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Lin Y, Wu C, An R, Liu H, Chen M, Tan H, Chen L, Deng J. The association of iron status, supplement iron in the first-trimester pregnancy with gestational diabetes mellitus: A nested case-control study. J Obstet Gynaecol Res 2023; 49:597-605. [PMID: 36443988 DOI: 10.1111/jog.15509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022]
Abstract
AIMS The objective of this study was to examine whether the level of iron and iron supplements in the first-trimester pregnancy is associated with gestational diabetes mellitus (GDM). METHODS This was a nested case-control study using data from an established cohort in the Hunan Provincial Maternal and Child Health Hospital (HPMCHH) in South China. A total of 119 patients with GDM and 238 controls were enrolled in the study. Iron status indicators were tested in early pregnancy. Information on iron supplements use was collected by questionnaires. Binary logistic regression was used to obtain odds ratio (OR). The relative excess risk of interaction (RERI) was applied to evaluate the interaction. RESULTS We observed that pregnant women with normal ferritin levels (≥30 ng/ml) and iron supplements were associated with a 3.701-fold increased risk of GDM (OR: 3.701, 95% CI: 1.689-8.112) compared with the ferritin <30 ng/ml and without iron supplements group. Similarly, pregnant women with normal serum iron (SI) levels (≥9 μmol/L) and iron supplements were associated with a 5.447-fold increased risk of GDM (OR: 5.447, 95% CI: 2.246-13.209) compared with the SI < 9 μmol/L and without iron supplement group. We found an additive interaction between ferritin and iron supplements on the presence of GDM (RERI: 1.164, 95%CI: 0.333-1.994) and SI and iron supplements on the risk of GDM (RERI: 6.375, 95%CI: 4.494-8.256). CONCLUSION Pregnant women with normal ferritin or SI levels and iron supplements could significantly increase the risks for GDM.
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Affiliation(s)
- Ying Lin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Chunli Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Rongjing An
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huixia Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mengshi Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
| | - Jing Deng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, Changsha, China
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Al-Rifai RH, Abdo NM, Paulo MS, Saha S, Ahmed LA. Prevalence of Gestational Diabetes Mellitus in the Middle East and North Africa, 2000-2019: A Systematic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne) 2021; 12:668447. [PMID: 34512543 PMCID: PMC8427302 DOI: 10.3389/fendo.2021.668447] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Women in the Middle East and North Africa (MENA) region are burdened with several risk factors related to gestational diabetes mellitus (GDM) including overweight and high parity. We systematically reviewed the literature and quantified the weighted prevalence of GDM in MENA at the regional, subregional, and national levels. Studies published from 2000 to 2019 reporting the prevalence of GDM in the MENA region were retrieved and were assessed for their eligibility. Overall and subgroup pooled prevalence of GDM was quantified by random-effects meta-analysis. Sources of heterogeneity were investigated by meta-regression. The risk of bias (RoB) was assessed by the National Heart, Lung, and Blood Institute's tool. One hundred and two research articles with 279,202 tested pregnant women for GDM from 16 MENA countries were included. Most of the research reports sourced from Iran (36.3%) and Saudi Arabia (21.6%), with an overall low RoB. In the 16 countries, the pooled prevalence of GDM was 13.0% (95% confidence interval [CI], 11.5-14.6%, I2 , 99.3%). Nationally, GDM was highest in Qatar (20.7%, 95% CI, 15.2-26.7% I2 , 99.0%), whereas subregionally, GDM was highest in Gulf Cooperation Council (GCC) countries (14.7%, 95% CI, 13.0-16.5%, I2 , 99.0%). The prevalence of GDM was high in pregnant women aged ≥30 years (21.9%, 95% CI, 18.5-25.5%, I2 , 97.1%), in their third trimester (20.0%, 95% CI, 13.1-27.9%, I2 , 98.8%), and who were obese (17.2%, 95% CI, 12.8-22.0%, I2 , 93.8%). The prevalence of GDM was 10.6% (95% CI, 8.1-13.4%, I2 , 98.9%) in studies conducted before 2009, whereas it was 14.0% (95% CI, 12.1-16.0%, I2 , 99.3%) in studies conducted in or after 2010. Pregnant women in the MENA region are burdened with a substantial prevalence of GDM, particularly in GCC and North African countries. Findings have implications for maternal health in the MENA region and call for advocacy to unify GDM diagnostic criteria. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018100629.
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Affiliation(s)
- Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- *Correspondence: Rami H. Al-Rifai,
| | - Noor Motea Abdo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marília Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sumanta Saha
- Department of Community Medicine, R. G. Kar Medical College, Kolkata, India
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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The relationship between iron metabolism, stress hormones, and insulin resistance in gestational diabetes mellitus. Nutr Diabetes 2020; 10:17. [PMID: 32513913 PMCID: PMC7280284 DOI: 10.1038/s41387-020-0122-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
AIM To analyze the relationship between iron metabolism index and stress hormones, insulin resistance, and oxidative stress in gestational diabetes mellitus (GDM). METHODS From January to November 2019, 75 patients with GDM were selected as GDM group, according to age of 1:1; 75 normal pregnant women were selected as Control group. Blood glucose, insulin, stress hormones such as cortisol, norepinephrine (NE), and epinephrine (E), and iron metabolism index such as serum iron, serum ferritin (SF), and transferrin saturation (TS) were measured. Insulin resistance was evaluated by homeostasis model insulin resistance index (HOMA-IR). Multiple linear regression was used to analyze the relationship between iron metabolism index and stress hormones, insulin resistance, and oxidative stress. RESULTS The levels of NE, E, serum iron, SF, and TS saturation in the GDM group were higher than Control group (t = 3.82, 2.75, 3.14, 6.12, and 3.90, P < 0.05, <0.05, <0.05, <0.01, <0.01); HOMA-IR was higher in the GDM group (t = 4.92, P < 0.01); malondialdehyde (MDA) was higher, while superoxide dismutase (SOD) was lower than Control group (t = 5.25, 4.98, both P < 0.01). Epinephrine, norepinephrine, cortisol, and serum ferritin were positively correlated (r = 0.21, 0.17, and 0.21); epinephrine, cortisol, and transferrin were positively correlated (r = 0.12, 0.31). There was a positive correlation between HOMA-IR and SF and TS (r = 0.34, 0.34). MDA was positively correlated with SF and TS (r = 0.24, 0.29); SOD was negatively related to SF and TS (r = -0.12, -0.17). CONCLUSIONS Iron metabolism index is related to insulin resistance in GDM women. The change in iron metabolism may be involved in the pathogenesis of gestational diabetes caused by stress- adaptive disorder.
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Sun C, Wu Q, Gao S, Ma Z, Liu Y, Zhang J, Zhao Y. Association between the ferritin level and risk of gestational diabetes mellitus: A meta-analysis of observational studies. J Diabetes Investig 2020; 11:707-718. [PMID: 31667982 PMCID: PMC7232272 DOI: 10.1111/jdi.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/12/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS/INTRODUCTION The relationship between ferritin and the risk of gestational diabetes mellitus (GDM) has not been established. Thus, we carried out a meta-analysis based on the current literature. MATERIALS AND METHODS We searched relevant databases on Embase, PubMed, Cochrane Library and Web of Science before 10 May 2019 to determine the relationship between ferritin and the risk of GDM. The relative risks and 95% confidence intervals of GDM risk were summarized using a random effects model. Studies using categories of ferritin as exposure were combined by dose-response analysis. We carried out both linear and non-linear trends. We also carried out subgroup analysis, whether or not the studies adjusted for potential confounders, and meta-regression analysis to explore the source of heterogeneity. Sensitivity analysis was carried out to explore the robustness of the meta-analysis results. RESULTS A total of 10 studies involving 4,690 participants were identified. The summary relative risk comparing persons with the highest concentration categories of ferritin with the lowest concentration categories of ferritin was 1.87 (95% confidence interval 1.50-2.34; I2 = 20.1%). Linear dose-response showed that an increase in ferritin of 10 μg/L increased the risk of GDM by 8% (1.08, 95% confidence interval 1.05-1.13, I2 = 55.1%; n = 4). A non-linear dose-response relationship also showed a consistently increasing risk of GDM with increased ferritin. No evidence of publication bias was detected. CONCLUSIONS The findings from this meta-analysis suggest that increased ferritin levels are associated with an increased risk of GDM; however, we require further prospective cohort studies to confirm the results, especially the dose-response relationship between ferritin and GDM.
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Affiliation(s)
- Ce Sun
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Qi‐Jun Wu
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Shan‐Yan Gao
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Zhi‐Min Ma
- School of Public HealthCapital Medical UniversityBeijingChina
| | - Ya‐Shu Liu
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Jia‐Yu Zhang
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
| | - Yu‐Hong Zhao
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangLiaoningChina
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Cheng Y, Li T, He M, Liu J, Wu K, Liu S, Ma Z, Lu J, Zhang Q, Cheng H. The association of elevated serum ferritin concentration in early pregnancy with gestational diabetes mellitus: a prospective observational study. Eur J Clin Nutr 2020; 74:741-748. [PMID: 31932742 DOI: 10.1038/s41430-019-0542-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES The results linking body iron stores to the risk of gestational diabetes mellitus (GDM) are conflicting. We aimed to measure the serum ferritin level of women in early pregnancy and evaluate the risk of GDM in a Chinese urban population. SUBJECTS/METHODS In total, 851 pregnant women between 10 and 20 weeks of gestation took part in the prospective, observational study conducted. The women were divided into four groups by quartiles of serum ferritin levels (Q1-4). Their blood samples were collected and assayed for several biochemical variables at the beginning of the study, and the women were followed up with a 75-g oral glucose tolerance test at 24-28 weeks of gestation. RESULTS The participants had an average serum ferritin concentration of 65.67 μg/L. GDM prevalence within each serum ferritin quartile was 9.4%, 14.6%, 18.8% and 19.3%, respectively, (P = 0.016). The odds ratio for GDM in the ferritin Q2-4 was 1.64 (CI: 0.90-2.99), 2.23 (CI: 1.26-3.96) and 2.31 (CI: 1.30-4.10), compared with Q1, respectively. This association persisted after adjusting for potential confounders factors. In addition, in Q4, pregnant women with a pre-pregnancy body mass index ≥24 kg/m2, maternal age ≤35 years old or haemoglobin≥ 110 g/L did have an increased risk of developing GDM. CONCLUSIONS Elevated serum ferritin concentrations in early gestation are associated with an increased risk of GDM, especially in pregnant women who have a high baseline iron storage status with no anaemia or who are overweight/obese. Individual iron supplementation should be considered to minimize the risk of GDM.
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Affiliation(s)
- Yan Cheng
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China
| | - Tingting Li
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China
| | - Mulan He
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China
| | - Junxiu Liu
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, PR China
| | - Kui Wu
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China
| | - Shuangping Liu
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China
| | - Ziwen Ma
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China
| | - Jingbo Lu
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, PR China
| | - Qingying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China.
| | - Haidong Cheng
- Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, PR China.
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Iron Status and Gestational Diabetes-A Meta-Analysis. Nutrients 2018; 10:nu10050621. [PMID: 29762515 PMCID: PMC5986501 DOI: 10.3390/nu10050621] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/30/2018] [Accepted: 05/11/2018] [Indexed: 12/21/2022] Open
Abstract
A meta-analysis of the association of iron overload with gestational diabetes mellitus (GDM) may inform the health debate. We performed a meta-analysis investigating the association of iron biomarkers and dietary iron exposure with GDM. We identified 33 eligible studies (N = 44,110) published in 2001–2017. The standardized mean differences (SMD) in women who had GDM compared to pregnant women without were 0.25 µg/dL (95% CI: 0.001–0.50) for iron, 1.54 ng/mL (0.56–2.53) for ferritin, 1.05% (0.02 to 2.08) for transferrin saturation, and 0.81 g/dL (0.40–1.22) for hemoglobin. Adjusted odds ratio for GDM were 1.58 (95% CI: 1.20–2.08) for ferritin, 1.30 (1.01–1.67) for hemoglobin, and 1.48 (1.29–1.69) for dietary heme intake. We did not find any differences in TIBC or transferrin concentration in women with and without GDM. We also did not find any association of increased transferrin receptor or increased intake of total dietary iron, non-heme iron or supplemental iron, with increased odds ratios for GDM. Considerable heterogeneity was present among the studies (0–99%), but no evidence of publication bias. Accumulating evidence suggests that circulating and dietary iron biomarkers among pregnant women are associated with GDM, but the results should be interpreted with caution due to the high heterogeneity of analyses. Randomized trials investigating the benefits of iron reduction in women at high risk for GDM are warranted.
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Li J, Bao W, Zhang T, Zhou Y, Yang H, Jia H, Wang R, Cao Y, Xiao C. Independent relationship between serum ferritin levels and dyslipidemia in Chinese adults: A population study. PLoS One 2017; 12:e0190310. [PMID: 29272309 PMCID: PMC5741262 DOI: 10.1371/journal.pone.0190310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
Objective Several studies have indicated that elevated levels of circulating ferritin are associated with disturbances in energy metabolism. But none of this gave a clearly pathologic mechanism. We aimed to explore the independent relationship between serum ferritin levels and dyslipidemia. Methods We performed multivariable logistic regression analyses to estimate the odds ratios (ORs) for dyslipidemia, lipid parameters, the homeostasis model assessment of insulin resistance (HOMA-IR) and the risk of diabetes, according to sex-specific quartiles of serum ferritin by using the data of China Health and Nutrition Survey (2009 CHNS). We used three models to estimate the strength of the correlation. The basic model (Model 1) is without adjustment and the Model 2 and Model 3 are adjusted for demographic, anthropometric, and lifestyle confounding factors. Results In both genders, the ORs for high TG level, TC level and LDL-C level increased progressively and for HDL-C decreased across the ferritin quartiles (P<0.001 for trend). After adjustment for confounding factors in different logistic regression models, the results remained unchanged. The ORs for the risk of diabetes and high HOMA-IR level in the highest quartile group of serum ferritin levels were significantly increased in Model 1, but after adjustment for lipid parameters, the ORs for the risk of diabetes was decreased from 1.91 (95% CI: 1.37–2.67; P<0.001 for trend) to 1.48 (95% CI: 1.03–2.12; P = 0.036 for trend) in men, and from 5.40 (95% CI: 3.38–8.63; P<0.001 for trend) to 1.43 (95% CI: 0.83–2.43; P = 0.498 for trend) in women, and the ORs for IR was decreased from 1.86 (95% CI: 1.57–2.20; P<0.001 for trend) to 1.25 (95% CI: 1.05–1.50; P = 0.114 for trend) in men, and from 1.93 (95% CI: 1.63–2.28; P<0.001 for trend) to 1.24 (95% CI: 1.01–1.51; P = 0.012 for trend) in women. Conclusion Our results provide evidence that serum ferritin levels are significantly associated with lipid parameters, independent of glucose metabolism disorders and components of metabolic syndrome (MetS). Thus, serum ferritin plays a key role in energy metabolism disorders and may affect glucose metabolism through lipid metabolism.
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Affiliation(s)
- Jiang Li
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Weimin Bao
- Community Health Service Center of Hepingli of Dongcheng District, Beijing, China
| | - Tie Zhang
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yun Zhou
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Hui Yang
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Hongbing Jia
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Rui Wang
- Blood Screening Laboratory, Beijing Red Cross Blood Center, Beijing, China
| | - Yongtong Cao
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
- * E-mail: (YC); (CX)
| | - Cheng Xiao
- Institute of Clinical Medicine, China-Japan Friendship Hospital, Beijing, China
- * E-mail: (YC); (CX)
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