Background: Gestational diabetes mellitus (GDM) is a common pregnancy disorder
screened for between the 24th and 28th weeks of gestation
using oral glucose tolerance test. GDM
has maternal and fetal health implications. Objective: To assess the
relation between folic acid supplementation in pregnant women and the risk of
developing GDM.Search Strategy: The search employed topic-based strategies designed for each database in
June 2020. Databases searched were Pubmed, Cochrane Library, Embase and Lebanese American University online
database.Selection Criteria: Studies eligible were those targeting the association of GDM development
and folic acid supplementation, including pregnant women who have developed GDM
and pregnant women who were on folic acid supplementation and developedGDM. Both interventional and
observational studies were included. Data Collection and Analysis: Two
reviewers extracted the data independently. A third reviewer checked the data
for consistency and clarity. Data extracted included the sample characteristics,
sample size and outcomes. Cohen’s κ was used to assess
agreement between reviewers. All tools and processes were piloted prior to use. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data was presented in a
tabulated form. Main Results: Six studies showed a proportional relation
between folic acid intake and GDM, two reported a protective effect, and one
cohort found no association. Conclusion: The inconsistent results made
the formulation of a definitive conclusion difficult. Hence, larger studies are
needed.
References
[1]
American Diabetes Association (2018) Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes. Diabetes Care, 41, S137-S143. https://doi.org/10.2337/dc18-S013
[2]
Deputy, N.P., Kim, S.Y., Conrey, E.J. and Bullard, K.M. (2018) Prevalence and Changes in Preexisting Diabetes and Gestational Diabetes among Women Who Had a Live Birth—United States, 2012-2016. Morbidity and Mortality Weekly Report, 67, 1201-1207. https://doi.org/10.15585/mmwr.mm6743a2
[3]
Ferrara, A. (2007) Increasing Prevalence of Gestational Diabetes Mellitus: A Public Health Perspective. Diabetes Care, 30, S141-S146. https://doi.org/10.2337/dc07-s206
[4]
Simmons, D. (2011) Diabetes and Obesity in Pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 25, 25-36. https://doi.org/10.1016/j.bpobgyn.2010.10.006
[5]
Feig, D.S., Hwe, J., Shah, B.R., Booth, G.L., Bierman, A.S. and Lipscombe, L.L. (2014) Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996-2010. Diabetes Care, 37, 1590-1596. https://doi.org/10.2337/dc13-2717
[6]
Yogev, Y., Xenakis, E.M.J. and Langer, O. (2020) The Association between Preeclampsia and the Severity of Gestational Diabetes: The Impact of Glycemic Control. American Journal of Obstetrics and Gynecology, 191, 1655-1660. https://pubmed.ncbi.nlm.nih.gov/15547538
[7]
Ehrenberg, H.M., et al. (2004) The Influence of Obesity and Diabetes on the Risk of Cesarean Delivery. American Journal of Obstetrics and Gynecology, 191, 969-974. https://pubmed.ncbi.nlm.nih.gov/15467574
[8]
Rosenstein, M.G., Cheng, Y.W., Snowden, J.M., Nicholson, J.M. and Caughey, A.B. (2012) Risk of Stillbirth and Infant Death Stratified by Gestational Age. Obstetrics & Gynecology, 120, 76-82. https://doi.org/10.1097/AOG.0b013e31825bd286
[9]
Jiwani, A., Marseille, E., Lohse, N., Damm, P., Hod, M. and Kahn, J.G. (2012) Gestational Diabetes Mellitus: Results from a Survey of Country Prevalence and Practices. Journal of Maternal-Fetal and Neonatal Medicine, 25, 600-610. https://doi.org/10.3109/14767058.2011.587921
[10]
Imbard, A., Benoist, J.-F. and Blom, H.J. (2013) Neural Tube Defects, Folic Acid and Methylation. International Journal of Environmental Research and Public Health, 10, 4352-4389. https://doi.org/10.3390/ijerph10094352
[11]
Castaño, E., Piñuñuri, R., Hirsch, S. and Ronco, A.M. (2017) Folate and Pregnancy, Current Concepts: It Is Required Folic Acid Supplementation? Revista Chilena de Pediatría, 88, 199-206. https://doi.org/10.4067/S0370-41062017000200001
[12]
Yajnik, C.S., Deshpande, S.S., Jackson, A.A., Refsum, H., Rao, S., Fisher, D.J., et al. (2008) Vitamin B12 and Folate Concentrations during Pregnancy and Insulin Resistance in the Offspring: The Pune Maternal Nutrition Study. Diabetologia, 51, 29-38. https://doi.org/10.1007/s00125-007-0793-y
[13]
Cheng, G., Sha, T., Gao, X., He, Q., Wu, X., Tian, Q., et al. (2019) The Associations between the Duration of Folic Acid Supplementation, Gestational Diabetes Mellitus, and Adverse Birth Outcomes Based on a Birth Cohort. International Journal of Environmental Research and Public Health, 16, 4511. https://doi.org/10.3390/ijerph16224511
[14]
Huang, L., Yu, X., Li, L., Chen, Y., Yang, Y., Yang, Y., et al. (2019) Duration of Periconceptional Folic Acid Supplementation and Risk of Gestational Diabetes Mellitus. Asia Pacific Journal of Clinical Nutrition, 28, 321-329.
[15]
Krishnaveni, G.V., Hill, J.C., Veena, S.R., Bhat, D.S., Wills, A.K., Karat, C.L.S., et al. (2009) Low Plasma Vitamin B12 in Pregnancy Is Associated with Gestational “Diabesity” and Later Diabetes. Diabetologia, 52, 2350-2358. https://doi.org/10.1007/s00125-009-1499-0
[16]
Lai, J.S., Pang, W.W., Cai, S., Lee, Y.S., Chan, J.K.Y., Shek, L.P.C., et al. (2018) High Folate and Low Vitamin B12 Status during Pregnancy Is Associated with Gestational Diabetes Mellitus. Clinical Nutrition, 37, 940-947. https://doi.org/10.1016/j.clnu.2017.03.022
[17]
Li, Q., Zhang, Y., Huang, L., Zhong, C., Chen, R., Zhou, X., et al. (2019) High-Dose Folic Acid Supplement Use from Prepregnancy through Midpregnancy Is Associated with Increased Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care, 42, e113-e115. https://doi.org/10.2337/dc18-2572
[18]
Li, S., Hou, Y., Yan, X., Wang, Y., Shi, C., Wu, X., et al. (2019) Joint Effects of Folate and Vitamin B12 Imbalance with Maternal Characteristics on Gestational Diabetes Mellitus. Journal of Diabetes, 11, 744-751. https://doi.org/10.1111/1753-0407.12899
[19]
Zhu, B., Ge, X., Huang, K., Mao, L., Yan, S., Xu, Y., et al. (2016) Folic Acid Supplement Intake in Early Pregnancy Increases Risk of Gestational Diabetes Mellitus: Evidence from a Prospective Cohort Study. Diabetes Care, 39, e36-e37. https://doi.org/10.2337/dc15-2389
[20]
Xie, K., Xu, P., Fu, Z., Gu, X., Li, H., Cui, X., et al. (2019) Association of Maternal Folate Status in the Second Trimester of Pregnancy with the Risk of Gestational Diabetes Mellitus. Food Science & Nutrition, 7, 3759-3765. https://doi.org/10.1002/fsn3.1235
[21]
Liu, P., Liu, Y., Ma, L., Yao, A.M., Chen, X.Y., Hou, Y.X., et al. (2020) Associations between Gestational Diabetes Mellitus Risk and Folate Status in Early Pregnancy and MTHFR C677T Polymorphisms in Chinese Women. Diabetes, Metabolic Syndrome and Obesity, 13, 1499-1507. https://doi.org/10.2147/DMSO.S250279
[22]
Zhang, H., Dong, H., Ren, M., Liang, Q., Shen, X., Wang, Q., et al. (2020) Ambient Air Pollution Exposure and Gestational Diabetes Mellitus in Guangzhou, China: A Prospective Cohort Study. Science of the Total Environment, 699, Article ID: 134390. https://doi.org/10.1016/j.scitotenv.2019.134390
[23]
Li, X., Jiang, J., Xu, M., Xu, M., Yang, Y., Lu, W., et al. (2015) Individualized Supplementation of Folic Acid According to Polymorphisms of Methylenetetrahydrofolate Reductase (MTHFR), Methionine Synthase Reductase (MTRR) Reduced Pregnant Complications. Gynecologic and Obstetric Investigation, 79, 107-112. https://doi.org/10.1159/000367656
[24]
Chen, Q., Feng, Y., Yang, H., Wu, W., Zhang, P., Wang, K., et al. (2019) A Vitamin Pattern Diet Is Associated with Decreased Risk of Gestational Diabetes Mellitus in Chinese Women: Results from a Case Control Study in Taiyuan, China. Journal of Diabetes Research, 2019, Article ID: 5232308. https://doi.org/10.1155/2019/5232308
[25]
Li, M., Li, S., Chavarro, J.E., Gaskins, A.J., Ley, S.H., Hinkle, S.N., et al. (2019) Prepregnancy Habitual Intakes of Total, Supplemental, and Food Folate and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care, 42, 1034-1041. https://doi.org/10.2337/dc18-2198
[26]
Kozlowska, A., Jagielska, A.M., Okreglicka, K.M., Dabrowski, F., Kanecki, K., Nitsch-Osuch, A., et al. (2018) Dietary Vitamin and Mineral Intakes in a Sample of Pregnant Women with Either Gestational Diabetes or Type 1 Diabetes Mellitus, Assessed in Comparison with Polish Nutritional Guidelines. Ginekologia Polska, 89, 581-586. https://doi.org/10.5603/GP.a2018.0100
[27]
Looman, M., Schoenaker, D.A.J.M., Soedamah-Muthu, S.S., Mishra, G.D., Geelen, A. and Feskens, E.J.M. (2019) Pre-Pregnancy Dietary Micronutrient Adequacy Is Associated with Lower Risk of Developing Gestational Diabetes in Australian Women. Nutrition Research, 62, 32-40. https://doi.org/10.1016/j.nutres.2018.11.006
[28]
Barzilay, E., Moon, A., Plumptre, L., Masih, S.P., Sohn, K.-J., Visentin, C.E., et al. (2018) Fetal One-Carbon Nutrient Concentrations May Be Affected by Gestational Diabetes. Nutrition Research, 55, 57-64. https://doi.org/10.1016/j.nutres.2018.04.010
[29]
Berglund, S.K., García-Valdés, L., Torres-Espinola, F.J., Segura, M.T., Martínez-Zaldívar, C., Aguilar, M.J., et al. (2016) Maternal, Fetal and Perinatal Alterations Associated with Obesity, Overweight and Gestational Diabetes: An Observational Cohort Study (PREOBE). BMC Public Health, 16, 207. https://doi.org/10.1186/s12889-016-2809-3
[30]
Guven, M.A., Kilinc, M., Batukan, C., Ekerbicer, H.C. and Aksu, T. (2006) Elevated Second Trimester Serum Homocysteine Levels in Women with Gestational Diabetes Mellitus. Archives of Gynecology and Obstetrics, 274, 333-337. https://doi.org/10.1007/s00404-006-0191-6
