| Objective:With the popularity of folic acid supplementation,more attention has been paid to the potential impact of folate levels on gestational diabetes mellitus（GDM）.However,the results are not yet consistent.Based on the Anhui Huaibei Birth Cohort（A-HBBC）carried out in Huaibei Maternal and Child Health Hospital,this study combined with folate level to study the effects of folic acid supplementation on GDM,blood glucose level and blood glucose stability,so as to provide scientific basis for the prevention and treatment of GDM and the control of blood glucose level and blood glucose stability.Methods:In November 2020-November 2021,a follow-up survey was conducted in Huaibei maternal and child health hospital.Pregnant women aged 18 to 45 within 14weeks of pregnancy were selected from the hospital,and 225 people were finally included in the study.The contents of the survey mainly include:social demographic status,diet and lifestyle,pregnancy characteristics and the use of nutritional supplements.According to the International Diabetes and Pregnancy Association Research Group（IADPSG）standard diagnosis:at 24～28 weeks of pregnancy,75g oral glucose tolerance test（OGTT）was used to diagnose GDM.The duration of taking before pregnancy is divided into 0,<30d,≥30d,the duration of taking in the first and second trimesters is divided into 0,<60d,≥60d,and the total duration in the first and second trimesters is divided into 0,<70d,≥70d.The average daily dose during pregnancy was divided into 0,0-0.4mg and≥0.4mg.The subjects were divided into three quantiles of serum folate level in the second trimester of pregnancy,and the red blood cell folate levels in the first and second trimester of pregnancy were divided into three groups according to<400ng/m L,400-600ng/m L and≥600ng/m L.The changes of red blood cell folate level during pregnancy and the level of homocysteine（Hcy）in the second trimester of pregnancy was divided into two groups by means.The continuous variables were expressed by means±standard deviation;All categorical variables are expressed as a percentage（%）.Comparing differences between continuous variables using t-test and one-way ANOVA;Logistic regression was used to analyze the relationship between folic acid supplementation,folate level and GDM;We used multiple linear regression to analyze the relationship between folate levels and blood glucose levels and glycemic stability.Results:After strict exclusion criteria,225 pregnant women were included in this study.（1）The incidence rate of GDM was 7.11%.The average age of pregnant women was28.01±4.42 years,the youngest age was 19,the oldest age was 43,the body mass index（BMI）before pregnancy was 21.80±3.13kg/m~2,and the weight gain during pregnancy was 8.48±4.54kg.There was statistically significant difference in per capita monthly income between GDM and normal group（P<0.05）.（2）The folate supplement rate reached 97.78%,and 32.44%in the first trimester of pregnancy;97.33%of pregnant women were supplemented with folic acid;Folic acid supplementation in pregnancy was 67.11%.（3）There was a significant difference in first trimester red blood cell folate levels in the pre-pregnancy and early pregnancy whether supplemented with folic acid（P<0.05）,and the folic acid level in the supplemented group was higher than that in the non-supplemented group.（4）Chi-square analysis was used to analyze the relationship between folic acid supplementation（whether supplementation,whether continuous supplementation,duration,dose）and GDM,and no association was found between them.（5）One-way ANOVA and t-test were used to analyze the relationship between folic acid supplementation（whether supplementation,whether continuous supplementation,duration,dose）and blood sugar level and blood sugar stability.No relationship was found between folic acid supplementation and blood glucose level and glycemic stability in different pregnancy.（6）T-test was used to analyze the correlation between folate level,Hcy and GDM.It was found that there was a significant difference in the level of red blood cell in the second trimester of pregnancy between GDM group and normal group（P=0.037）,and the level of red blood cell in the second trimester of pregnancy in normal pregnant group was higher than that in GDM group.Logistic regression was further used to analyze the relationship between folate level,Hcy and GDM.Before adjustment,the odds ratio of erythrocyte folate levelin the second trimester of pregnancy was 0.996（0.990,1.000）（P=0.049）,while after adjustment,it was 0.992（0.982,1.002）（P=0.124）.After grouping folate level and Hcy level,T test and one-way ANOVA were used to compare the differences of blood glucose levels in groups with different folate levels.The study found that there were differences in FBG levels between groups in red blood cell folate levels in the first trimester（P=0.010）,and there were differences in FBG levels between groups with red blood cell folic acid changes during pregnancy（P=0.043）.The relationship between them and blood glucose level was analyzed by multiple linear regression model.It was found that folate400-600 in early pregnancy decreased by-0.241（-0.428,-0.053）（P=0.012）compared with<400,while there was no significant difference between≥600 and<400（P=0.069）。Conclusion:The folic acid level of red blood cells in early pregnancy supplemented with folic acid before and after pregnancy was higher than that in the non-supplemented group.First trimester red blood cell folate levels in the 400-600 ng/ml had lower FBG levels compared to the<400.However,there is no relationship between folic acid supplementation in different pregnancy periods（whether supplementation,whether continuous supplementation,duration,dose）and GDM,blood glucose level,and glycemic stability. |
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