| Background and objectiveIn recent years,the incidence rate of Gestational diabetes（GDM）has gradually increased in China.The increased risk of GDM and the serious health threat to mothers and infants have become public health problems that need to be solved urgently in China.Determining that perinatal GDM can change risk factors will help prevent the occurrence of diseases.There is still controversy in domestic and international research on the relationship between insufficient and excess folic acid（FA）,vitamin B6,and vitamin B12during pregnancy and the risk of developing GDM.In recent years,the number of women who successfully conceive through assisted reproductive technology（ART）has been increasing year by year,and the risk of pregnancy complications in women has also increased.At the same time,FA and vitamin B12 can improve the reproductive success rate of women after receiving ART.To understand whether ART affects the relationship between FA,vitamin B6,and vitamin B12 with GDM,this study mainly explored the impact of dietary and supplement sources of FA,vitamin B6,and vitamin B12 on the incidence of GDM,and further analyzed the impact of B vitamins on the risk of GDM in different pregnancy modes.MethodsThis is a prospective cohort study of pregnant women（12-14 weeks gestation）who were registered at Qingdao Women’s and Children’s Hospital between May 2019 and May 2022.A questionnaire was used to collect demographic data,behavioral lifestyle,disease history,and pregnancy history of the study subjects from the first three months of pregnancy to the first trimester.At the same time,physical indicators such as pregnant women’s height,weight,blood pressure,and visceral fat were measured.The Food Frequency Questionnaire（FFQ）and the FA Supplemental Intake Questionnaire were used in this study to collect dietary content and B vitamins supplementation among singleton pregnant women from the first three months to the first trimester.The B vitamins intake in the diet and supplements was calculated using the Chinese Food Composition Database,and the supplement brand,dosage,and duration of use.During the first 24-28 weeks of pregnancy,monitor the results of the 75 g oral glucose tolerance test（OGTT）.The subjects were divided into GDM and non-GDM groups based on the results of the 75g OGTT experiment,and the basic characteristics of the two groups were compared.The association between B vitamins and GDM risk was investigated using Logistic regression.Furthermore,the median intake of each nutrient group was used as a continuous variable when fitting the model to investigate the linear trend of GDM risk.Based on this,an interaction analysis was performed between B vitamins and ART associated with the risk of GDM to see whether their interaction has a combined effect on GDM.ResultsA total of 3,252 study subjects were included in this study,of which 3,133（96.34%）pregnant women received FA,vitamin B6,and vitamin B12 supplements from the first three months of pregnancy to the first trimester.Among them,the highest proportion of people taking complex vitamins was 2,000（63.84%）;A relatively small number of 719people,accounting for 22.95%,only took FA supplements alone;414 people（13.21%）took both FA and multivitamins simultaneously.This study also found that pregnant women have deficiencies in FA supplementation（<400μg/day,30.04%）and overdoses（>800μg/day,26.94%）.The highest and lowest quartile intervals of B vitamins and GDM were compared in a regression analysis,and the results revealed that dietary vitamin B6 was a risk factor for GDM（a OR=1.58,95%CI:1.23-2.37）,similar findings were found for total vitamin B6（a OR=1.30,95%CI:1.08-1.80）;dietary vitamin B12 and total vitamin B12 both increased the risk of GDM in the highest quartile（a OR=1.70,95%CI:1.24-2.46;a OR=1.32,95%CI:1.05-1.98）;and dietary and total FA intake were both positively correlated with the risk of GDM.The a ORs of GDM for dietary FA and total FA intake were respectively 1.55（95%CI:1.04-2.41）and 1.34（95%CI:1.10-1.69）(both P for trend（27）0.05).Taking FA supplements with an intake dose of 800μg/day had a 46%increased risk of GDM（a OR=1.46,95%CI:1.11-1.92）compared to 400-800μg/day.In this study,a total of 333 women（10.24%）received ART.Further analysis revealed that ART was the risk of GDM（a OR=1.49,95%CI:1.12-2.28）,and there was an interaction between ART and FA supplementation on the risk of GDM（a OR=2.17,95%CI:1.45-3.69）.FA supplementation>800μg/day remained a risk factor for GDM in the ART group after stratification by mode of conception（a OR=2.19）.Conclusion1.Women in Qingdao have a high rate of FA supplementation during the perinatal period,but it is more common for women to receive insufficient supplemental dose of FA（<400μg/day）and excessive dose（>800μg/day）.2.Excessive intake of FA,vitamin B6,and vitamin B12 in the diet can increase the risk of developing GDM;There is no correlation between vitamin B6 and B12 from supplements and the risk of developing GDM;Only FA at high doses（>800μg/d）increases the risk of developing GDM.3.Women receiving ART have a higher risk of developing GDM compared to women with natural pregnancies,and there is an interaction between conception methods and FA from supplements in the onset of GDM.Taking FA supplements>800μg/d in ART women increases the risk of developing GDM. |
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