| Objective: Gestational diabetes mellitus(GDM),a common pregnancy-related complication,has been found to be closely related to iron metabolism.Excessive serum ferritin(SF)levels was shown to be related to an increased risk of GDM.On the contrary,insufficient ferritin levels can cause a number of obstetric complications such as high incidence rates of anemia and gestational hypertension.Therefore,high or low ferritin levels may have adverse effects on the mother and the fetus,putting clinicians in a dilemma when giving pregnant women iron supplements.The purpose of this study was to prospectively study the relationship between serum ferritin and GDM,its predictive effect on obstetric outcome and the exploration of iron supplementation strategy during pregnancy.Methods: In this study,4695 pregnant women were selected from the outpatient service of Shengjing Hospital of China Medical University and included in the database from September 2016 to December 2022.According to the inclusion and exclusion criteria,4178 pregnant women were finally included,distributed in different parts of this study.We collect the basic clinical information,laboratory indicators,gestational glucose tolerance test results and obstetric outcomes of the patients,and divide the subjects into four groups according to the serum ferritin values of different pregnancy periods,namely,quartile(Q),namely,quartile 1(Q1),Q2,Q3 and Q4,of which Q1 group has the lowest ferritin value and Q4 group has the highest ferritin value.To complete the following exploration:(1)The predictive role of ferritin level in the second trimester(14-20 weeks)of pregnancy on the risk of GDM;(2)The correlation between ferritin level and glucose tolerance status during 24-28 weeks of pregnancy;(3)The predictive effect of ferritin level of pregnant women with hyperglycemia during pregnancy 28 weeks before delivery on adverse obstetric outcomes;(4)The relationship between iron supplementation during pregnancy and the change of ferritin level and its influencing factors.Results:1.At 14-20 weeks of gestation,976 people were included and 238 people developed GDM.The risk of GDM in Q4 group was significantly higher than that in Q1group(OR=1.576,P<0.05).After adjusting for confounding factors,the risk of GDM in Q4 group was still significantly higher than that in Q1 group.2.During 24-28 weeks of pregnancy,1191 people were included and 445 people developed GDM.There was a significant positive correlation between ferritin level and FPG,1h PG,2h PG and AUC-GLU of Hb and OGTT(r = 0.073,0.170,0.138,0.122 and 0.149,respectively,P<0.05).The risk of GDM in Q3 and Q4 groups was significantly higher than that in Q1group(OR 1.757 and 1.919,respectively,P<0.05).After adjusting for confounding factors,the risk of GDM in Q3 and Q4 groups was still significantly higher than that in Q1 group.3.At 28 weeks of gestation and before delivery,845 people were included.The ferritin level was significantly positively correlated with Hb and delivery weight(r=0.271,0.110,P<0.05);There was a significant negative correlation with newborn weight,newborn length,newborn head circumference and newborn chest circumference(r =-0.139,-0.147,0.140,0.122 and-0.119,respectively,P<0.05).The risk of adverse maternal outcome,premature rupture of membranes,hypertensive pregnancy,adverse neonatal outcome,premature delivery,paediatric intensive care unit,neonatal distress,small for gestational age,and low birth weight infants in Q4 group was significantly higher than that in Q1 group(OR:2.464,2.071,2.381,2.042,3.281,4.057,3.722,3.579,4.467,respectively,P<0.05).After adjusting for confounding factors,the risk of adverse maternal outcome,hypertensive pregnancy,adverse neonatal outcome,premature delivery,neonatal distress and small for gestational age in Q4 group was still significantly higher than that in Q1 group.4.Among the iron supplement population during pregnancy,263 pregnant women were collected with complete iron supplement information,16 of whom achieved the ferritin standard(>30ng/ml)after iron supplementation at different times.After iron supplementation,54.8% of pregnant women still showed a gradual decrease in ferritin with the increase of gestational age.The baseline ferritin level is an independent risk factor for predicting ferritin reaching the standard(OR=11.294,P<0.05).Further making ROC curve,the baseline ferritin is 20.15ng/ml,and the AUC of the standard ferritin is predicted to be 0.651.Conclusion: The ferritin level can predict the risk of GDM,and can predict the risk of some adverse obstetric outcomes in patients with hyperglycemia during pregnancy.The baseline ferritin level is an independent risk factor for predicting the effect of iron supplementation.Starting iron supplementation before the ferritin level drops to20.15ng/ml is expected to increase the possibility of reaching the standard of ferritin,but attention should also be paid to the adverse effects of high ferritin on glucose metabolism and obstetric outcome during pregnancy. |
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