High iron level in early pregnancy increased glucose intolerance

Zein, Sharif Hussein Sharif; Rachidi, Samar; Awada, Sanaa; Osman, Mohamed; Al‐Hajje, Amal; Shami, Nadine; Sharara, Iman; Cheikh-Ali, Khawla; Salameh, Pascale; Hininger‐Favier, Isabelle

doi:10.1016/j.jtemb.2014.09.004

Cited by 43 publications

(67 citation statements)

References 26 publications

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“…Studies that have prospectively examined the association of ferritin with GDM risk have, however, been limited and inconsistent in their findings [8][9][10][11][12]. For instance, a study based in Lebanon found that high ferritin levels in early pregnancy were significantly associated with impaired glucose tolerance but not with GDM incidence, although the latter could be attributed to the small number of women with GDM in the study (n = 16) [8]. In another prospective study, the association between serum ferritin and GDM was found to be significant after accounting for several confounders, including ethnicity and a family history of diabetes, but was attenuated to non-significance after additionally accounting for prepregnancy BMI [11].…”

Section: Discussionmentioning

confidence: 99%

“…Prospective studies investigating the association between iron status in pregnancy and the risk of GDM are few and inconsistent in their findings [8][9][10][11][12], and none have examined these associations with longitudinal measurements of iron status. In addition, the vast majority of the existing literature centres on serum ferritin as a biomarker of iron stores.…”

Section: Introductionmentioning

confidence: 99%

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A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort

et al. 2016

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Aims/hypothesis The aim of this study was to prospectively and longitudinally investigate maternal iron status during early to mid-pregnancy, and subsequent risk of gestational diabetes mellitus (GDM), using a comprehensive panel of conventional and novel iron biomarkers. Methods A case-control study of 107 women with GDM and 214 controls (matched on age, race/ethnicity and gestational week during blood collection) was conducted within the the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort (2009)(2010)(2011)(2012)(2013), a prospective and multiracial pregnancy cohort. Plasma hepcidin, ferritin and soluble transferrin receptor (sTfR) were measured and sTfR:ferritin ratio was derived, twice before GDM diagnosis (gestational weeks 10-14 and 15-26) and at weeks 23-31 and 33-39. GDM diagnosis was ascertained from medical records. Adjusted ORs (aORs) for GDM were estimated using conditional logistic regression analysis, adjusting for demographics, prepregnancy BMI and other major risk factors. Results Hepcidin concentrations during weeks 15-26 were 16% higher among women with GDM vs controls (median 6.4 vs 5.5 ng/ml; p = 0.02 ), and were positively associated with GDM risk; the aOR (95% CI) for highest vs lowest quartile was 2.61 (1.07, 6.36). Ferritin levels were also positively associated with GDM risk; the aOR (95% CI) for highest vs lowest quartile was 2.43 (1.12, 5.28) at weeks 10-14 and 3.95 (1.38, 11.30) at weeks 15-26. The sTfR:ferritin ratio was inversely related to GDM risk; the aOR (95% CI) for highest vs lowest quartile was 0.33 (0.14, 0.80) at weeks 10-14 and 0.15 (0.05, 0.48) at weeks 15-26. Conclusions/interpretation Our findings suggest that elevated iron stores may be involved in the development of GDM from as early as the first trimester. This raises potential concerns for the recommendation of routine iron supplementation among iron-replete pregnant women.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort

et al. 2016

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“…SF concentration, an indicator of iron stores, has been most often examined in relation to the risk of GDM. A significant and positive association between SF concentration and GDM has been observed in several (41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55), although not in all, previous studies (56)(57)(58)(59). The majority of these studies were cross-sectional in design, with SF concentration measured either during or close to the time of GDM diagnosis (41,44,45,47,(50)(51)(52)(53)56).…”

Section: Sf Concentration and Gdm Riskmentioning

confidence: 94%

“…Prospective studies that measure SF concentration well before GDM diagnosis are, hence, critical to preclude the possibility of reverse causation. Only a few prospective studies (42,43,48,49,54,55,57) to date have investigated associations of SF concentration with the subsequent risk of GDM ( Table 2). Overall, findings from prospective studies consistently support that high SF concentrations in pregnancy are associated with an elevated risk of GDM.…”

Section: Sf Concentration and Gdm Riskmentioning

confidence: 99%

“…Findings from 2 recent meta-analyses (37,48) also demonstrated a significant and positive association between SF concentrations and the risk of GDM. For instance, in one of the meta-analyses (37) that included 4 prospective studies (42,43,46,57), women with the highest SF concentrations had a .3-fold greater risk of GDM compared with those with the lowest concentrations (pooled RR: 3.22; 95% CI: 1.73, 6.00).…”

Section: Sf Concentration and Gdm Riskmentioning

confidence: 99%

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Dietary iron intake, iron status, and gestational diabetes

Zhang

Rawal

2017

The American Journal of Clinical Nutrition

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Pregnant women are particularly vulnerable to iron deficiency and related adverse pregnancy outcomes and, as such, are routinely recommended for iron supplementation. Emerging evidence from both animal and population-based studies, however, has raised potential concerns because significant associations have been observed between greater iron stores and disturbances in glucose metabolism, including increased risk of type 2 diabetes among nonpregnant individuals. Yet, the evidence is uncertain regarding the role of iron in the development of gestational diabetes mellitus (GDM), a common pregnancy complication which has short-term and long-term adverse health ramifications for both women and their children. In this review, we critically and systematically evaluate available data examining the risk of GDM associated with dietary iron, iron supplementation, and iron status as measured by blood concentrations of several indicators. We also discuss major methodologic concerns regarding the available epidemiologic studies on iron and GDM.Am J Clin Nutr 2017;106(Suppl):1672S-80S.

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Association of elevated mid‐pregnancy maternal plasma ferritin concentrations and triglyceride concentrations with the risk of gestational diabetes mellitus: A prospective cohort study

Kong

Zhong

Gao

et al. 2023

Diabetes Metabolism Res

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ObjectiveFerritin levels are well known to be associated with gestational diabetes mellitus (GDM). However, the association of the combination of ferritin and triglyceride (TG) levels in early mid‐pregnancy with GDM has not been studied in depth. We investigated the independent and combined relationships of plasma ferritin and TG concentrations with the risk of GDM as well as the mediation effect of TG on ferritin.MethodsWe analysed 2071 pregnant women from the Tongji Maternal and Child Health Cohort who had their plasma ferritin and TG concentrations measured at 11–20 weeks of gestation. Associations between ferritin and TG concentrations and GDM risk were estimated using multivariable logistic regression models. Youden's index was calculated to find the cut‐off values of ferritin and TG by ROC curve analysis. The mediation effect of the TG concentration on the ferritin level with GDM risk was explored by a mediation analysis.ResultsA total of 264 (12.3%) participants developed GDM. The median and IQR of ferritin was 53.9 (30.5–92.7) ng/mL. After adjusting for potential confounders, the relative risks (RRs) and 95% confidence intervals of GDM were 2.19 (1.42, 3.39) for ferritin and 2.02 (1.37, 2.97) for TG. The adjusted RR for combination was 2.40 (1.62, 3.55). Moreover, we found that the TG concentration mediated 15.0% of the total effect of the ferritin concentration on the risk of GDM.ConclusionsWomen with a combination of both high plasma ferritin (˃55.7 ng/mL) and high TG (˃1.9 mmoL/L) were at the highest risk of GDM. Additionally, we have revealed for the first time that an elevated maternal TG concentration in early pregnancy mediates the relationship between ferritin concentration and GDM risk.Trial registrationThis trial is registered at https://ClinicalTrials.gov as NCT03099837.

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High iron level in early pregnancy increased glucose intolerance

Cited by 43 publications

References 26 publications

A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort

A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort

Dietary iron intake, iron status, and gestational diabetes

Association of elevated mid‐pregnancy maternal plasma ferritin concentrations and triglyceride concentrations with the risk of gestational diabetes mellitus: A prospective cohort study

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