The Influence of Maternal Vitamin E Concentrations in Different Trimesters on Gestational Diabetes and Large-for-Gestational-Age: A Retrospective Study in China

Multi-Organ Regulation Mechanisms and Nutritional Intervention Strategies in Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) affects millions of pregnant women worldwide and leads to both short- and long-term complications for mothers and their fetuses. Managing GDM through diet, physical activity, and medical interventions can significantly reduce these risks. Studies have identified the individual and combined roles of organs regulated by placental hormones, cytokines and gut microbiota as key pathways contributing to impaired glucose homeostasis. In this context, placental hormones mediate the crosstalk among the placenta, pancreas and adipose tissue, stimulating endocrine pancreas adaptation and adipose tissue expansion. However, insufficient maternal physiological adaptations, such as dysregulated adipocytokines, adipokines, and oxidative stress in the pancreas, can create an environment conducive to the onset of GDM. Furthermore, gut dysbiosis implies potential mechanisms of gut-host interaction associated with the occurrence of GDM, with short-chain fatty acids (SCFAs) possibly serving as crucial targets. Nutritional therapy is recognized as the first-line approach for managing GDM, encompassing dietary guidance and supplementation with micro- and macronutrients as well as bioactive components. Importantly, combined interventions involving multiple nutrients, such as probiotics and prebiotics with vitamins or minerals, may exert stronger beneficial effects on the prevention and treatment of GDM and its complications. This review article discusses the regulatory role of multi-organs in GDM and the implementation of nutritional therapy for its prevention and management, along with associated complications.

The correlation between hemoglobin concentration and blood pressure during pregnancy in different trimesters

BACKGROUND

Maternal hemoglobin (Hb) is related to nutritional status, and it widely fluctuates during pregnancy. However, the relationship between Hb and blood pressure (BP) during pregnancy is unclear. This study aimed to estimate the associations between maternal Hb in various trimesters and its changes with BP during pregnancy.

METHODS

We conducted this study by using data from the Electronic Medical Record System (EMRS) database of Zhoushan Maternal and Child Care Hospital in Zhejiang Province, China. The pregnancy duration was divided into seven periods: before 14th, 14 to 17th, 18 to 22nd, 23 to 27th, 28 to 31st, 32 to 35th, and 36 to delivery; generalized estimating equations (GEE) and multiple linear regressions were used for exploring their associations.

RESULTS

8168 pregnant women in the first trimester were included in this study. Hb level decreased significantly from the first to late-second trimester and then increased but did not return to the level of the first trimester. After adjustment for the potential confounders, compared with women with Hb 110 ~ 119 g/L, those with Hb < 110 g/L had low systolic BP (SBP) and diastolic BP (DBP) in the second and third trimesters and those with Hb ≥ 120 g/L had high SBP and DBP in various trimesters. Furthermore, the dose-response effect was observed between them; except that those with Hb < 100 g/L had high SBP in T1 (β = 2.85, P = 0.012). Hb concentration changes during pregnancy were also positively associated with BP level. Furthermore, Hb had a higher effect on DBP than SBP. It is worth noting that the Hb concentration in > = 140 g/L groups had significantly higher SBP and DBP than the other groups. A significant nonlinear relationship was found between hemoglobin changes with both SBP and DBP in different gestational weeks (P non-linear < 0.05).

CONCLUSIONS

This study found that maternal Hb was positively associated with BP during pregnancy and maternal Hb > 120 g/L during pregnancy and increased maternal Hb from the first to third trimesters should especially be given more attention.

Genetic evidence linking retinol to birth weight: A two-sample Mendelian randomization study

This study aims to clarify the potential causal effects of dietary antioxidant vitamins on pregnancy outcomes (miscarriage, preterm labor, and birth weight) using Mendelian randomization (MR). Our instrumental variables (IVs) were single-nucleotide polymorphisms (SNPs) linked to retinol, vitamin C, carotene, and vitamin E (P < 5×10-6). The summary statistics for miscarriage, preterm labor, and birth weight were extracted from genome-wide association studies (GWASs), with a sample size of 56,172, 5480, and 261,932, respectively. The present MR study primarily used the inverse-variance weighted method, with additional sensitivity analyses conducted to evaluate the robustness of the findings. We found that retinol was closely related to the birth weight (β=0.091, 95 %CI: 0.009-0.172, P=0.028), and sensitivity analyses showed similar results (MR-RAPS: OR=1.101, 95 %CI: 1.027-1.180; maximum likelihood: OR=1.098, 95 %CI: 1.011-1.194). While the relationship of retinol with miscarriage or preterm labor was not statistically significant. Additionally, our study did not reveal an association between the carotene, vitamin E, and vitamin C and pregnancy-related outcomes, miscarriage, preterm labor, and birth weight (all P > 0.05). In conclusion, our findings indicated a causal effect between retinol and birth weight and suggested that maintaining retinol at normal levels during pregnancy can prevent low birth weight. Therefore, it would be beneficial to measure retinol levels in pregnant women and to supplement with vitamin A in cases of deficiency, as these could be valuable strategies for improving pregnancy outcomes.

Cord blood vitamin E and lipids in infants born small for gestational age

Vitamin E is associated with the regulation of lipid metabolism. Our previous study revealed an inverse relationship between birth weight and cord blood vitamin E levels, suggesting a potential link between vitamin E and fetal growth. The aim of this study was to determine the association between vitamin E with fetal growth and lipids. In this investigation, a study involving 146 mother-infant pairs was performed. Cord plasma concentrations of vitamin E and lipids were measured. Our findings showed that cord plasma vitamin E levels were elevated in small for gestational age (SGA) infants, and higher vitamin E levels were associated with an increased risk of SGA (OR = 2.239, 95% CI 1.208, 4.742). Additionally, among lipid levels, higher cord plasma triglyceride (TG) levels were associated with increased risks of SGA (OR = 97.020, 95% CI 5.137, 1832.305), whereas after adjusting for confounding factors, the risk became no longer statistically significant. We also found a positive correlation between cord blood vitamin E concentrations and lipid levels.

CONCLUSION

 elevated cord blood vitamin E concentrations may be associated with a higher risk of SGA and are positively correlated with lipid levels, suggesting a potential role for vitamin E in fetal lipid metabolism.

WHAT IS KNOWN

• Vitamin E is associated with the regulation of lipid metabolism. • Vitamin E is inversely related to birth weight.

WHAT IS NEW

• Elevated cord blood vitamin E concentrations may be associated with a higher risk of SGA and positively correlated with lipid levels.

Dietary management of gestational diabetes: A review

Gestational diabetes mellitus (GDM) is a common condition in pregnant women that can affect the health of both the mother and the fetus. A healthy diet reduces the risk of GDM, while on the contrary, an unhealthy diet can increase the risk of developing GDM. Dietary interventions remain an important way to control GDM at this time. However, real-life diets are complex and varied, and the effect of these diets on gestational diabetes is unknown. This article summarizes research related to dietary control of GDM. Hopefully, this will help with dietary interventions for people with GDM.

Trajectory of gestational weight gain is related to birthweight: The TAWS cohort study in China

Few studies have reported the timing and amount of gestational weight gain (GWG) to prevent large-for-gestational-age (LGA) or small-for-gestational-age (SGA). This study aimed to evaluate the association of GWG velocity in each trimester with LGA or SGA based on data from the Taicang and Wuqiang cohort study (TAWS, n = 2008). We used a linear mixed model to evaluate the association of trimester-specific GWG velocity with birthweight categories and stratified by prepregnancy body mass index category and parity. For normal-weight pregnant women, mothers with LGA births had higher GWG velocities than mothers with appropriate-for-gestational-age (AGA) births in the first trimester (0.108 vs. 0.031 kg/week, p < 0.01), second trimester (0.755 vs. 0.631 kg/week, p < 0.01) and third trimester (0.664 vs. 0.594 kg/week, p < 0.01); in contrast, mothers with SGA births had lower GWG velocities than mothers with AGA births in the second trimester (0.528 vs. 0.631 kg/week, p < 0.01) and third trimester (0.541 vs. 0.594 kg/week, p < 0.01). For normal-weight pregnant women with AGA births, multiparous women had lower GWG velocities than primiparous women in the second (0.602 vs. 0.643 kg/week, p < 0.01) and third trimesters (0.553 vs. 0.606 kg/week, p < 0.01). Therefore, for normal-weight women, LGA prevention would begin in early pregnancy and continue until delivery and the second and third trimesters may be critical periods for preventing SGA; in addition, among normal-weight pregnant women with AGA births, multiparous women tend to have lower weight gain velocities than primiparous women.

Micronutrients in Maternal and Infant Health: Where We Are and Where We Should Go

The first 1000 days of life are defined by the World Health Organization as a "window of opportunity" for a person's growth and development, and nutrition is particularly important during this time window [...].

Gestational Vitamin E Status and Gestational Diabetes Mellitus: A Retrospective Cohort Study

Objectives: To examine the association between vitamin E (VE) status and gestational diabetes mellitus (GDM). Methods: A retrospective cohort study was conducted by using data of 52,791 women at 137 hospitals across 22 provinces of China. A fasting plasma glucose (FPG) level of ≥5.1 mmol/L between the 24th and 40th weeks of gestation was used as the criteria for the diagnosis of GDM. Mean FPG level and GDM rate were calculated within each combination of the first-trimester VE concentration categories and gestational change categories. The associations of the first-trimester VE concentrations and gestational VE change with FPG and GDM were examined by employing generalized additive models (GAMs). Results: 7162 (13.57%) cases were diagnosed with GDM. The GDM rate was 22.44%, 11.50%, 13.41%, 12.87%, 13.17%, 13.44%, 12.64%, and 14.24% among women with the first-trimester VE concentrations of <7.2, 7.2–7.9, 8.0–9.3, 9.4–11.0, 11.1–13.2, 13.3–15.8, 15.9–17.7, and 17.8–35.9 mg/L, respectively. The GDM rate was 15.96%, 13.10%, 13.64%, and 12.87% among women with gestational VE change of <0, 0–0.19, 0.20–0.29, ≥0.30 mg/L per week, respectively. Multivariable adjusted GAM analyses found that the first-trimester VE concentration was associated with the FPG levels and GDM risk in an L-shaped pattern; the FPG levels and GDM risk decreased sharply to a threshold (around 7 mg/L), and then were keep flat. Gestational VE decreases when the first-trimester VE level was less than 11 mg/L were related to increased FPG levels and GDM risk. Conclusions: Both low first-trimester VE levels and subsequent gestational VE decrease were related with increased risk of GDM. The findings suggest the necessity of having VE-rich foods and appropriate VE supplementation to prevent GDM for pregnant women with low baseline VE levels.