Maternal supplementation with multiple micronutrients containing folic
acid increased the risk for Gestational Diabetes Mellitus: Results from
a prospective cohort study in China
Abstract
Objective To investigate the relationship between maternal
supplementation with folic acid/ multiple micronutrients containing
folic acid (MM-FA) and gestational diabetes mellitus (GDM) risk. Design
Prospective cohort study. Setting Haidian Maternal and Child Health
Hospital, Beijing, China. Population 3,458 pregnant women and 653 cases
of GDM were approached between October 2017 and December 2020. Methods
Sociodemographic characteristics, lifestyle data, and information on
folic acid supplementation were obtained from a structured
questionnaire. GDM was diagnosed according to IADPSG criteria (2010).
After adjusting for confounding variables, associations between folic
acid/MM-FA supplementation and GDM risk were estimated using binary
logistic regression analysis. Main outcome measures Incident GDM.
Results Taking MM-FA periconceptionally was associated with a higher GDM
risk (aOR 1.33; 95% CI 1.05–1.69) compared to exclusive folic acid
supplementation. And this association was observed exclusively in women
with a pre-pregnancy BMI < 24kg/m2 (aOR 1.39; 95% CI
1.06–1.82). In separate analysis of pre-conception supplementation,
women without folic acid supplementation before conception were more
likely to develop GDM than those taking folic acid alone (aOR 1.40; 95%
CI 1.01–1.96). Conclusions Maternal MM-FA supplementation may enhance
the risk for GDM. These findings indicated that pregnant women should to
be mindful of the risk of iron and other micronutrients
over-supplementation when using folic acid supplements. It’s recommended
that women take pure folic acid in preference and begin taking them from
pre-conception in accordance with the recommended guidelines. Key words
Folic acid; Multiple micronutrients; Gestational diabetes mellitus;
Cohort