Association of Maternal Folate and Vitamin B12 in Early Pregnancy With Gestational Diabetes Mellitus: A Prospective Cohort Study

Abstract

To investigate the association of folate and vitamin B 12 in early pregnancy with gestational diabetes mellitus (GDM) risk. RESEARCH DESIGN AND METHODSThe data of this study were from a subcohort within the Shanghai Preconception Cohort Study. We included pregnancies with red blood cell (RBC) folate and vitamin B 12 measurements at recruitment (between 9 and 13 gestational weeks) and those with three samples available for glucose measurements under an oral glucose tolerance test. GDM was diagnosed between 24 and 28 weeks' gestation. Odds ratio (OR) and 95% CI of having GDM was used to quantify the association. RESULTSA total of 1,058 pregnant women were included, and GDM occurred in 180 (17.01%). RBC folate and vitamin B 12 were significantly higher in pregnancies with GDM than those without GDM (P values were 0.045 and 0.002, respectively) and positively correlated with 1-h and 2-h serum glucose. Daily folic acid supplementation in early pregnancy increases the risk of GDM; OR (95% CI) was 1.73 (1.19-2.53) (P 5 0.004). Compared with RBC folate <400 ng/mL, pregnancies with RBC folate ‡600 ng/mL were associated with ∼1.60-fold higher odds of GDM; the adjusted OR (95% CI) was 1.58 (1.03-2.41) (P 5 0.033). A significant trend of risk effect on GDM risk across categories of RBC folate was observed (P trend 5 0.021). Vitamin B 12 was significantly associated with GDM risk (OR 1.14 per 100 pg/mL; P 5 0.002). No significant association of serum folate and percentile ratio of RBC folate/vitamin B 12 with GDM was observed. CONCLUSIONSHigher maternal RBC folate and vitamin B 12 levels in early pregnancy are significantly associated with GDM risk, while the balance of folate/vitamin B 12 is not significantly associated with GDM.As one of the most common pregnancy complications, gestational diabetes mellitus (GDM) affects ;17% of pregnancies worldwide (1). In China, ;2.9 million pregnant women suffer from this disorder (2). GDM has long-term adverse outcomes in both mothers and offspring (3). Despite its serious complications, the diagnosis of GDM is

Vitamin B12 and Folate Levels During Pregnancy and Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…Similar results were noted by Lai et al (23). However, contrasting results were demonstrated by Chen et al (13), who reported higher vitamin B12 levels to be associated with an increased risk of GDM. The variation of results may be explained by the timing of serum vitamin B12 measurements in the included studies.…”

“…Liu et al ( 27 ) reported 2.473 times (95% CI: 1.013, 6.037) increased risk of GDM with RBC folate levels of ≥ 380.6 ng/ml. Similarly, Chen et al ( 13 ) reported 1.58 times (95% CI: 1.03, 2.41) and Xie et al ( 24 ) reported 2.76 times (95% CI: 1.56, 4.89) increased risk of GDM with RBC folate levels of ≥600 ng/ml and 570.2 ng/ml, respectively. Of the six studies assessing the relation between serum folate and GDM, four ( 13 , 20 , 22 , 26 ) reported no statistically significant association between serum folate levels and risk of GDM.…”

“…Figure 1 presents the study flow-chart. A total of 12 studies fulfilled the inclusion criteria and were included in the review (13,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Details of the included studies are presented in Table 1.…”

“…Studies have implicated lower vitamin B12 levels in pregnancy with adverse outcomes like obesity, insulin resistance, and GDM ( 12 ). On the other hand, a recent Chinese study on 1,058 pregnant females demonstrated an increased risk of GDM with higher vitamin B12 levels ( 13 ).…”

Current Nanocarrier Strategies Improve Vitamin B12 Pharmacokinetics, Ameliorate Patients’ Lives, and Reduce Costs

“…For example, it has been observed that polymorphisms in the protein transcobalamin II (a carrier of VitB12 in the blood flow) and transcobalamin receptor TCblR (which binds the complex VitB12/transcobalamin II allowing the receptor-mediated endocytosis in target organs) are associated with RSA [21]. Moreover, altered levels of VitB12 are correlated with metabolic insulin resistance, gestational diabetes mellitus [23], and preeclampsia [24].…”