| Background In recent years,the incidence of gestational diabetes mellitus(GDM)has increased year by year and has become one of the common complications of pregnant women.Its pathogenesis and influencing factors are also the focus of current research.Studies at home and abroad generally believe that the pathogenesis of GDM is mainly related to insulin resistance(IR)and islet β-cell hypofunction.Folic acid is an important vitamin recommended to prevent neural tube defects during pregnancy.In recent years,some scholars have noted the impact of insufficient intake of folic acid during pregnancy and excessive supplementation on other adverse pregnancy outcomes such as GDM,high blood pressure during pregnancy,and premature delivery.There are currently few studies exploring the association between folic acid intake during pregnancy and GDM,but these studies mostly consider one aspect of folic acid concentration,Dietary folate intake,and folic acid supplementation.Evaluation of folic acid supplementation is often limited to duration and there are differences in the division of pregnancy.Moreover,due to the inconsistency of influencing factors such as folic acid supplementation dose,duration,Dietary folate intake and folic acid concentration,the research results are controversial.Therefore,a more comprehensive design is needed to explore the relationship between folic acid intake during pregnancy and GDM.In this study,Dietary folate intake and folic acid supplementation were used to evaluate the folic acid intake of pregnant women.At the same time,combined with serum folic acid concentration to analyze the relationship between folic acid intake and GDM,we provide targeted guidance for folic acid supplementation for medical staff.Health interventions provide a reference to promote the health of pregnant women during pregnancy.Objective The purpose of this study was to explore the relationship between maternal folic acid intake and gestational diabetes mellitus and explore the relationship between serum folic acid concentration and gestational diabetes mellitus.Methods Using a 1: 1 paired case-control study,81 GDM pregnant women diagnosed with 75 g oral glucose tolerance test(OGTT)at a top three hospital in Hefei from 2018 to 2019 were used as the case group,and the OGTT diagnosis was normal during the same period.Among the pregnant women,a 1: 1 match was matched a pregnant woman with an age difference ≦ 3 years old and the same parity(same primipara or same-term mother)was used as a control group,and a unified questionnaire survey was conducted.Use general information questionnaires to investigate general conditions such as age,height,pre-pregnancy weight,parity,family history of diabetes,et;Food frequency questionnaire(FFQ)was used to investigate their diet during pregnancy,and the daily average intake of dietary folate was calculated.The self-edited "Folic Acid Supplement Intake Questionnaire" was used to investigate the brand,manufacturer,batch number,dose,and duration of folic acid supplementation in pregnant women in the first 3 months of pregnancy,early pregnancy,and second trimester pregnancy to assess the status of folic acid supplementation.All subjects were collected fasting venous blood and separated serum,and the serum folic acid concentration was determined by Electrochemiluminescence immunoassay.The daily average intake of dietary folate,serum folic acid concentration,and categorical variables divided by supplement duration,dose,and source were included in the logistic regression analysis.The odds ratio and 95% confidence interval were calculated,and possible confounding factors were adjusted to explore the strength of its association with gestational diabetes.Results(1)In this survey,9(11.11%)pregnant women in the GDM group did not supplement with folic acid during pregnancy,and 10(12.35%)had an average daily supplementation amount> 800?g / d Of the normal control group,2(2.47%)were not supplemented,and 3(3.7%)were> 800?g / d.The difference between the two groups was statistically significant(P <0.05).There were significant differences in the total duration of folic acid supplementation before and during pregnancy between the two groups(P <0.05).Among the GDM group,there were 22 pregnant women(27.16%)over 24 weeks and 17 in the normal control group(20.99%).There was no significant difference in the source category of folic acid supplementation intake between the two groups.(2)Logistic regression analysis after adjusting for confounding factors showed that pregnant women who only took folic acid supplements in the first trimester were used as controls,pregnant women who did not take folic acid supplements(OR = 21.38,95% CI: 2.85~160.1),Pregnant women who took folic acid supplements in the first trimester(OR = 5.5,95% CI: 1.25 ~ 24.12),pregnant women who took folic acid supplements in the first and second trimester(OR = 5.03,95% CI: 1.34~18.9)The intake of folic acid supplements before and during pregnancy(OR = 3.83,95% CI:1.04 ~14.12))significantly increased the risk of GDM,while the intake of folic acid supplements only during the first trimester was not related to the occurrence of GDM.In terms of the average daily intake dose,taking the average daily intake ≤400?g / d as a control,not taking folic acid supplements,> 800?g / d can increase the risk of GDM(OR = 6.86,respectively)95% CI: 1.27~37.13;OR = 4.44,95% CI: 1.08~18.18),400~800?g / d supplement has no statistical significance.Regarding the source of folic acid supplements,taking simple folic acid supplements in early pregnancy as a control,not taking folic acid supplements in early pregnancy can increase the risk of GDM(OR= 3.28,95% CI: 1.01~10.72).In terms of the length of supplementation,taking less than 24 weeks of intake as a control,no intake of folic acid supplements can increase the risk of GDM(OR = 6.69,95% CI: 1.24~36.15),but no statistical significance over24 weeks.(3)The average daily intake of dietary folate during pregnancy was 339.94 ±125.5 ?g / d,the case group was 341.22 ± 137.39 ?g / d,and the control group was338.66 ± 113.2 ?g / d,and there was no significant difference between the two groups(P> 0.05).According to the daily dietary folate intake,the first quartile interval was used as the control group,and dietary folate intake during pregnancy has no effect on reducing the risk of GDM(Q2 251.7~311.5:OR=0.82,95%CI:0.32~2.07;Q3311.5~411.4:OR=1.1,95%CI:0.43~2.79;Q4 >411.4:OR=1.73,95%CI:0.29~1.83).(4)The average serum folic acid concentration of pregnant women is 24.41 ±10.07 nmol / L,the case group is 23.9 ± 8.59 nmol / L,and the control group is 24.89 ±11.39 nmol / L,there was no significant difference between the two groups(P> 0.05).Grouped according to the interquartile range of serum folic acid concentration,with the first interquartile range as the pair Group,pregnant women’s serum folic acid concentration had nothing to do with reducing the incidence of GDM(Q2 16.8~23.9:OR=2.05,95%CI:0.82~5.13;Q3 23.9~31.65:OR=0.91,95%CI:0.34~2.45;Q4 >31.65:OR=1.12,95%CI:0.43~2.92).Although the serum folic acid concentration of pregnant women in the control group was higher than that in the case group,the difference was not statistically significant(P> 0.05).Conclusions(1)pregnant women who took folic acid supplements only in the first trimester were used as controls.The risk of GDM without folic acid intake and pre-pregnancy and early-pregnancy intake,both early and mid-pregnancy intake,and folic acid supplements before and during pregnancy Increased,and pregnant women who only took folic acid supplements during the first trimester had nothing to do with the occurrence of GDM.(2)The source of folic acid supplement intake: Compared with the intake of folic acid in the first trimester,non-folic acid supplement intake can increase the risk of GDM.(3)Intake dose of folic acid supplements: Taking the pre-pregnancy and pregnancy doses within 400?g / d as a control,not ingesting folic acid supplements and ingesting doses exceeding 800?g / d can effectively increase the risk of GDM,400~800?g / d has nothing to do with the occurrence of GDM,and has a U-shaped distribution.(4)Duration of intake of folic acid supplements: within 24 weeks of intake before and during pregnancy as a control,no intake of folic acid supplements can effectively increase GDM risk of morbidity,and the total duration of more than 24 weeks is not related to the occurrence of GDM. |
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