Joint Effect of Maternal Pre-pregnancy Body Mass Index and Folic Acid Supplements on Gestational Diabetes Mellitus Risk: a Prospective Cohort Study

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2023 Mar 24

PMID 36959594

Authors

Minyu Li

Lijiang Wang

Zhanhui Du

Qianqian Shen

Lu Jiang

Lun Sui

Nan Zhang

Hong Wang

Guoju Li

Affiliations

Soon will be listed here.

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/m 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/m), 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/m ≤ BMI < 30.0 kg/m). 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.

References

Chan Y, Bailey R, OConnor D . Folate. Adv Nutr. 2013; 4(1):123-5. PMC: 3648733. DOI: 10.3945/an.112.003392. View

Cueto H, Riis A, Hatch E, Wise L, Rothman K, Mikkelsen E . Predictors of preconceptional folic acid or multivitamin supplement use: a cross-sectional study of Danish pregnancy planners. Clin Epidemiol. 2012; 4:259-65. PMC: 3470456. DOI: 10.2147/CLEP.S35463. View

McNulty H, Pentieva K . Folate bioavailability. Proc Nutr Soc. 2005; 63(4):529-36. DOI: 10.1079/pns2004383. View

Peschansky V, Wahlestedt C . Non-coding RNAs as direct and indirect modulators of epigenetic regulation. Epigenetics. 2014; 9(1):3-12. PMC: 3928183. DOI: 10.4161/epi.27473. View

Gong T, Wang J, Yang M, Shao Y, Liu J, Wu Q . Serum homocysteine level and gestational diabetes mellitus: A meta-analysis. J Diabetes Investig. 2016; 7(4):622-8. PMC: 4931215. DOI: 10.1111/jdi.12460. View

Moat S, Lang D, McDowell I, Clarke Z, Madhavan A, Lewis M . Folate, homocysteine, endothelial function and cardiovascular disease. J Nutr Biochem. 2004; 15(2):64-79. DOI: 10.1016/j.jnutbio.2003.08.010. View

Vitner D, Harris K, Maxwell C, Farine D . Obesity in pregnancy: a comparison of four national guidelines. J Matern Fetal Neonatal Med. 2018; 32(15):2580-2590. DOI: 10.1080/14767058.2018.1440546. View

Flores A, Cordero A, Dunn M, Sniezek J, Arce M, Crider K . Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities. Prev Med. 2017; 106:26-30. PMC: 5912337. DOI: 10.1016/j.ypmed.2017.11.003. View

Goh Y, Koren G . Folic acid in pregnancy and fetal outcomes. J Obstet Gynaecol. 2008; 28(1):3-13. DOI: 10.1080/01443610701814195. View

10.

Stern S, Matok I, Kapur B, Koren G . A comparison of folic acid pharmacokinetics in obese and nonobese women of childbearing age. Ther Drug Monit. 2011; 33(3):336-40. DOI: 10.1097/FTD.0b013e318219407a. View

11.

Juan J, Yang H . Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China. Int J Environ Res Public Health. 2020; 17(24). PMC: 7766930. DOI: 10.3390/ijerph17249517. View

12.

Toh S, Zarshenas N, Jorgensen J . Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009; 25(11-12):1150-6. DOI: 10.1016/j.nut.2009.03.012. View

13.

Hesketh T, Zhu W . Maternal and child health in China. BMJ. 1997; 314(7098):1898-900. PMC: 2126969. DOI: 10.1136/bmj.314.7098.1898. View

14.

Perez-Perez A, Vilarino-Garcia T, Guadix P, Duenas J, Sanchez-Margalet V . Leptin and Nutrition in Gestational Diabetes. Nutrients. 2020; 12(7). PMC: 7400219. DOI: 10.3390/nu12071970. View

15.

Meigs J, Jacques P, Selhub J, Singer D, Nathan D, Rifai N . Fasting plasma homocysteine levels in the insulin resistance syndrome: the Framingham offspring study. Diabetes Care. 2001; 24(8):1403-10. DOI: 10.2337/diacare.24.8.1403. View

16.

Hollenstein U, Brunner M, Schmid R, Muller M . Soft tissue concentrations of ciprofloxacin in obese and lean subjects following weight-adjusted dosing. Int J Obes Relat Metab Disord. 2001; 25(3):354-8. DOI: 10.1038/sj.ijo.0801555. View

17.

Chen X, Zhang Y, Chen H, Jiang Y, Wang Y, Wang D . Association of Maternal Folate and Vitamin B in Early Pregnancy With Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care. 2020; 44(1):217-223. PMC: 7783943. DOI: 10.2337/dc20-1607. View

18.

Mentch S, Locasale J . One-carbon metabolism and epigenetics: understanding the specificity. Ann N Y Acad Sci. 2015; 1363:91-8. PMC: 4801744. DOI: 10.1111/nyas.12956. View

19.

Mulinare J, Cordero J, Erickson J, Berry R . Periconceptional use of multivitamins and the occurrence of neural tube defects. JAMA. 1988; 260(21):3141-5. View

20.

Riskin-Mashiah S, Younes G, Damti A, Auslender R . First-trimester fasting hyperglycemia and adverse pregnancy outcomes. Diabetes Care. 2009; 32(9):1639-43. PMC: 2732138. DOI: 10.2337/dc09-0688. View