Dietary iron intake, iron status, and gestational diabetes

Zhang, Cuilin; Rawal, Shristi

doi:10.3945/ajcn.117.156034

Cited by 83 publications

(79 citation statements)

References 77 publications

(128 reference statements)

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“…In contrast to the results of our study, other studies did report associations between intakes of individual micronutrients and risk of developing GDM. A recent review summarized the limited evidence suggesting an association between higher intake of iron, particularly heme iron, and higher risk of GDM [45]. In our study, we observed a 30% increased risk of GDM in women with inadequate iron intakes, but this was not statistically significant, and we were not able to distinguish between heme and non-heme iron intakes.…”

Section: Accepted Manuscriptcontrasting

confidence: 90%

Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women

et al. 2019

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Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women. Ntr (2018), https://doi. AbstractEvidence on pre-pregnancy dietary micronutrient intake in relation to gestational diabetes (GDM) development is limited. Therefore, we examined the prevalence of inadequate micronutrient intake before pregnancy and the association between pre-pregnancy dietary micronutrient adequacy, i.e. meeting micronutrient intake recommendations for a range of micronutrients, and risk of developing GDM in an Australian population. We hypothesized that women with an overall higher micronutrient adequacy would have a lower risk of developing GDM. We used data from the prospective Australian Longitudinal Study on Women's Health cohort, in which 3,607 women, aged 25-30 years at baseline in 2003 and without diabetes, were followed-up until 2015. Diet was assessed with a validated 101-item food frequency questionnaire. The Micronutrient Adequacy Ratio (MAR) was calculated as the micronutrient intake divided by its recommended dietary intake averaged over thirteen micronutrients. Multivariable regression models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (95% CI). In 6,263 pregnancies, 285 cases of GDM were documented (4.6%). High prevalences of inadequate dietary micronutrient intake were observed for calcium (47.9%), folate (80.8%), magnesium (52.5%), potassium (63.8%) and vitamin E (78.6%), indicating suboptimal pre-pregnancy micronutrient intakes. Inadequate intakes of individual micronutrients were not associated with risk of developing GDM. However, women in the highest quartile of the MAR had a 39% lower risk of developing GDM compared to women in the lowest quartile (RR 0.61, 95% CI 0.43-0.86, p for trend 0.01). These results highlight the importance of adequate prepregnancy micronutrient intake.

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Section: Accepted Manuscriptcontrasting

confidence: 90%

Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women

et al. 2019

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“…Ferritin, a key protein regulating iron metabolism, is an important clinical determinant of iron status [19][20][21][22]. Multiple experimental studies [7,8,[23][24][25][26] have shown that serum ferritin levels are significantly higher in women with GDM than in women without GDM. Moreover, serum ferritin levels have been found to strongly correlate with levels of plasma glucose, insulin and HbA1c, and elevated ferritin is an independent risk factor for the development of GDM.…”

Section: Discussionmentioning

confidence: 99%

Elevated hepcidin, ferroportin associated with glucose metabolism disorder in midpregnancy

Ma¹,

Cheng²,

Zhang³

et al. 2020

Preprint

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[Objective]: Hepcidin and ferroportin are major regulators of iron metabolism. Although many previous studies have shown that iron metabolism disorder may contribute to the pathogenesis of Type 2 diabetes mellitus (DM), few studies have investigated hepcidin and other iron metabolism parameters in women with gestational diabetes mellitus (GDM). The purpose of this study was to determine the relationship between hepcidin, ferroportin and GDM. [Methods]: A case-control study was conducted in 85 women with GDM and 85 women without GDM (controls) who received regular prenatal care at the Obstetrics and Gynecology Hospital of Fudan University from October 2015 to May 2016. Serum ferritin (SF), hepcidin (Hepc), ferroportin (FPN), and soluble transferrin receptor (sTfR), as well as other clinical parameters, were detected and analyzed in all groups. [Results]: The levels of fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) 1-h and 2-h plasma glucose, glycated hemoglobin (HbA1c), SF, Hepc, FPN and sTfR as well as homeostasis model assessment for insulin resistance (HOMA-IR) were significantly higher in the GDM group (P<0.05 for all). In the GDM group, FPN was positively correlated OGTT-1 h and OGTT-2 h In the control group, only sTfR was positively correlated with OGTT-1 h. There was no correlation between the iron metabolism indicators in both GDM and control group.[Conclusion]: Hepc, FPN sRfR and SF levels were higher in the GDM group. Elevated Hepc and FPN are associated with glucose metabolism disorder and may play an important role in GDM.

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“…Yet adaptations of iron homeostasis to pregnancy and early infancy raise the possibility that higher absorption rates might, with high intakes, result in excess iron exposure in those who are iron replete or have high stores, but further research is needed to examine this possibility. Excess iron accumulates preferentially in some target tissues, such as the brain, stem cells, and erythropoietic cells (36) as well as the pancreas (37). As a pro-oxidant, excess iron can result in increased reactive oxygen species, oxidative stress, and potentially oxidative damage (36).…”

Section: Supplementing Iron-replete Pregnant Women and Young Childrenmentioning

confidence: 99%

“…Emerging evidence of adverse outcomes of supplementation or high iron status in iron-replete pregnant women and young children derives from studies in both developed and developing countries linking high iron status to a variety of health outcomes including GDM (observational case-control and prospective cohort studies and limited randomized controlled trials), preterm birth (observational studies and randomized controlled trials), and impaired fetal growth (observational studies) (2,33,37). The nature of this evidence is summarized in the evidence map presented in Table 1 in terms of the types of evidence (mechanistic, observational, or randomized controlled trials) with a summary of the nature of the totality of the evidence.…”

Section: Supplementing Iron-replete Pregnant Women and Young Childrenmentioning

confidence: 99%

“…Factors to be considered in future research include the mechanisms whereby high iron exposure in these critical periods may affect short-and long-term adverse health outcomes. A possible mechanism considered may be oxidative stress and damage of pancreatic b cells resulting in diabetes (37), of brain cells resulting in neurodegenerative diseases (36), and of stem cells potentially contributing to DOHaD (36).…”

Section: Supplementing Iron-replete Pregnant Women and Young Childrenmentioning

confidence: 99%

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Integrating themes, evidence gaps, and research needs identified by workshop on iron screening and supplementation in iron-replete pregnant women and young children

Brannon

Stover

Taylor

2017

The American Journal of Clinical Nutrition

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This report addresses the evidence and the uncertainties, knowledge gaps, and research needs identified by participants at the NIH workshop related to iron screening and routine iron supplementation of largely iron-replete pregnant women and young children (6-24 mo) in developed countries. The workshop presentations and panel discussions focused on current understanding and knowledge gaps related to iron homeostasis, measurement of and evidence for iron status, and emerging concerns about supplementing iron-replete members of these vulnerable populations. Four integrating themes emerged across workshop presentations and discussion and centered on 1) physiologic or developmental adaptations of iron homeostasis to pregnancy and early infancy, respectively, and their implications, 2) improvement of the assessment of iron status across the full continuum from iron deficiency anemia to iron deficiency to iron replete to iron excess, 3) the linkage of iron status with health outcomes beyond hematologic outcomes, and 4) the balance of benefit and harm of iron supplementation of iron-replete pregnant women and young children. Research that addresses these themes in the context of the full continuum of iron status is needed to inform approaches to the balancing of benefits and harms of screening and routine supplementation.Am J Clin Nutr 2017;106(Suppl):1703S-12S.

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Dietary iron intake, iron status, and gestational diabetes

Cited by 83 publications

References 77 publications

Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women

Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women

Elevated hepcidin, ferroportin associated with glucose metabolism disorder in midpregnancy

Integrating themes, evidence gaps, and research needs identified by workshop on iron screening and supplementation in iron-replete pregnant women and young children

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