Nutrition, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ling Xiang
- Department of Clinical Nutrition, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ling Luo
- Department of Clinical Nutrition, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Haixia Qin
- Department of Clinical Nutrition, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shiwen Tong
- Department of Clinical Nutrition, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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17
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Barlow‐Mosha LN, Ahimbisibwe GM, Chappell E, Amuge PM, Nanduudu A, Kaudha E, Amukele T, Balamusani D, Kafufu B, Nimwesiga A, Kataike H, Namwanje R, Kasangaki G, Mulindwa A, Muzorah GA, Bbuye D, Musiime V, Mujyambere E, Ssenyonga M, Mulima D, Kyambadde RC, Namusanje J, Isabirye R, Nabalamba M, Nakirya BM, Kityo C, Kekitiinwa AR, Giaquinto C, Copp A, Gibb DM, Ford D, Musoke P, Turkova A. Effect of dolutegravir on folate, vitamin B12 and mean corpuscular volume levels among children and adolescents with HIV: a sub-study of the ODYSSEY randomized controlled trial. J Int AIDS Soc 2023; 26:e26174. [PMID: 37766505 PMCID: PMC10534059 DOI: 10.1002/jia2.26174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Dolutegravir-based antiretroviral therapy (ART) is the preferred antiretroviral treatment for children and adolescents living with HIV. A large surveillance study in Botswana previously raised concerns about an association between pre-conception dolutegravir and neural tube defects. Before these concerns were subsequently resolved, we set up a sub-study to look at the effect of dolutegravir on levels of folate and vitamin B12 in children and adolescents within the randomized ODYSSEY trial, as folate and vitamin B12 are known to play a crucial role in neural tube development. METHODS We conducted the sub-study among Ugandan ODYSSEY participants and compared folate and vitamin B12 between children randomized to dolutegravir-based ART (DTG) and non-dolutegravir-based standard-of-care treatment (SOC). Plasma folate was measured at enrolment and week 4 on stored samples; in addition, plasma and red blood cell (RBC) folate and vitamin B12 were assayed at week ≥96 in prospectively collected samples. RBC mean corpuscular volume (MCV) was measured 24-weekly in all ODYSSEY participants. Samples analysed in the sub-study were collected between September 2016 and October 2020. RESULTS A total of 229 children aged ≥6 years were included in the sub-study with median age at trial enrolment of 12.3 (interquartile range [IQR] 9.0, 14.7) years, and CD4 count of 501 (IQR 228, 695); 112 (49%) children were male. Most participants (225/229, 98%) had plasma folate results at enrolment and 214 (93%) children had results available for RBC folate, vitamin B12 and plasma folate at week ≥96. MCV results were analysed on 679 children aged ≥6 years enrolled in ODYSSEY. At week 4, mean plasma folate was significantly higher in the dolutegravir arm than in SOC (difference [DTG-SOC] 1.6 ng/ml, 95% CI 0.8, 2.3; p<0.001), and this difference persisted to week ≥96 (2.7 ng/ml, 95% CI 1.7, 3.7; p<0.001). Mean RBC folate at ≥96 weeks was also higher in the DTG arm (difference 73 ng/ml, 95% CI 3, 143; p = 0.041). There was no difference in the treatment arms for vitamin B12 levels at ≥96 weeks or change in MCV through trial follow-up. CONCLUSIONS Plasma and RBC folate levels were higher in children and adolescents receiving dolutegravir-based ART than on other ART regimens. Further studies are needed to clarify the mechanisms of these interactions and the clinical implications of increased blood folate levels.
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Affiliation(s)
| | | | - Elizabeth Chappell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | | | | | | | - Timothy Amukele
- Department of PathologyICON Central Laboratories IncFarmingdaleNew YorkUSA
| | | | - Bosco Kafufu
- Infectious Diseases Institute Core LaboratoryKampalaUganda
| | | | - Hajira Kataike
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | - Rosemary Namwanje
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | - Gladys Kasangaki
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | | | - Dickson Bbuye
- Baylor College of Medicine Children's Foundation‐UgandaKampalaUganda
| | - Victor Musiime
- Joint Clinical Research CentreKampalaUganda
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
| | | | - Mark Ssenyonga
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | | | | | - Richard Isabirye
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | - Barbara Musoke Nakirya
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
| | | | | | - Carlo Giaquinto
- Department of Women and Child HealthUniversity of PadovaPadovaItaly
| | - Andrew Copp
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - Diana M. Gibb
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | - Deborah Ford
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | - Philippa Musoke
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
- Department of Paediatrics and Child HealthMakerere University College of Health SciencesKampalaUganda
| | - Anna Turkova
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyLondonUK
| | - the ODYSSEY trial team
- Makerere University‐Johns Hopkins University (MU‐JHU) Research CollaborationKampalaUganda
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18
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Xu R, Liu S, Zhong Z, Guo Y, Xia T, Chen Y, Ding L. The Influence of Maternal Folate Status on Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2766. [PMID: 37375669 DOI: 10.3390/nu15122766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Maternal folate has been shown to relate to the risk of gestational diabetes mellitus (GDM). However, the existing studies have yielded inconsistent conclusions. The purpose of this study was to systematically review the association between maternal folate status and the risk of GDM. Observational studies up to 31 October 2022 were included. Study characteristics, the means and standard deviations (SDs) of folate levels (serum/red blood cell (RBC)), the odds ratios (ORs) with 95% confidence intervals (CIs) and the time for folate measurement were extracted. Compared with the non-GDM group, serum and RBC folate levels in women with GDM were significantly higher. Our subgroup analysis demonstrated that serum folate levels in the GDM group were significantly higher than in the non-GDM group only in the second trimester. RBC folate levels in the GDM group were significantly higher than in the non-GDM group in the first and second trimesters. Taking serum/RBC folate levels as continuous variables, the adjusted odds ratios of GDM risk showed that increased serum folate concentration rather than RBC folate elevated the risk of GDM. In the descriptive analysis, five studies reported high serum folate levels increased GDM risk, whereas the other five showed no association between serum folate levels and GDM risk. Moreover, the rest three studies pointed out high RBC folate levels increased GDM risk. Altogether we found that the risk of GDM is associated with high serum/plasma and RBC folate levels. Future studies should determine the recommended folic acid cutoff balancing the risk for GDM and fetal malformations.
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Affiliation(s)
- Ruhan Xu
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Shenhao Liu
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Zhiqi Zhong
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Yifei Guo
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Tianqi Xia
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Yanyan Chen
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
- Department of Pharmacology, School of Medicine, Jiangsu University, Zhenjiang 212013, China
| | - Lingling Ding
- School of Medicine, Jiangsu University, Zhenjiang 212013, China
- Department of Physiology, School of Medicine, Jiangsu University, Zhenjiang 212013, China
- Key Laboratory of Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang 212013, China
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Liu XH, Cao ZJ, Chen LW, Zhang DL, Qu XX, Li YH, Tang YP, Bao YR, Ying H. The association between serum folate and gestational diabetes mellitus: a large retrospective cohort study in Chinese population. Public Health Nutr 2023; 26:1014-1021. [PMID: 36093642 PMCID: PMC10346082 DOI: 10.1017/s136898002200194x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/28/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the association between folate levels and the risk of gestational diabetes mellitus (GDM) risk during the whole pregnancy. DESIGN In this retrospective cohort study of pregnant women, serum folate levels were measured before 24 gestational weeks (GW). GDM was diagnosed between 24th and 28th GW based on the criteria of the International Association of Diabetes and Pregnancy Study Groups. General linear models were performed to examine the association of serum folate with plasma glucose (i.e. linear regressions) and risk of GDM (i.e. log-binomial regressions) after controlling for confounders. Restricted cubic spline regression was conducted to test the dosage-response relationship between serum folate and the risk of GDM. SETTING A sigle, urban hospital in Shanghai, China. PARTICIPANTS A total of 42 478 women who received antenatal care from April 2013 to March 2017 were included. RESULTS Consistent positive associations were observed between serum folate and plasma glucose levels (fasting, 1-h, 2-h). The adjusted relative risks (RR) and 95 % CI of GDM across serum folate quartiles were 1·00 (reference), 1·15 (95 % CI (1·04, 1·26)), 1·40 (95 % CI (1·27, 1·54)) and 1·54 (95 % CI (1·40, 1·69)), respectively (P-for-trend < 0·001). The positive association between serum folate and GDM remained when stratified by vitamin B12 (adequate v. deficient groups) and the GW of serum folate measurement (≤13 GW v. >13 GWs). CONCLUSIONS The findings of this study may provide important evidence for the public health and clinical guidelines of pregnancy folate supplementation in terms of GDM prevention.
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Affiliation(s)
- Xiao-Hui Liu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 550 Hunan RD, Shanghai201204, People’s Republic of China
| | - Zhi-Juan Cao
- Department of Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Li-Wei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Dong-Lan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University, Long Island, School of Medicine, Mineola, NY, USA
| | - Xiao-Xian Qu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 550 Hunan RD, Shanghai201204, People’s Republic of China
| | - Yu-Hong Li
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 550 Hunan RD, Shanghai201204, People’s Republic of China
| | - Yu-Ping Tang
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 550 Hunan RD, Shanghai201204, People’s Republic of China
| | - Yi-Rong Bao
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 550 Hunan RD, Shanghai201204, People’s Republic of China
| | - Hao Ying
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, No. 550 Hunan RD, Shanghai201204, People’s Republic of China
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20
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Chibireva M, Szoke D, Borille S, Rovegno L, Panteghini M. Association of maternal folate and B12 vitamin status with gestational diabetes mellitus: still an open issue. Clin Chim Acta 2023; 544:117307. [PMID: 37019326 DOI: 10.1016/j.cca.2023.117307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/27/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES There is conflicting evidence about the role of folate and B12in gestational diabetes mellitus (GDM) onset. The association of vitamin status with GDM was therefore revalued, also measuring the B12active form holotranscobalamin. METHODS 677 women were evaluated at 24-28 weeks of gestation when OGTT was carried out. The 'one-step' strategy was employed for GDM diagnosis. Odds ratio (OR) of having GDM was estimated to quantify the association with vitamin levels. RESULTS 180 women (26.6%) had GDM. They were older (median, 34.6 vs. 33.3 years, p=0.019) and had higher body mass index (BMI) (25.8 vs. 24.1 kg/m2, p<0.001). Multiparous women had lower levels of all evaluated micronutrients, while overweight lowered both folate and total B12, but not holotranscobalamin. Lower total B12(270 vs. 290 ng/L, p=0.005), but not holotranscobalamin, was observed in GDM, being weakly negatively correlated with fasting glycemia (r=-0.11, p=0.005) and 1-h OGTT serum insulin (r=-0.09, p=0.014). At multivariate analysis, age, BMI and multiparity remained the strongest GDM predictors, while total B12(but not holotranscobalamin and folate) showed a slight protective effect (OR=0.996, p=0.038). CONCLUSIONS A weak association between total B12 levels and GDM risk was shown, but it was not confirmed when holotranscobalamin was measured.
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Affiliation(s)
| | | | | | | | - Mauro Panteghini
- Luigi Sacco University Hospital, Milan, Italy; Luigi Sacco Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milan, Italy
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21
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Li M, Wang L, Du Z, Shen Q, Jiang L, Sui L, Zhang N, Wang H, Li G. Joint effect of maternal pre-pregnancy body mass index and folic acid supplements on gestational diabetes mellitus risk: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:202. [PMID: 36959594 PMCID: PMC10035259 DOI: 10.1186/s12884-023-05510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 03/09/2023] [Indexed: 03/25/2023] Open
Abstract
Background 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. Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- Minyu Li
- grid.410645.20000 0001 0455 0905Public Health School, Medical College of Qingdao University, Qingdao, Shandong Province P.R. China
| | - Lijiang Wang
- grid.410645.20000 0001 0455 0905Qingdao Women and Children’s Hospital, Qingdao University, Qingdao City, Shandong Province P.R. China
| | - Zhanhui Du
- grid.410645.20000 0001 0455 0905Qingdao Women and Children’s Hospital, Qingdao University, Qingdao City, Shandong Province P.R. China
| | - Qianqian Shen
- grid.11135.370000 0001 2256 9319School of Public Health, Peking university, Beijing, 100191 China
| | - Lu Jiang
- grid.410645.20000 0001 0455 0905Qingdao Women and Children’s Hospital, Qingdao University, Qingdao City, Shandong Province P.R. China
| | - Lun Sui
- grid.410645.20000 0001 0455 0905Qingdao Women and Children’s Hospital, Qingdao University, Qingdao City, Shandong Province P.R. China
| | - Nan Zhang
- grid.410645.20000 0001 0455 0905Qingdao Women and Children’s Hospital, Qingdao University, Qingdao City, Shandong Province P.R. China
| | - Hong Wang
- grid.410645.20000 0001 0455 0905Public Health School, Medical College of Qingdao University, Qingdao, Shandong Province P.R. China
| | - Guoju Li
- grid.410645.20000 0001 0455 0905Qingdao Women and Children’s Hospital, Qingdao University, Qingdao City, Shandong Province P.R. China
- grid.410645.20000 0001 0455 0905Qingdao Women and Children’s Hospital, Qingdao University, No.6 Tongfu Road, Qingdao, 266000 China
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22
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Jankovic-Karasoulos T, Smith MD, Leemaqz S, Williamson J, McCullough D, Arthurs AL, Jones LA, Bogias KJ, Mol BW, Dalton J, Dekker GA, Roberts CT. Elevated Maternal Folate Status and Changes in Maternal Prolactin, Placental Lactogen and Placental Growth Hormone Following Folic Acid Food Fortification: Evidence from Two Prospective Pregnancy Cohorts. Nutrients 2023; 15:1553. [PMID: 37049394 PMCID: PMC10097170 DOI: 10.3390/nu15071553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 04/14/2023] Open
Abstract
Folic acid (FA) food fortification in Australia has resulted in a higher-than-expected intake of FA during pregnancy. High FA intake is associated with increased insulin resistance and gestational diabetes. We aimed to establish whether maternal one-carbon metabolism and hormones that regulate glucose homeostasis change in healthy pregnancies post-FA food fortification. Circulating folate, B12, homocysteine, prolactin (PRL), human placental lactogen (hPL) and placental growth hormone (GH2) were measured in early pregnancy maternal blood in women with uncomplicated pregnancies prior to (SCOPE: N = 604) and post (STOP: N = 711)-FA food fortification. FA food fortification resulted in 63% higher maternal folate. STOP women had lower hPL (33%) and GH2 (43%) after 10 weeks of gestation, but they had higher PRL (29%) and hPL (28%) after 16 weeks. FA supplementation during pregnancy increased maternal folate and reduced homocysteine but only in the SCOPE group, and it was associated with 54% higher PRL in SCOPE but 28% lower PRL in STOP. FA food fortification increased maternal folate status, but supplements no longer had an effect, thereby calling into question their utility. An altered secretion of hormones that regulate glucose homeostasis in pregnancy could place women post-fortification at an increased risk of insulin resistance and gestational diabetes, particularly for older women and those with obesity.
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Affiliation(s)
| | - Melanie D. Smith
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5000, Australia
| | - Shalem Leemaqz
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5000, Australia
| | - Jessica Williamson
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5000, Australia
| | - Dylan McCullough
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5000, Australia
| | - Anya L. Arthurs
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5000, Australia
| | - Lauren A. Jones
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5000, Australia
| | | | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3800, Australia
| | - Julia Dalton
- Lyell McEwin Hospital, Adelaide, SA 5112, Australia
| | - Gustaaf A. Dekker
- Lyell McEwin Hospital, Adelaide, SA 5112, Australia
- Lyell McEwin Hospital, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Claire T. Roberts
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5000, Australia
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23
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Zhu L, Zhou Y, Fu Y, Sun W, Chen J, Yu N, Zhao M. Association of Folic Acid Supplementation, Dietary Folate Intake and Serum Folate Levels with Risk of Gestational Diabetes Mellitus: A Matched Case-Control Study. J Nutr Sci Vitaminol (Tokyo) 2023; 69:28-37. [PMID: 36858538 DOI: 10.3177/jnsv.69.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Periconceptional folate supplementation is prevalent, raising concerns about possible side effects. The aim of this study was to investigate the associations of folic acid supplementation, dietary folate, serum folate with gestational diabetes mellitus (GDM) risk. In this matched case-control study, 81 pregnant women with GDM (cases) and 81 pregnant women with non-GDM (controls) were identified through age difference (≤3 y) and parity (Both primipara or multipara women) matching, and serum folate levels were measured during the GDM screening (24-28 gestational wk). Folic acid supplementation and dietary folate intake from three months prepregnancy through midpregnancy were assessed using a self-reported questionnaire and food frequency questionnaire. Multivariate binary logistic regression models were used to evaluate the association between folate and GDM. After adjusting for confounding factors, we observed that compared with folic acid supplementation dose ≤400 μg/d, pregnancies without folic acid supplementation and supplemental dose >800 μg/d were associated with GDM risk (adjusted odds ratio=7.25, 95% confidence interval: 1.34-39.36; adjusted odds ratio=4.20, 95% confidence interval: 1.03-17.22), while no significant association with a 400-800 μg/d dose of folic acid supplementation and GDM. Compared with folic acid supplementation dose ≤24 wk, pregnancies without folic acid supplementation were associated with GDM risk (adjusted odds ratio=6.70, 95% confidence interval: 1.22-36.77), while no significant association with folic acid supplementation dose >24 wk and GDM. No significant association of dietary folate and serum folate with GDM was found. No or a higher dose of folic acid supplementation would increase GDM risk and a dose of <800 μg/d is the safe dose.
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Affiliation(s)
- Liyuan Zhu
- School of Nursing, Anhui Medical University
| | - Ya Zhou
- Medical School, Anhui University of Science and Technology
| | - Yueqi Fu
- School of Nursing, Anhui Medical University
| | | | - Jing Chen
- School of Nursing, Anhui Medical University
| | | | - Mei Zhao
- School of Nursing, Anhui Medical University
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24
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Zou J, Fu Q, Huang X, Yao Z, Wang W. U-shaped Association Between Folic Acid Supplementation and the Risk of Gestational Diabetes Mellitus in Chinese Women. Can J Diabetes 2023; 47:78-84. [PMID: 36372696 DOI: 10.1016/j.jcjd.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Our aim in this study was to assess the association between folic acid (FA) supplementation before and during pregnancy and risk of gestational diabetes mellitus (GDM) in Chinese women. METHODS This case-control study was conducted at 2 hospitals in central China. A total of 1,300 pregnant women, including 396 GDM patients and 904 controls, participated in the study. Information on the dose and duration of FA supplementation was collected using a self-report questionnaire at enrolment (24 to 28 weeks of gestation). RESULTS We observed a U-shaped association between FA supplementation and GDM risk that demonstrated a 228% increased risk of GDM among women who never took FA supplements, a 28% increased risk among women who took supplements containing <400 μg/day FA or took FA supplements for <1 month and a 188% increased risk among women who took supplements containing ≥800 μg/day FA for an adequate duration (>1 month before pregnancy and >3 months during pregnancy) compared with women who took supplements containing 400 to 799 μg/day FA for an adequate duration (all p<0.05). For women who took supplements containing ≥800 μg/day FA for an adequate duration, the association between FA supplementation and GDM risk appeared to be stronger among those women with a prepregnancy body mass index (BMI) of ≥25 kg/m2 than among those with a prepregnancy BMI of <25 kg/m2 (p=0.006 for interaction). CONCLUSIONS There was a U-shaped association of FA supplementation with GDM risk; that is, FA supplementation both below and above the recommended levels may increase the risk of GDM.
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Affiliation(s)
- Jiuming Zou
- Department of Clinical Laboratory, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, PR China
| | - Qiang Fu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, Ji'an, Jiangxi, PR China
| | - Xiaoliu Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, Ji'an, Jiangxi, PR China
| | - Zhao Yao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, Ji'an, Jiangxi, PR China
| | - Weiye Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, Ji'an, Jiangxi, PR China.
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Kaldygulova L, Ukybassova T, Aimagambetova G, Gaiday A, Tussupkaliyev A. Biological Role of Folic Acid in Pregnancy and Possible Therapeutic Application for the Prevention of Preeclampsia. Biomedicines 2023; 11:biomedicines11020272. [PMID: 36830809 PMCID: PMC9953465 DOI: 10.3390/biomedicines11020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
The rationale and importance of folic acid supplementation during pregnancy for fetal congenital defect prevention are accepted worldwide. Moreover, a sufficient plasma concentration of folates can reduce the incidence of spontaneous abortions, and support the normal expansion of placental blood vessels, ensuring physiological placental blood flow, thus promoting appropriate fetal growth and development. Furthermore, there is emerging evidence that long-term supplementation with folic acid can effectively prevent preeclampsia. Preeclampsia is unique to the human species in complications during pregnancy, which contributes to maternal and perinatal mortality worldwide. In the pathogenesis of preeclampsia abnormal placental invasion, the excess of antiangiogenic factors and maternal-placental syndrome play a key role. Increased blood levels of homocysteine during pregnancy are associated with the risk of preeclampsia. Moreover, hyperhomocysteinemia has been proposed to be an independent risk factor for preeclampsia. Folate supplementation helps to decrease elevated levels of homocysteine; thus, the role of folic acid supplementation in pregnancy is even more important. Multiple reports suggest that folate administration decreases the level of serum homocysteine and, therefore, reduce the risk and severity of preeclampsia. However, the association between folic acid supplementation and the decreased risk of preeclampsia has been investigated with controversial conclusions. Currently, the optimal dose of folic acid that is effective for preeclampsia prevention remains uncertain. In this review, we aim to summarize the accumulated knowledge on the role of folic acid in the pathogenesis of preeclampsia, and the possible impact of folate supplementation on the decreased risk of preeclampsia.
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Affiliation(s)
- Lyazzat Kaldygulova
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030012, Kazakhstan
| | - Talshyn Ukybassova
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Correspondence:
| | - Andrey Gaiday
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030012, Kazakhstan
| | - Akylbek Tussupkaliyev
- Department of Obstetrics and Gynecology #2, West-Kazakhstan Marat Ospanov Medical University, Aktobe 030012, Kazakhstan
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Li M, Chen Y, Wang Y, Wang H, Ding X, Li G. Maternal gestational diabetes in singleton pregnancies conceived by ART may be modified by periconceptional B vitamins. Front Nutr 2023; 9:1069911. [PMID: 36741994 PMCID: PMC9889836 DOI: 10.3389/fnut.2022.1069911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Background The risk of maternal gestational diabetes mellitus (GDM) may be influenced by pregnancies conceived through assisted reproductive technology (ART). However, the influence of the dosage of B vitamins (folate, vitamin B6 and vitamin B12) on GDM weren't considered. Thus, we hypothesized that periconceptional B vitamins could modify maternal GDM in singleton pregnancies conceived by ART. Methods This study is a prospective cohort study using data from 3,252 women with singleton pregnancies and received a 75 g oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. We included an interaction term in the multivariable logistic and linear regression models, respectively, to test our hypothesis. Results Women who underwent ART were significantly associated with the incidence of GDM compared with spontaneous pregnancy women. The adjusted odds ratio (aOR) was 1.59, and the 95% confidence interval (CI) was 1.08-2.34. ART pregnancies also elevated OGTT (oral glucose tolerance test) 1-h blood glucose levels and OGTT 2-h blood glucose levels (P < 0.05). A positive association between dietary vitamin B6 (aOR = 1.60, 95% CI: 1.13-2.27), dietary vitamin B12 (aOR = 1.88, 95% CI: 1.34-2.64) and dietary folate (aOR = 1.66, 95% CI: 1.19-2.32) with GDM risk comparing the highest to the lowest quartile (all P trend < 0.001). The aORs of GDM for inadequate (< 400 μg/day), adequate (400-800 μg/day), and excessive (> 800 μg/day) supplemental folate intake were 1.00, 0.93, and 1.30, respectively (P trend = 0.033). Since only the supplemental folate illustrates a statistically significant interaction with ART (P for interaction < 0.05), the association between ART and GDM and OGTT blood glucose levels stratifying by supplemental folate were further evaluated. These increased risks of GDM (aOR = 1.62, 95% CI: 1.39-3.39) and the regression coefficients (β) of 1-h blood glucose (β = 0.76, 95% CI: 0.39-1.13) and 2-h blood glucose (β = 0.60, 95% CI: 0.29-0.92) in the multiple linear regression model were significant only in the ART group with excessive supplemental folate (> 800 μg/day). Conclusion The risk of GDM is significantly elevated, particularly among those women who conceived ART with the intake of excessive supplemental folate (> 800 μg/day).
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Affiliation(s)
- Minyu Li
- Public Health School, Medical College of Qingdao University, Qingdao, Shandong, China
| | - Yanping Chen
- Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, Shandong, China
| | - Yongxiang Wang
- Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, Shandong, China
| | - Hong Wang
- Public Health School, Medical College of Qingdao University, Qingdao, Shandong, China
| | - Xueteng Ding
- Public Health School, Medical College of Qingdao University, Qingdao, Shandong, China
| | - Guoju Li
- Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, Shandong, China,*Correspondence: Guoju Li,
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Is the Tradeoff between Folic Acid or/and Multivitamin Supplementation against Birth Defects in Early Pregnancy Reconsidered? Evidence Based on a Chinese Birth Cohort Study. Nutrients 2023; 15:nu15020279. [PMID: 36678149 PMCID: PMC9865336 DOI: 10.3390/nu15020279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several studies have reported conflicting results on the association between maternal exposure to folic acid (FA) and/or multivitamin (MV) supplements and the risk of birth defects (BDs), especially for different subtypes of BDs. The present study aimed to identify the association between maternal exposure to FA or/and MV and BDs in offspring. METHODS In the Chinese Birth Cohort Study initiated from 20 November 2017, 120,652 pregnant women completed follow-up until 20 August 2021. The participants were classified into four groups: without exposure to FA and MV, exposure to only FA, exposure to only MV, and exposure to FA and MV. Birth defects were coded by the International Classification of Diseases (ICD)-10. In order to explore the structural relationship between maternal FA or MV supplements and BDs, directed acyclic graphs were drawn. Then, an inverse probability treatment weighting was utilized to reduce the systematic differences in the baseline characteristics among the different groups. Lastly, a two-level mixed-effect log binomial regression analysis was used to estimate the relative risk (RR) value of the different subtypes of BDs under different exposures to FA and/or MV. RESULTS Compared with the maternal group without exposure to FA and MV, the RR values of nervous system defects, face, ear, and neck defects, limb defects, and CHDs in the maternal group with only FA supplementation were less than 1.0, but they were not statistically significant. The RR values of genitourinary defects, abnormal chromosomes, and oral clefts were more than 1.0, and they were also not statistically significant. However, the risk of genitourinary defects (RR: 3.22, 95% CI: 1.42-7.29) and chromosomal abnormalities (RR: 2.57, 95% CI: 1.16-5.73) in the maternal group with only MV supplementation increased more than those in the maternal group without exposure to FA and MV. In addition, the RR values of all subtypes of BDs in the maternal group with exposure to FA and MV were closer to 1.0 than those in maternal group with exposure to only MV, but they were not statistically significant. CONCLUSIONS It was indicated that the simultaneous supplementation of FA and MV in early pregnancy may have an interaction for the prevention of BDs and may have inconsistent effects for different subtypes of BDs. At the same time, excessive FA supplementation in pregnant women may increase the risk of BDs in their offspring. Although the mechanism is not clear, this evidence reminded us that more trade-offs are necessary for formulating strategies for the prevention of BDs with FA and/or MV supplementation in early pregnancy.
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Guo J, Zhou M, Zhao M, Li S, Fang Z, Li A, Zhang M. TIGAR deficiency induces caspase-1-dependent trophoblasts pyroptosis through NLRP3-ASC inflammasome. Front Immunol 2023; 14:1114620. [PMID: 37122710 PMCID: PMC10140348 DOI: 10.3389/fimmu.2023.1114620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/06/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Gestational diabetes mellitus (GDM), a common complication of pregnancy, is risky for both mother and fetus. Previous studies about TP53-induced glycolysis and apoptosis regulator (TIGAR) focused on the occurrence and development of cancer, cardiovascular disease, and neurological disease, however, it is still unclear whether TIGAR plays a regulatory role in gestational diabetes mellitus (GDM). Methods Utilizing HG exposure, we explored the role of TIGAR in oxidative stress limitation, excessive inflammatory toxicity defense, and pyroptosis prevention. Results TIGAR was up-regulated in vivo and in vitro under HG condition, and loss of TIGAR increased ROS in trophoblast cells which drove a phenotypic switch and hindered the capacity of migration, invasion, and tube formation. This switch depended on the increased activation of NLRP3-ASC-caspase-1 signaling, which caused a distinctive characteristic of pyroptosis, and these findings could finally be reverted by antioxidant treatment (NAC) and receptor block (MCC950). Collectively, trophoblast pyroptosis is an upstream event of TIGAR deficiency-induced inflammation, which is promoted by ROS accumulation through NLRP3-ASC inflammasome. Conclusion Taken together, our results uncovered that, as the upstream event of TIGAR deficiency-induced inflammation, pyroptosis is stimulated by ROS accumulation through NLRP3-ASC inflammasome.
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Affiliation(s)
| | | | | | | | | | - Anna Li
- *Correspondence: Anna Li, ; Meihua Zhang,
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Wang D, Pham VT, Steinert RE, Zhernakova A, Fu J. Microbial vitamin production mediates dietary effects on diabetic risk. Gut Microbes 2022; 14:2154550. [PMID: 36474346 PMCID: PMC9733697 DOI: 10.1080/19490976.2022.2154550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Adequate levels of essential vitamins are important for the prevention of diabetes. While the main efforts to address this are currently focused on the intake of vitamin supplements, improving and maintaining intrinsic vitamin production capacity, which is determined by gut microbes, has received insufficient attention. In this study, we systematically investigated the relationship between gut microbial vitamin production and factors related to diabetes and cardiometabolic health in a deeply phenotyped cohort, Lifelines-DEEP (N = 1,135). We found that blood glucose-related factors, lipids, circulating inflammation, and fecal short-chain fatty acids are associated with gut microbial vitamin production. Use of laxatives and metformin are associated with increased levels of vitamin B1/B6 biosynthesis pathways. We further reveal a mediatory role for microbial vitamin B1/B2 production on the influence of fruit intake on diabetes risk. This study provides preliminary evidence for microbiome-targeted vitamin metabolism interventions to promote health.
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Affiliation(s)
- Daoming Wang
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen9713AV, the Netherlands,Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen9713AV, the Netherlands
| | - Van T. Pham
- Global R&D Center Human Nutrition and Care (HNC), DSM Nutritional Products Ltd, Basel, Switzerland
| | - Robert E. Steinert
- Global R&D Center Human Nutrition and Care (HNC), DSM Nutritional Products Ltd, Basel, Switzerland,Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Zhernakova
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen9713AV, the Netherlands
| | - Jingyuan Fu
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen9713AV, the Netherlands,Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen9713AV, the Netherlands,CONTACT Jingyuan Fu Department of Genetics, University of Groningen, University Medical Center Groningen; Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen9713AV, the Netherlands
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Bankole T, Winn H, Li Y. Dietary Impacts on Gestational Diabetes: Connection between Gut Microbiome and Epigenetic Mechanisms. Nutrients 2022; 14:nu14245269. [PMID: 36558427 PMCID: PMC9786016 DOI: 10.3390/nu14245269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common obstetric complications due to an increased level of glucose intolerance during pregnancy. The prevalence of GDM increases due to the obesity epidemic. GDM is also associated with an increased risk of gestational hypertension and preeclampsia resulting in elevated maternal and perinatal morbidity and mortality. Diet is one of the most important environmental factors associated with etiology of GDM. Studies have shown that the consumption of certain bioactive diets and nutrients before and during pregnancy might have preventive effects against GDM leading to a healthy pregnancy outcome as well as beneficial metabolic outcomes later in the offspring's life. Gut microbiome as a biological ecosystem bridges the gap between human health and diseases through diets. Maternal diets affect maternal and fetal gut microbiome and metabolomics profiles, which consequently regulate the host epigenome, thus contributing to later-life metabolic health in both mother and offspring. This review discusses the current knowledge regarding how epigenetic mechanisms mediate the interaction between maternal bioactive diets, the gut microbiome and the metabolome leading to improved metabolic health in both mother and offspring.
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Affiliation(s)
- Taiwo Bankole
- Department of Nutrition and Food Science, University of Maryland, College Park, MD 20742, USA
| | - Hung Winn
- Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO 65212, USA
| | - Yuanyuan Li
- Department of Nutrition and Food Science, University of Maryland, College Park, MD 20742, USA
- Correspondence:
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The association of maternal fat-soluble antioxidants in early pregnancy with gestational diabetes mellitus: a prospective cohort study. Nutr Diabetes 2022; 12:49. [PMID: 36494332 PMCID: PMC9734187 DOI: 10.1038/s41387-022-00227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Oxidative stress is linked to the development of gestational diabetes mellitus (GDM). Maternal antioxidant vitamins in early pregnancy may play a role in GDM occurrence. We aimed to investigate the associations of vitamins A and E in early pregnancy with the risk of GDM and to explore whether these antioxidant vitamins can be biomarkers for the early prediction of GDM. METHODS We carried out a prospective cohort study conducted in Beijing and enrolled pregnant women (n = 667) with vitamins A and E measurements at 9 weeks (IQR 8-10) of gestation and having one-step GDM screened with a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation. RESULTS The vitamin A levels in early pregnancy were significantly higher in women with GDM than in those without GDM (p < 0.0001) and positively correlated with fasting blood glucose. In multivariate models, vitamin A levels were significantly associated with GDM (OR, 1.46; 95% CI: 1.14-1.88; p = 0.0032) per SD. A significant trend of risk effect on GDM risk across quartiles of vitamin A was observed (ptrend = 0.016). No significant association of serum vitamin E with GDM was observed overall. However, a noted trend of protective effect on GDM risk across quartiles of vitamin E/cholesterol ratio was observed (ptrend = 0.043). In ROC analysis, the multivariate model consisting of vitamin A and other risk factors showed the best predictive performance (AUC: 0.760; 95% CI: 0.705-0.815; p < 0.001). CONCLUSIONS Higher levels of vitamin A in early pregnancy were significantly associated with an increased risk of GDM. Vitamin A has the potential to be a biomarker indicating pathogenesis of GDM.
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He J, Jiang D, Cui X, Ji C. Vitamin B12 status and folic acid/vitamin B12 related to the risk of gestational diabetes mellitus in pregnancy: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth 2022; 22:587. [PMID: 35870897 PMCID: PMC9308279 DOI: 10.1186/s12884-022-04911-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background This review was conducted to investigate the association between serum vitamin B12 levels as well as folic acid/vitamin B12 during pregnancy and the risk of gestational diabetes mellitus (GDM). Methods A comprehensive search of electronic databases (Embase, PubMed, and Web of Science) was performed. The odds ratios (ORs) with 95% confidence intervals (CIs) of GDM risk were summarized using a random effects model. We also performed subgroup analyses to explore the source of heterogeneity. Results A total of 10 studies, including 10,595 pregnant women were assessed. Women with vitamin B12 deficiency were at higher risk for developing GDM when compared with those who were vitamin B12 sufficient (OR, 1.46; 95% CI 1.21–1.79; I2: 59.0%). Subgroup analysis indicated that this association might differ based on sample size and geographical distribution. Elevated vitamin B12 levels may decrease the risk of GDM by 23%. The role of excess folic acid and low vitamin B12 levels in the occurrence of GDM is also controversial. Conclusion In summary, vitamin B12 deficiency is associated with increased risk of GDM, it is necessary to pay more attention to the balance of vitamin B12 and folic acid. However, more in-depth studies across multiple populations are needed to verify these results. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04911-9.
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Wang N, Zhou T, Ma X, Lin Y, Ding Y. The Association between Maternal B Vitamins in Early Pregnancy and Gestational Diabetes Mellitus: A Prospective Cohort Study. Nutrients 2022; 14:nu14235016. [PMID: 36501046 PMCID: PMC9736031 DOI: 10.3390/nu14235016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background: This study evaluated the association between maternal B vitamins in early pregnancy and gestational diabetes mellitus (GDM) risk. Methods: A cohort of 1265 pregnant women was recruited at 8−15 weeks of gestation in 2021−2022 (Shanghai, China). Pregnancies with both serum B vitamin measurements at recruitment and glucose measurements at 24−28 weeks of gestation were included in the final analysis. Results: Of the 1065 pregnancies, in the final analysis, GDM occurred in 121 women (11.36%). In multivariate logistic models, an increased risk trend across serum vitamin B1 quartiles with GDM was observed (p-Trend = 0.001). Compared with women in the lowest quartile of serum vitamin B6, those in the upper two quartiles had approximately twofold higher odds of GDM. Moreover, compared with women with vitamin B12 levels < 150 pmol/L, those with vitamin B12 levels > 150 pmol/L had lower odds of GDM (p = 0.005). The restricted cubic spline regression models also revealed that serum vitamin B6 and vitamin B12 were associated with an increased risk of GDM in a nonlinear fashion. Conclusions: Our study shows that higher maternal serum vitamin B1 and B6 levels in early pregnancy are associated with increased GDM risk, while sufficient vitamin B12 status is associated with lower GDM risk.
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Affiliation(s)
- Na Wang
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai 200090, China
| | - Tianchun Zhou
- School of Nursing, Fudan University, Shanghai 200032, China
| | - Xiaoxia Ma
- School of Nursing, Fudan University, Shanghai 200032, China
| | - Yuping Lin
- School of Nursing, Fudan University, Shanghai 200032, China
| | - Yan Ding
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai 200090, China
- Correspondence: ; Tel.:+86-137-9535-7887
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High Folate, Perturbed One-Carbon Metabolism and Gestational Diabetes Mellitus. Nutrients 2022; 14:nu14193930. [PMID: 36235580 PMCID: PMC9573299 DOI: 10.3390/nu14193930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Folate is a dietary micronutrient essential to one-carbon metabolism. The World Health Organisation recommends folic acid (FA) supplementation pre-conception and in early pregnancy to reduce the risk of fetal neural tube defects (NTDs). Subsequently, many countries (~92) have mandatory FA fortification policies, as well as recommendations for periconceptional FA supplementation. Mandatory fortification initiatives have been largely successful in reducing the incidence of NTDs. However, humans have limited capacity to incorporate FA into the one-carbon metabolic pathway, resulting in the increasingly ubiquitous presence of circulating unmetabolised folic acid (uFA). Excess FA intake has emerged as a risk factor in gestational diabetes mellitus (GDM). Several other one-carbon metabolism components (vitamin B12, homocysteine and choline-derived betaine) are also closely entwined with GDM risk, suggesting a role for one-carbon metabolism in GDM pathogenesis. There is growing evidence from in vitro and animal studies suggesting a role for excess FA in dysregulation of one-carbon metabolism. Specifically, high levels of FA reduce methylenetetrahydrofolate reductase (MTHFR) activity, dysregulate the balance of thymidylate synthase (TS) and methionine synthase (MTR) activity, and elevate homocysteine. High homocysteine is associated with increased oxidative stress and trophoblast apoptosis and reduced human chorionic gonadotrophin (hCG) secretion and pancreatic β-cell function. While the relationship between high FA, perturbed one-carbon metabolism and GDM pathogenesis is not yet fully understood, here we summarise the current state of knowledge. Given rising rates of GDM, now estimated to be 14% globally, and widespread FA food fortification, further research is urgently needed to elucidate the mechanisms which underpin GDM pathogenesis.
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Chen H, Zhang Y, Wang D, Chen X, Li M, Huang X, Jiang Y, Dou Y, Wang Y, Ma X, Sheng W, Jia B, Yan W, Huang G. Periconception Red Blood Cell Folate and Offspring Congenital Heart Disease : Nested Case-Control and Mendelian Randomization Studies. Ann Intern Med 2022; 175:1212-1220. [PMID: 35994746 DOI: 10.7326/m22-0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Periconception folic acid supplementation has been suggested to protect against congenital heart disease (CHD), but the association between maternal red blood cell (RBC) folate, the gold-standard biomarker of folate exposure, and subsequent offspring CHD risk is lacking. OBJECTIVE To quantify the association between periconception maternal RBC folate and offspring CHD risk. DESIGN Prospective, nested, case-control study and 1-sample Mendelian randomization. (ClinicalTrials.gov: NCT02737644). SETTING 29 maternity institutions in 12 districts of Greater Shanghai, China. PARTICIPANTS All 197 mothers of offspring with CHD and 788 individually matched mothers of unaffected offspring from the SPCC (Shanghai Preconception Cohort). MEASUREMENTS Maternal RBC folate was measured before or at early pregnancy. Odds ratios [ORs] were estimated using conditional logistic regression after adjustment for covariates. Mendelian randomization was done using the methylenetetrahydrofolate reductase (MTHFR) C677T as the genetic instrument. RESULTS Case patients had lower median maternal RBC folate concentrations than control participants (714 nmol/L [interquartile range, 482 to 1008 nmol/L] vs. 788 nmol/L [557 to 1094 nmol/L]). Maternal RBC folate concentrations were inversely associated with offspring CHD (adjusted OR per 100 nmol/L, 0.93 [95% CI, 0.89 to 0.99]). The adjusted OR for mothers with periconception RBC folate of 906 nmol/L or more (vs. <906 nmol/L) was 0.61 (CI, 0.40 to 0.93). Mendelian randomization showed that each 100-nmol increase in maternal RBC folate concentrations was significantly associated with reduced offspring CHD risk (OR, 0.75 [CI, 0.61 to 0.92]). LIMITATION Potential confounding due to unmeasured covariates in the nested case-control study. CONCLUSION Higher maternal RBC folate is associated with reduced offspring CHD risk. For primary CHD prevention, higher target RBC folate levels than currently recommended for neural tube defect prevention may be needed and warrant further study. PRIMARY FUNDING SOURCE National Key Research and Development Program of China, National Natural Science Foundation of China, China Postdoctoral Science Foundation, and Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences.
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Affiliation(s)
- Hongyan Chen
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (H.C., Y.Z., X.C., Y.J., Y.D., Y.W.)
| | - Yi Zhang
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (H.C., Y.Z., X.C., Y.J., Y.D., Y.W.)
| | - Dingmei Wang
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China (D.W., M.L.)
| | - Xiaotian Chen
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (H.C., Y.Z., X.C., Y.J., Y.D., Y.W.)
| | - Mengru Li
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China (D.W., M.L.)
| | - Xiangyuan Huang
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China (X.H.)
| | - Yuan Jiang
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (H.C., Y.Z., X.C., Y.J., Y.D., Y.W.)
| | - Yalan Dou
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (H.C., Y.Z., X.C., Y.J., Y.D., Y.W.)
| | - Yin Wang
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (H.C., Y.Z., X.C., Y.J., Y.D., Y.W.)
| | - Xiaojing Ma
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (X.M., B.J.)
| | - Wei Sheng
- Shanghai Key Laboratory of Birth Defects, Shanghai, China (W.S.)
| | - Bing Jia
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, and Shanghai Key Laboratory of Birth Defects, Shanghai, China (X.M., B.J.)
| | - Weili Yan
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, Shanghai Key Laboratory of Birth Defects, Shanghai, and Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China (W.Y.)
| | - Guoying Huang
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, Shanghai Key Laboratory of Birth Defects, Shanghai, and Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China (G.H.)
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Zhang DY, Cheng DC, Cao YN, Su Y, Chen L, Liu WY, Yu YX, Xu XM. The effect of dietary fiber supplement on prevention of gestational diabetes mellitus in women with pre-pregnancy overweight/obesity: A randomized controlled trial. Front Pharmacol 2022; 13:922015. [PMID: 36105207 PMCID: PMC9465204 DOI: 10.3389/fphar.2022.922015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the effect of dietary fiber intake during pregnancy on the prevention of gestational diabetes mellitus (GDM) in women who are overweight/obese prior to pregnancy. Methods: This randomized controlled trial was conducted in Shanghai General Hospital from June 2021 to March 2022. A total of 98 women who reported BMI≥24 kg/m2 prior to pregnancy were recruited before their 20th gestational week, and randomly (simple random allocation) assigned to the fiber supplement group (12 g of dietary fiber power twice daily) and the control group (standard prenatal care) from 20 to 24+6 gestational weeks. Both groups received nutrition education and dietary advice during the study. GDM diagnosis was performed by an oral glucose tolerance test (OGTT) at 25–28 weeks’ gestation. Data are presented as means with SD, as medians with IQR, or as counts with percentages as appropriate. Comparisons were conducted using a t-test, Mann-Whitney U test, and χ2 test, respectively. Results: The incidence of GDM was significantly reduced in the fiber supplement group compared with the control group: 8.3 vs. 24.0% (χ2 = 4.40, p = 0.036). At OGTT, the mean fasting plasma glucose in the fiber supplement group was significantly lower than before the intervention (4.57 ± 0.38 mmol/L vs. 4.41 ± 0.29 mmol/L, p < 0.01) but not in the control group (4.48 ± 0.42 mmol/L vs. 4.37 ± 0.58 mmol/L, p = 0.150). Compared with the control group, the TG and TG/HDL-C ratio levels in the intervention group were significantly higher than those in the control group (2.19 ± 0.54 mmol/L vs. 2.70 ± 0.82 mmol/L and 1.19 ± 0.49 vs.1.63 ± 0.63, respectively, all P<0.05). The body weight gain was significantly lower in the fiber supplement group than the control group (1.99 ± 1.09 kg vs. 2.53 ± 1.20kg, p = 0.022). None of the women randomized to the fiber supplement group experienced preterm birth (<37 weeks gestation) compared with 12.0% in the control group (p = 0.040). Excessive weight gain (total weight gain >11.5 kg for overweight, and >9.0 kg for obesity) occurred in 46.7% of women in the fiber supplement group compared with 68.0% in the control group (p = 0.035). There were no differences in other maternal and neonatal outcomes. Conclusion: Increased dietary fiber intake in pregnant women who were overweight/obese prior to pregnancy may reduce the risk of GDM, excessive weight gain, and preterm birth, but it did not improve blood lipids.
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Yuan X, Han X, Zhou W, Long W, Wang H, Yu B, Zhang B. Association of folate and vitamin B12 imbalance with adverse pregnancy outcomes among 11,549 pregnant women: An observational cohort study. Front Nutr 2022; 9:947118. [PMID: 35958250 PMCID: PMC9358651 DOI: 10.3389/fnut.2022.947118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 01/05/2023] Open
Abstract
Objective This study aimed to evaluate maternal serum levels of folate, vitamin B12, and their ratio on admission for labor and determine whether an imbalance between folate and vitamin B12, represented by a higher or lower serum folate to vitamin B12 ratio (SFVB12R), was associated with adverse pregnancy outcomes. Methods A retrospective cohort study of 11,549 pregnant women attending a district specialized hospital and who had serum folate (SF) and serum vitamin B12 (SVB12) levels measured at delivery was performed. The levels of SF, SVB12, and SFVB12R were defined as high (>95th percentile), normal (5–95th percentile), and low (<5th percentile). Information on pregnancy outcomes was retrieved from medical records. Linear regression was performed to examine the association of abnormal SF, SVB12, and SFVB12R levels with fetal growth indicators. Logistic regression was applied to estimate the association between abnormal SF, SVB12, and SFVB12R levels and pregnancy outcomes. Results Lower SF levels were associated with higher risks of intrahepatic cholestasis of pregnancy (ICP, OR 1.58; 95% CI 1.15–2.17), pre-eclampsia (PE, OR 1.89; 95% CI 1.28–2.81), and a lower risk of gestational diabetes mellitus (GDM, OR 0.40; 95% CI 0.23–0.70), whereas higher SVB12 levels were associated with a higher risk of ICP (OR 2.22; 95% CI 1.67–2.96), PE (OR 1.69; 95% CI 1.04-2.74), and GDM (OR 1.62; 95% CI 1.24–2.11). A higher SFVB12R increased birthweight (β 60.99; 95% CI 29.52–92.45) and was associated with a higher risk of large-for-gestational-age (LGA) newborns (OR 3.08; 95% CI 1.63–5.83); a lower SFVB12R decreased birthweight (β −43.81; 95% CI −75.62, −12.00) and was associated with a lower risk of LGA newborns (OR 0.75; 95% CI 0.56–1.00), and with higher risks of ICP (OR 2.03; 95% CI 1.54–2.67) and pregnancy-induced hypertension (PIH, OR 1.81; 95% CI 1.09–3.00). Conclusion An imbalance between folate and vitamin B12, represented by a higher or lower SFVB12R before delivery, was significantly associated with adverse pregnancy outcomes (ICP/PIH/LGA).
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Affiliation(s)
- Xiaosong Yuan
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Xiaoya Han
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Wenbo Zhou
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Wei Long
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Changzhou, China
| | - Bin Yu
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Bin Zhang
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
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Association between folic acid use during pregnancy and gestational diabetes mellitus: Two population-based Nordic cohort studies. PLoS One 2022; 17:e0272046. [PMID: 35951607 PMCID: PMC9371283 DOI: 10.1371/journal.pone.0272046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/13/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Inconsistent results have been reported on the association between folic acid use in pregnancy and risk of GDM. The aim of this study was to estimate the association between folic acid use and GDM in two population-based Nordic cohorts.
Material and methods
Two cohort studies were conducted using data from the national population registers in Norway (2005–2018, n = 791,709) and Sweden (2006–2016, n = 1,112,817). Logistic regression was used to estimate the associations between GDM and self-reported folic acid use and prescribed folic acid use, compared to non-users, adjusting for covariates. To quantify how potential unmeasured confounders may affect the estimates, E-values were reported. An exposure misclassification bias analysis was also performed.
Results
In Norwegian and Swedish cohorts, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for maternal self-reported folic acid use were 1.10 (1.06–1.14) and 0.89 (0.85–0.93), with E-values of 1.43 (1.31) and 1.50 (1.36), respectively. For prescribed folic acid use, ORs were 1.33 (1.15–1.53) and 1.56 (1.41–1.74), with E-values of 1.99 (1.57) and 2.49 (2.17), in Norway and Sweden respectively.
Conclusions
The slightly higher or lower odds for GDM in self-reported users of folic acid in Norway and Sweden respectively, are likely not of clinical relevance and recommendations for folic acid use in pregnancy should remain unchanged. The two Nordic cohorts showed different directions of the association between self-reported folic acid use and GDM, but based on bias analysis, exposure misclassification is an unlikely explanation since there may still be differences in prevalence of use and residual confounding. Prescribed folic acid is used by women with specific comorbidities and co-medications, which likely underlies the higher odds for GDM.
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Chen X, Du Y, Xia S, Li Z, Liu J. Vitamin B 12 and gestational diabetes mellitus: a systematic review and meta-analysis. Br J Nutr 2022; 129:1-8. [PMID: 35915058 DOI: 10.1017/s000711452200246x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The relationship between vitamin B12 and gestational diabetes mellitus (GDM) remains controversial. To comprehensively evaluate the relationship between vitamin B12 and GDM, and to provide more information on GDM prevention, this study provides a systematic review and meta-analysis of vitamin B12 and GDM. As of September 22, 2021, 304 articles were searched in PubMed, Web of Science, EMBASE, and Cochrane databases, of which 15 studies met the inclusion criteria. Results presented there was no association between maternal vitamin B12 concentration during the first trimester with GDM, however, low vitamin B12 concentration in the second or third trimester of pregnancy was related to an increased risk of GDM. Compared with the non-GDM group, the vitamin B12 concentration in the GDM group was remarkably decreased (MD: -10·79; 95%CI: -21·37, -0·21), and vitamin B12 deficiency increased the risk for GDM (OR: 1·59; 95%CI: 1·10, 2·29). These effects were more significant among Asians. In addition, an increased ratio of high folate to low vitamin B12 in serum also increased the risk of GDM (OR: 1·87; 95% CI: 1·46, 2·41). These results suggest that more vitamin B12 may need to be provided during pregnancy.
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Affiliation(s)
- Xue Chen
- School of Public Health, Bengbu Medical College, Bengbu, Anhui Province, 233030, People's Republic of China
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Yushan Du
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Shuangbo Xia
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Jufen Liu
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
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Effects of Early Nursing Monitoring on Pregnancy Outcomes of Pregnant Women with Gestational Diabetes Mellitus under Internet of Things. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8535714. [PMID: 35693264 PMCID: PMC9177328 DOI: 10.1155/2022/8535714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
To analyze the effect of early nursing intervention based on fetal heart signal extraction algorithm and Internet of Things (IoT) wireless communication technology on the adverse pregnancy outcomes of pregnant women with gestational diabetes mellitus (GDM) and newborns, 88 pregnant women diagnosed with GDM who underwent the 75 g glucose tolerance test at 24-28 gestational weeks in the hospital were selected as the research objects. According to the different intervention methods, the patients were divided into 44 cases of the experimental group (nursing intervention based on maternal and infant monitoring system) and 44 cases of the control group (outpatient follow-up intervention). The results showed that the compliance score and diet compliance rate of patients in the experimental group were signally higher than those in the control group at 1 and 3 months after intervention (P < 0.05). The levels of fasting blood glucose (FBG), blood glucose 2 hours after the meal, and hemoglobin A1c (HbA1c) in the experimental group were lower than those in the control group at 1 and 3 months after intervention (P < 0.05). The number of giant babies, hypoglycemia, hyperbilirubinemia, fetal distress, premature delivery, and birth weight in the experimental group was all lower than those in the control group, while the Apgar scores were higher than that in the control group (P < 0.05). To sum up, the intervention based on the intelligent maternal and infant monitoring system could timely help pregnant women adjust their diet structure and optimize the management of blood glucose and blood lipids, thus effectively improving the adverse pregnancy outcome and maintaining the health of pregnant women and newborns.
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Xiong H, Li X, Cheng S, Chen P, Guo S, Huang X, Lu Y. Folate Status and Mortality in US Adults With Diabetes: A Nationally Representative Cohort Study. Front Cardiovasc Med 2022; 9:802247. [PMID: 35548409 PMCID: PMC9082538 DOI: 10.3389/fcvm.2022.802247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPublic health concerns have gradually shifted from inadequate intakes to potential adverse effects associated with excessive folate intakes following the full implementation of mandatory folate fortification. This study aimed to examine the associations of red blood cell (RBC) folate with all-cause and cardiovascular disease (CVD) mortality among patients with diabetes.MethodsData of 15,514 adults aged 20 years or older, who participated in the National Health and Nutrition Examination Survey (1988–1994), were analyzed as the baseline examination. The participants were linked to mortality data from the survey date until December 31, 2015. The associations of RBC folate with all-cause and CVD mortality were examined using multivariable Cox regression models.ResultsDuring 297,708 person–years of follow-up (median of 19.2 years), 6,106 total deaths occurred, including 1,867 deaths from CVD, 1452 deaths from ischemic heart disease, and 415 deaths from stroke disease. The participants with the highest quartile of RBC folate had higher odds of diabetes (fully-adjusted odds ratio: 1.94 [95% CI: 1.53–2.48]). In Cox regression analyses, compared with the participants with the lowest quartile of RBC folate for diabetes, those from quartile 3 and quartile 4 had HRs (95% CIs) of 1.12 (0.87, 1.43) and 1.30 (1.04, 1.63) in all-cause mortality, respectively; in CVD mortality, the HRs were 1.73 (1.08, 2.76) and 1.47 (0.98, 2.22); in ischemic heart disease mortality, they were 2.01 (1.19, 3.39) and 1.62 (1.05, 2.50), respectively. However, high levels of RBC folate were negatively associated with all-cause mortality, CVD mortality and ischemic heart disease mortality in non-diabetes.ConclusionFrom the nationally representative data, increasing levels in RBC folate were independently associated with an increased risk of all-cause and CVD mortality among those diagnosed with diabetes, but high levels of RBC folate had a mild protective effect in non-diabetes. The underlying mechanism regarding folate and adverse outcomes in diabetes warrants further clarification.
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Affiliation(s)
- Hui Xiong
- Cardiac Function Department, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Xiaoxiao Li
- Cardiac Function Department, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Shuxian Cheng
- Department of Cardiovascular Medicine, School of Clinical Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Pengyu Chen
- Cardiac Function Department, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Sixu Guo
- Cardiac Function Department, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Xianli Huang
- Department of Cardiology, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Xianli Huang
| | - Yu Lu
- Department of Cardiology, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- Yu Lu
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Associations of Maternal rs1801131 Genotype in MTHFR and Serum Folate and Vitamin B12 with Gestational Diabetes Mellitus in Chinese Pregnant Women. Nutrients 2022; 14:nu14061169. [PMID: 35334827 PMCID: PMC8954918 DOI: 10.3390/nu14061169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023] Open
Abstract
Circumstantial evidence links one-carbon metabolism (OCM) related nutrients, such as folate and vitamin B12, with gestational diabetes mellitus (GDM). However, few studies have evaluated the combined effects of these nutrients with OCM related gene polymorphisms on GDM. This study investigated whether OCM related genetic variants modified the associations of folate and B12 with GDM. Logistic regression was used to estimate odds ratios (ORs) for OCM related nutrients and single nucleotide polymorphisms (SNPs) in genes encoding main OCM related enzymes (MTHFR, MTR, and MTRR) on GDM. Higher folate concentrations were associated with increased GDM risk (OR: 1.59; 95% CI: 1.22, 2.13). However, higher B12 concentrations were associated with reduced GDM risk (OR: 0.76; 95% CI: 0.65, 0.92). Pregnancies with MTHFR rs1801131 G alleles had a significantly lower risk of GDM than pregnancies with T alleles (OR: 0.65; 95% CI: 0.47, 0.91) under the dominant model. The genotype-stratified analysis revealed the association between folate and GDM (OR: 1.66, 95% CI: 1.20, 2.30) or B12 and GDM (OR: 0.80, 95% CI: 0.65, 0.98) was more evident in pregnancies with TT genotype. Higher folate and lower B12 are associated with GDM. Pregnancies with MTHFR rs1801131 TT genotype are more susceptible to OCM nutrient-related GDM.
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Li N, Jiang J, Guo L. Effects of maternal folate and vitamin B12 on gestational diabetes mellitus: a dose-response meta-analysis of observational studies. Eur J Clin Nutr 2022; 76:1502-1512. [PMID: 35105943 DOI: 10.1038/s41430-022-01076-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/16/2022]
Abstract
To comprehensively estimate the association of gestational diabetes mellitus (GDM) risk with maternal red blood cell (RBC) folate, plasma/serum folate, dose and duration of folic acid supplement (FAS) intake and vitamin B12 separately. PubMed, Web of science, CNKI, and Wanfang Databases were searched through March 26, 2021. We synthesized data using random-effects model meta-analysis in Stata 12.0. Sensitivity, subgroup and dose-response analyses were also performed. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Twenty six datasets from thirteen eligible observational studies were included in the study. We found a significant increase of GDM risk with the highest versus lowest category of RBC folate (OR = 1.96, 95% CI: 1.48-2.61, I2 = 0.0%, moderate-certainty evidence) and plasma/serum folate (OR = 1.23, 1.02-1.48, I2 = 57.8%, low-certainty evidence). The dose-response analysis revealed that each 200 ng/ml increase in RBC folate was significantly associated with 8% higher GDM risk. No significant association between dose of FAS intake and GDM risk was found with very low cetainty. Meanwhile, longer duration (≥3 months) of FAS conferred 56% significant higher GDM risk (OR = 1.56, 1.02-2.39, very low certainty evidence). No significant association of GDM risk with highest plasma/serum B12 was observed compared to lowest B12 (OR = 0.77, 0.58-1.02, very low-certainty evidence). Moderate-certainty evidence suggests that higher RBC folate appears to significantly increase GDM risk. Higher plasma/serum folate may increase GDM risk but with low certainty. Further well-designed trials or prospective studies are needed.
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Affiliation(s)
- Nana Li
- Department of Nutrient, Zhengzhou Central Hospital Affiliated to Zhengzhou University, No.195, Tongbai Road, Zhengzhou, China.
| | - Jicheng Jiang
- Department of Big Data Center for Cardiovascular Disease, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Leilei Guo
- Hospital Infection Management Section, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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Wang S, Wang Y, Wan X, Guo J, Zhang Y, Tian M, Fang S, Yu B. Cobalamin Intake and Related Biomarkers: Examining Associations With Mortality Risk Among Adults With Type 2 Diabetes in NHANES. Diabetes Care 2022; 45:276-284. [PMID: 34862259 PMCID: PMC8914415 DOI: 10.2337/dc21-1674] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/07/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Despite that periodical monitoring of cobalamin (vitamin B12) in metformin-treated patients with diabetes is recommended, cobalamin-associated mortality benefits or risks remain unclear. We investigated the association between cobalamin intake and related biomarkers and mortality risk in adults with diabetes using metformin or not. RESEARCH DESIGN AND METHODS This study included 3,277 adults with type 2 diabetes from the National Health and Nutrition Examination Survey (NHANES) and followed up until 31 December 2015. Weighted Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for mortality risk. RESULTS Among 3,277 participants, 865 all-cause deaths occurred during a median follow-up of 7.02 years. There was no robust relationship between all-cause mortality and serum cobalamin or intake of foods or cobalamin supplements, regardless of metformin treatment (each P ≥ 0.120). The doubling of methylmalonic acid (MMA), a cobalamin-deficiency marker, was significantly associated with higher all-cause (HR 1.31 [95% CI 1.18-1.45], P < 0.001) and cardiac (HR 1.38 [95% CI 1.14-1.67], P = 0.001) mortality. Cobalamin sensitivity was assessed by the combination of binary B12low/high and MMAlow/high (cutoff values: cobalamin 400 pg/mL, MMA 250 nmol/L). Patients with decreased cobalamin sensitivity (MMAhighB12high) had the highest mortality risk. The multivariable-adjusted HRs (95% CIs) of all-cause mortality in MMAlowB12low, MMAlowB12high, MMAhighB12low, and MMAhighB12high groups were 1.00 (reference), 0.98 (0.75-1.28), 1.49 (1.16-1.92), and 1.96 (1.38-2.78), respectively. That association was especially significant in metformin nonusers. CONCLUSIONS Serum and dietary cobalamin were not associated with reduced mortality. Decreased cobalamin sensitivity was significantly associated with all-cause and cardiac mortality, particularly among metformin nonusers.
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Affiliation(s)
- Shanjie Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ye Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xin Wan
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Junchen Guo
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yiying Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China.,The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Shaohong Fang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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Cheng Y, Lu X, Zhao F, Sun G. The Effects of Serum Folic Acid and Vitamin B12 on the Risk of Gestational Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:3891-3899. [PMID: 36545294 PMCID: PMC9760576 DOI: 10.2147/dmso.s391888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE In order to gain more knowledge on the risk of gestational diabetes mellitus (GDM), and to provide evidence for clinical guidance on the optimum level of serum folic acid and vitamin B12, this study aimed to clarify the relationship between serum folic acid and vitamin B12 and the risk of GDM. PATIENTS AND METHODS This retrospective case-control study was conducted based on the clinical information system of the Maternal and Child Health Hospital of Hubei Province. Clinical data including maternal socio-demographical characteristics, serum folic acid, and vitamin B12 were collected. Logistic regression analyses and restricted cubic splines were performed to examine the impact of serum folic acid and vitamin B12 on the risk of GDM. RESULTS Significantly elevated risks of GDM were observed in groups with high serum folic acid concentration (OR = 1.84, 95% CI: 1.07-3.16), and in low vitamin B12 concentration (OR = 2.14, 95% CI: 1.26-3.65). After stratified by age, the increased risk of GDM was still noticed in a low level of vitamin B12 among mothers aged <30 years (OR = 4.76, 95% CI: 1.45-15.61). In mothers with pre-pregnancy BMI <24, elevated risk of GDM was significantly associated with a high folic acid (OR = 2.09, 95% CI: 1.11-3.93) or a low vitamin B12 concentration (OR = 2.24, 95% CI: 1.22-4.14). Moreover, the risk of GDM was on the decline with the increased level of folic acid in the beginning, and it started to manifest an upward trend when the serum folic acid reached 19.02 ng/mL. CONCLUSION This study demonstrated that serum folic acid excess or vitamin B12 deficiency could contribute to the increased risk of GDM, and revealed the potential side effect of serum folic acid overdose. As serum folic acid and vitamin B12 tests are widely applied in clinical practice, this finding could help clinicians to evaluate maternal risk from a new perspective.
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Affiliation(s)
- Yao Cheng
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, People’s Republic of China
| | - Xinfeng Lu
- Medical Record Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, People’s Republic of China
| | - Feixia Zhao
- Medical College of Wuhan University of Science and Technology, Wuhan, People’s Republic of China
| | - Guoqiang Sun
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, People’s Republic of China
- Correspondence: Guoqiang Sun, Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road No. 745, Hongshan District, Wuhan, 430070, People’s Republic of China, Tel +86-15972153596, Email
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Chen Y, Lu M, Nie J, Liu J, Liu Y, Meng Y, Sun X, Ji C, Zhang J, Yang X. Increasing prevalence of gestational diabetes mellitus when carrying the T variant allele of the MTHFR gene C677T polymorphism: a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 305:1193-1202. [DOI: 10.1007/s00404-021-06303-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022]
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Saravanan P, Sukumar N, Adaikalakoteswari A, Goljan I, Venkataraman H, Gopinath A, Bagias C, Yajnik CS, Stallard N, Ghebremichael-Weldeselassie Y, Fall CHD. Association of maternal vitamin B 12 and folate levels in early pregnancy with gestational diabetes: a prospective UK cohort study (PRiDE study). Diabetologia 2021; 64:2170-2182. [PMID: 34296321 PMCID: PMC8423653 DOI: 10.1007/s00125-021-05510-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/28/2021] [Indexed: 12/30/2022]
Abstract
AIMS/HYPOTHESIS The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide in all ethnic groups. Low vitamin B12 and low/high folate levels may contribute to GDM risk, but there is conflicting evidence. Our aim is to assess the relationships of early pregnancy vitamin B12 and folate levels with the risk of GDM status at 26-28 weeks of gestation. METHODS This was a prospective, multi-centre, multi-ethnic cohort study (n = 4746) in the UK. Participants who were eligible to be selectively screened as per the National Institute for Health and Care Excellence (NICE) criteria were included in the study. RESULTS GDM prevalence was 12.5% by NICE and 14.7% by International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Folate deficiency (1.3%) was rare but B12 insufficiency (42.3% at <220 pmol/l) and folate excess (36.5%) were common in early pregnancy. Early pregnancy median B12 levels were lower, and folate levels higher, in women who were diagnosed with GDM at 26-28 weeks. B12 was negatively associated with fasting plasma glucose (1 SD: -0.06 mmol/l; 95% CI -0.04, -0.08; p < 0.0001) and 2 h plasma glucose levels (-0.07 mmol/l; 95% CI -0.02, -0.12; p = 0.004). Higher B12 was associated with 14.4% lower RR of IADPSG-GDM (0.856; 95% CI 0.786, 0.933; p = 0.0004) after adjusting for key confounders (age, parity, smoking status, ethnicity, family history, household income and folate status). Approximately half of this association was mediated through BMI. Folate was positively associated with 2 h plasma glucose levels (0.08 mmol/l; 95% CI 0.04, 0.13; p = 0.0005) but its relationship with fasting plasma glucose was U-shaped (quadratic β: 0.011; p = 0.05). Higher folate was associated with 11% higher RR of IADPSG-GDM (adjusted RR 1.11; 95% CI 1.036, 1.182; p = 0.002) (age, parity, smoking status, ethnicity, family history, household income and B12 status). Although no interactions were observed for B12 and folate (as continuous variables) with glucose levels and GDM risk, a low B12-high folate combination was associated with higher blood glucose level and risk of IADPSG-GDM (adjusted RR 1.742; 95% CI 1.226, 2.437; p = 0.003). CONCLUSIONS/INTERPRETATION B12 insufficiency and folate excess were common in early pregnancy. Low B12 and high folate levels in early pregnancy were associated with small but statistically significant changes in maternal blood glucose level and higher RR of GDM. Our findings warrant additional studies on the role of unmetabolised folic acid in glucose metabolism and investigating the effect of optimising early pregnancy or pre-conception B12 and folate levels on subsequent hyperglycaemia. TRIAL REGISTRATION ClinicalTrials.gov NCT03008824.
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Affiliation(s)
- Ponnusamy Saravanan
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, UK.
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK.
| | - Nithya Sukumar
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, UK
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Antonysunil Adaikalakoteswari
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, UK
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Clifton, Nottingham, UK
| | - Ilona Goljan
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
- Novo Nordisk Ltd, Gatwick, UK
| | - Hema Venkataraman
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, UK
- Heartlands Hospital, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Amitha Gopinath
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Christos Bagias
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, UK
| | | | - Nigel Stallard
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, UK
| | - Yonas Ghebremichael-Weldeselassie
- Division of Health Sciences, Warwick Medical School, Gibbet Hill, University of Warwick, Warwick, Coventry, UK
- School of Mathematics and Statistics, The Open University, Milton Keynes, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Wang L, Hou Y, Meng D, Yang L, Meng X, Liu F. Vitamin B12 and Folate Levels During Pregnancy and Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:670289. [PMID: 34195216 PMCID: PMC8236507 DOI: 10.3389/fnut.2021.670289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background: The role of vitamin B12 and folate levels with risk of gestational diabetes mellitus (GDM) is unclear. The purpose of the current study was to conduct a systematic review and meta-analysis for assessing the relationship between vitamin B12 and folate concentrations during pregnancy and the risk of GDM. Methods: PubMed, Embase, CENTRAL, and Ovid databases were searched up to 10th December, 2020 for all types of studies assessing the relationship. Qualitative and quantitative analysis of data was carried out. Results: Twelve studies were included. Pooled serum vitamin B12 concentrations were found to be significantly lower in the GDM group as compared to the non-GDM group. No such difference was noted in serum folate levels. On pooled analysis of adjusted odds ratio's for risk of GDM with red blood cell (RBC) folate, serum folate, and vitamin B12 as continuous variables, no significant relationship was seen. On qualitative analysis, studies reported higher RBC folate levels with a significantly increased risk of GDM. Majority studies reported no relationship between serum folate and risk of GDM. Four of six studies reported a lowered risk of GDM with higher or normal vitamin B12 levels. Conclusion: The association between vitamin B12 and folate levels during pregnancy and the risk of GDM is unclear. Limited number of studies indicate increased risk of GDM with higher RBC folate levels, but majority studies found no association between serum folate and risk of GDM. Based on available studies, the association between the risk of GDM with vitamin B12 deficiency is conflicting. There is a need for further large-scale studies from different regions worldwide to strengthen current evidence.
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Affiliation(s)
- Li Wang
- Department of Obstetrics, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, China
| | - Yanping Hou
- Department of Obstetrics, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, China
| | - Dexia Meng
- Department of Obstetrics, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, China
| | - Li Yang
- Department of Obstetrics, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, China
| | - Xiang Meng
- Department of Obstetrics, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, China
| | - Feng Liu
- Department of Obstetrics, Zaozhuang Maternal and Child Health Hospital, Zaozhuang, China
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Liu Q, Wei S, Lei J, Luo L, Wang F. Periconceptional folate and gestational diabetes mellitus: a systematic review and meta-analysis of cohort studies. J Matern Fetal Neonatal Med 2021; 35:6884-6893. [PMID: 34034602 DOI: 10.1080/14767058.2021.1929158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the relationship between periconceptional folate exposure and risk of gestational diabetes mellitus (GDM). METHODS Several electronic databases, including PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), and Cochrane Library, were searched for all relevant cohort studies by January 2021. Studies on relationship between folate exposure (intake or status) and GDM risk were included. Quality of included studies was assessed using Newcastle-Ottawa Scale. Random effects meta-analysis was performed to estimate overall odds ratio (OR) and 95% confidence intervals (CIs) by Stata software (Stata Corp., College Station, TX). RESULTS Ten cohort studies with 40,244 pregnancies were eligible for quantitative meta-analysis. Significant association was observed between folate exposure and risk of GDM (OR = 1.24, p=.036, 95% CI: 1.01-1.52). Subgroup analysis revealed that periconceptional folate exposure of population in China (OR = 1.35, 95% CI: 1.09-1.67) but not in western countries, folate exposure during pregnancy (OR = 1.49, 95% CI: 1.22-1.81) but not before pregnancy, and internal folate exposure (OR = 1.36, 95% CI: 1.10-1.67), were significantly associated with increased GDM risk. CONCLUSIONS Overall, periconceptional folate exposure is positively associated with GDM risk, especially the exposure during pregnancy and exposure in Chinese populations.
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Affiliation(s)
- Qingyun Liu
- Department of Clinical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Shanshan Wei
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jiafan Lei
- Central Laboratory, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Liangping Luo
- Medical Imaging Center,The First Affiliated Hospital of Jinan University, Guangzhou, China.,Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, Guangzhou, China
| | - Feng Wang
- Department of Clinical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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Kleinwechter H, Demandt N, Nolte A. Prädisposition/Phänotypen des Gestationsdiabetes mellitus. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1217-2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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