Prepregnancy Habitual Intakes of Total, Supplemental, and Food Folate and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study
Prepregnancy Habitual Intakes of Total, Supplemental, and Food Folate and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study
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DOI：
10.2337/dc18-2198
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发表时间：
2019-06-01
期刊：
影响因子：
16.2
通讯作者：
Zhang, Cuilin
中科院分区：
文献类型：
--
作者：
Li, Mengying;Li, Shanshan;Zhang, Cuilin
目的 通过检查孕前习惯性叶酸摄入量与 GDM 风险之间的关联，确定妊娠期糖尿病 (GDM) 的新的可改变危险因素。 研究设计和方法 该研究纳入了护士健康研究 II 中的 14,553 名女性，这些女性在 1991 年至 2001 年的调查问卷中至少报告了 1 例单胎妊娠。使用每 4 年进行一次的食物频率调查问卷来评估孕前总叶酸、补充叶酸和食物叶酸的摄入量。 GDM 事件是根据医生自我报告的诊断确定的。使用对数二项式模型估计 GDM 的相对风险 (RR)，并调整人口、生活方式和饮食因素。 结果 在研究随访期间，20,199 名妊娠中报告了 824 例 GDM 病例。叶酸摄入量充足的女性（>= 400 μg/天）的 GDM RR 为 0.83（95% CI 0.72, 0,95，P = 0.007），而叶酸摄入不足的女性（补充叶酸摄入量为 600 μg/天，与不补充叶酸的女性相比，GDM RR 分别为 0.83、0.77 和 0.70（P 趋势 = 0.002），在对多种维生素和其他微量营养素的摄入量进行额外调整后，以及在可能计划怀孕的女性中，补充叶酸摄入量与 GDM 风险之间的关联在很大程度上仍然存在。结论：如果得到证实，孕前补充叶酸与降低 GDM 风险显着相关。
OBJECTIVETo identify novel modifiable risk factors of gestational diabetes mellitus (GDM) by examining the association between prepregnancy habitual folate intake and GDM risk.RESEARCH DESIGN AND METHODSThe study included 14,553 women in the Nurses' Health Study II who reported at least one singleton pregnancy between the 1991 and 2001 questionnaires. Prepregnancy intakes of total folate, supplemental folate, and food folate were assessed using a food frequency questionnaire administered every 4 years. Incident GDM was ascertained from a self-reported physician diagnosis. Relative risks (RRs) of GDM were estimated using log-binomial models, with adjustment for demographic, lifestyle, and dietary factors.RESULTSOver the study follow-up, 824 incident GDM cases were reported among 20,199 pregnancies. Women with adequate total folate intake (>= 400 mu g/day) had an RR of GDM of 0.83 (95% CI 0.72, 0,95, P = 0.007) compared with women with inadequate intake (= 600 mu g/day of supplemental folate intake were 0.83, 0.77, and 0.70, respectively, compared with no supplemental folate intake (P-trend = 0.002). The association between supplemental folate intake and GDM risk largely persisted after additional adjustment for intake of multivitamins and other micronutrients, as well as among women who likely planned for the pregnancy.CONCLUSIONSHigher habitual intakes of supplemental folate before pregnancy were significantly associated with lower GDM risk. If confirmed, these findings indicate that prepregnancy folic acid supplementation could offer a novel and low-cost avenue to reduce GDM risk.