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U-shaped Association Between Folic Acid Supplementation and the Risk of Gestational Diabetes Mellitus in Chinese Women

Published:October 26, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.10.007

      Abstract

      Objective

      Our aim in this study was to assess the association between folic acid (FA) supplementation before and during pregnancy and risk of gestational diabetes mellitus (GDM) in Chinese women.

      Methods

      This case–control study was conducted at 2 hospitals in central China. A total of 1,300 pregnant women, including 396 GDM patients and 904 controls, participated in the study. Information on the dose and duration of FA supplementation was collected using a self-report questionnaire at enrolment (24 to 28 weeks of gestation).

      Results

      We observed a U-shaped association between FA supplementation and GDM risk that demonstrated a 228% increased risk of GDM among women who never took FA supplements, a 28% increased risk among women who took supplements containing <400 μg/day FA or took FA supplements for <1 month and a 188% increased risk among women who took supplements containing ≥800 μg/day FA for an adequate duration (>1 month before pregnancy and >3 months during pregnancy) compared with women who took supplements containing 400 to 799 μg/day FA for an adequate duration (all p<0.05). For women who took supplements containing ≥800 μg/day FA for an adequate duration, the association between FA supplementation and GDM risk appeared to be stronger among those women with a prepregnancy BMI of ≥25 kg/m2 than among those with a prepregnancy BMI of <25 kg/m2 (p=0.006 for interaction).

      Conclusions

      There was a U-shaped association of FA supplementation with GDM risk; that is, FA supplementation both below and above the recommended levels may increase the risk of GDM.

      Résumé

      Objectif

      L’objectif de notre étude était d’évaluer l’association entre la supplémentation en acide folique (AF) avant et pendant la grossesse et le risque de diabète sucré gestationnel (DSG) chez les femmes chinoises.

      Méthodes

      Cette étude cas-témoins a été menée dans 2 hôpitaux de la Chine centrale. Un total de 1300 femmes enceintes, soit 396 patientes atteintes du DSG et 904 témoins, ont participé à l’étude. Les informations sur la dose et la durée de la supplémentation en AF ont été collectées grâce à un auto-questionnaire lors de l’inscription (de 24 à 28 semaines de grossesse).

      Résultats

      Nous avons observé une association en U entre la supplémentation en AF et le risque de DSG qui démontrait une augmentation du risque de DSG de 228 % chez les femmes qui ne prenaient pas de suppléments d’AF, une augmentation du risque de 28 % chez les femmes qui prenaient des suppléments contenant < 400 μg/jour d’AF ou prenaient des suppléments d’AF depuis < 1 mois et une augmentation du risque de 188 % chez les femmes qui prenaient des suppléments contenant ≥ 800 μg/jour pendant une durée suffisante (> 1 mois avant la grossesse et > 3 mois pendant la grossesse) par rapport aux femmes qui prenaient des suppléments contenant 400 à 799 μg/jour d’AF pendant une durée suffisante FA (tous p < 0,05). Chez les femmes qui prenaient des suppléments contenant ≥ 800 μg/jour d’AF pendant une durée suffisante, l’association entre la supplémentation en AF et le risque de DSG semblait être plus forte chez ces femmes qui avaient un IMC ≥ 25 kg/m2 avant la grossesse que chez celles qui avaient un IMC < 25 kg/m2 avant la grossesse (p = 0,006 d’interaction).

      Conclusions

      Une association en U entre la supplémentation en AF et le risque de DSG existait; autrement dit, que la supplémentation en AF soit inférieure ou supérieure à l’apport recommandé peut augmenter le risque de DSG.

      Keywords

      Mots clés

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