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The Association Between Serum Magnesium Levels and Gestational Diabetes Mellitus: a Systematic Review and Meta-Analysis

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Qian Ren
Qian Ren
Qian Ren
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Hongya Wang
Hongya Wang
Hongya Wang
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Yan Zeng
Yan Zeng
Yan Zeng
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Xiaozhen Tan
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Observational studies suggest that the potential role of magnesium remains controversial in gestational diabetes mellitus (GDM). This meta-analysis aims to consolidate the available information from observational studies that have focused on the relationship between magnesium levels and GDM. A systematic and comprehensive literature search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang databases. Data were extracted independently by two investigators. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used to summarize the circulating magnesium levels (CI). This meta-analysis included a total of 17 studies involving 2858 participants including 1404 GDM cases and 1454 healthy controls, which showed that magnesium levels were significantly lower in GDM compared to healthy controls (SMD: − 0.35; 95% CI: − 0.62, − 0.07, P = 0.013). Likewise, the same phenomenon was observed in the third trimester (SMD = − 1.07; 95% CI: − 1.84 to − 0.29, P = 0.007). Other subgroup analyses revealed that this trend of decreasing magnesium concentration was only observed in Europeans (SMD = − 0.64; 95% CI: − 0.90, − 0.38, P < 0.0001). This meta-analysis revealed that serum magnesium levels were lower in patients with GDM than in healthy pregnant women, and this discrepancy was most pronounced in European populations and during the third trimester. Nevertheless, current evidence suggests that circulating magnesium deficiency is associated with gestational diabetes; the challenge for the future is to further elucidate the possible benefits of preventing gestational diabetes through magnesium supplementation.
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Biological Trace Element Research (2023) 201:5115–5125
https://doi.org/10.1007/s12011-023-03591-6
The Association Between Serum Magnesium Levels andGestational
Diabetes Mellitus: aSystematic Review andMeta‑Analysis
QianRen1,2,3,4· HongyaWang1,2,3,4· YanZeng1,2,3,4,5,6· XiaozhenTan1,2,3,4,7· XiCheng1,2,3,4· TingtingZhou1,2,3,4·
WeiHuang1,2,3,4· YongXu1,2,3,4
Received: 15 October 2022 / Accepted: 2 February 2023 / Published online: 15 February 2023
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023
Abstract
Observational studies suggest that the potential role of magnesium remains controversial in gestational diabetes mellitus
(GDM). This meta-analysis aims to consolidate the available information from observational studies that have focused on
the relationship between magnesium levels and GDM. A systematic and comprehensive literature search was conducted in
PubMed, Embase, Web of Science, CNKI, and Wanfang databases. Data were extracted independently by two investigators.
Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used to summarize the circulating magne-
sium levels (CI). This meta-analysis included a total of 17 studies involving 2858 participants including 1404 GDM cases
and 1454 healthy controls, which showed that magnesium levels were significantly lower in GDM compared to healthy
controls (SMD: − 0.35; 95% CI: − 0.62, − 0.07, P = 0.013). Likewise, the same phenomenon was observed in the third tri-
mester (SMD = − 1.07; 95% CI: − 1.84 to − 0.29, P = 0.007). Other subgroup analyses revealed that this trend of decreasing
magnesium concentration was only observed in Europeans (SMD = − 0.64; 95% CI: − 0.90, − 0.38, P < 0.0001). This meta-
analysis revealed that serum magnesium levels were lower in patients with GDM than in healthy pregnant women, and this
discrepancy was most pronounced in European populations and during the third trimester. Nevertheless, current evidence
suggests that circulating magnesium deficiency is associated with gestational diabetes; the challenge for the future is to further
elucidate the possible benefits of preventing gestational diabetes through magnesium supplementation.
Keywords Diabetes mellitus· Gestational diabetes mellitus (GDM)· Pregnancy complications· Magnesium·
Meta-analysis
Introduction
Gestational diabetes mellitus (GDM) refers to variable
degrees of glucose intolerance throughout pregnancy,
and it is estimated to be one of the most common clinical
Qian Ren and Hongya Wang contributed equally to the work as first
authors.
* Wei Huang
huangwei1212520@163.com
* Yong Xu
xywyll@swmu.edu.cn
1 Department ofEndocrinology andMetabolism, The
Affiliated Hospital ofSouthwest Medical University,
Luzhou, Sichuan, China
2 Metabolic Vascular Disease Key Laboratory ofSichuan
Province, Luzhou, Sichuan, China
3 Luzhou Key Laboratory ofCardiovascular andMetabolic
Diseases, The Affiliated Hospital ofSouthwest Medical
University, Luzhou, Sichuan, China
4 Sichuan Clinical Research Center forNephropathy, Luzhou,
Sichuan, China
5 Faculty ofChinese Medicine, Macau University ofScience
andTechnology, Avenida Wai Long, Taipa, China
6 State Key Laboratory ofQuality Research inChinese
Medicine, Macau University ofScience andTechnology,
Avenida Wai Long, Taipa, China
7 Experimental Medicine Center, The Affiliated Hospital
ofSouthwest Medical University, Luzhou, China
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The magnesium intake during pregnancy in the present cohort was also associated with increased GDM risk. The results of a recent meta-analysis showed that magnesium levels were lower in GDM pregnancies, but this association was more pronounced during the third trimester of pregnancy and observed in case-control studies, while, in crosssectional studies, there was no such association identified, highlighting the need for a prospective research design to evaluate this relationship [36]. ...
Impact of Maternal Micronutrient Intake on Gestational Diabetes Risk: Results from Greece’s BORN2020 Prospective Cohort Study
Article
Full-text available
  • Apr 2024
Understanding how maternal micronutrient intake and dietary habits impact gestational diabetes mellitus (GDM) is crucial. Data from 797 pregnant women were prospectively analyzed to assess GDM status with the oral glucose tolerance test (OGTT). Nutritional intake was evaluated using a validated food frequency questionnaire (FFQ) across two periods: Period A, covering 6 months before pregnancy, and Period B, from pregnancy onset to mid-gestation (24 weeks). Micronutrient intakes were compared against the European Food Safety Authority (EFSA) dietary reference values (DRVs) and were used to estimate the mean adequacy ratio (MAR) to assess dietary adequacy. GDM was diagnosed in 14.7% (n = 117) of women with the characteristics of a higher mean maternal age (MA) and pre-pregnancy body mass index (BMI). Out of the 13 vitamins assessed, biotin, folate, niacin, and pantothenic acid were found significantly higher in the GDM group, as did iron, magnesium, manganese, phosphorus, and zinc from the 10 minerals. The results were influenced by the timing of the assessment. Importantly, MAR was higher during pregnancy and was found to increase the risk of GDM by 1% (95%CI: 1, 1.02). A sensitivity analysis revealed that reducing MAR significantly raised the GDM risk by 68% (95%CI: 1.02, 2.79). No association was revealed between adherence to the Mediterranean diet (MD) and GDM risk. These findings highlight areas for further investigation into whether dietary modifications involving these specific micronutrients could effectively influence GDM outcomes.
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... Previous studies showed that changes in some blood trace elements concentrations may be related to the odds of GDM (McKeating et al. 2019). It has been shown that compared to those without GDM during pregnancy, women with GDM are associated with lower blood levels of selenium (Xu et al. 2022), magnesium (Ren et al. 2023), zinc (Fan et al. 2021), but higher blood levels of iron (Yang et al. 2022) and copper (Lian et al. 2021). Besides these trace elements, a change in blood manganese (Mn) has also been observed in patients with diabetes. ...
Blood manganese level and gestational diabetes mellitus: a systematic review and meta-analysis
Article
Full-text available
  • Nov 2023
Background Previous studies evaluating the relationship between blood manganese (Mn) level and gestational diabetes mellitus (GDM) in pregnant women showed inconsistent results. A systematic review and meta-analysis was therefore performed to investigate the above association. Methods Relevant observational studies were obtained by search of electronic databases including Medline, Embase, Cochrane Library and Web of Science from database inception to 10 March 2023. Two authors independently performed database search, literature identification and data extraction. A randomised-effects model was selected to pool the data by incorporating the influence of potential heterogeneity. Subgroup analysis was performed to evaluate the influence of study characteristics on the results of the meta-analysis. Results Six datasets from five observational studies, involving 91,249 pregnant women were included in the meta-analysis. Among the participants, 3597 (3.9%) were diagnosed as GDM. Overall, pooled results showed that a high blood level of Mn was associated with a higher risk of GDM (compared between women with highest versus lowest category blood Mn, odds ratio: 1.31, 95% confidence interval: 1.19–1.44, p < .001) with no significant heterogeneity (p for Cochrane Q-test = 0.93, I² = 0%). Subgroup analyses according to study design, mean maternal age, matrix or methods for measuring blood Mn, and the incidence of GDM also showed consistent results (p for subgroup difference all >.05). Conclusions Results of the meta-analysis suggest that a high blood Mn level may be a risk factor of GDM in pregnant women. Studies are needed to determine the underlying mechanisms, and to investigate if the relationship between blood Mn level and GDM is dose-dependent.
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... In women with GDM, there is evidence that magnesium participates in glucose metabolism inverse relationship between low magnesium intake and glucose metabolism [7]. A recent meta-analysis confirmed magnesium levels are lower in GDM cases than in control pregnant women [8]. Ambient air pollution exposure during the preconception period and the first half of pregnancy is associated with GDM risk [9]. ...
Telomere Length in Patients with Gestational Diabetes Mellitus and Normoglycemic Pregnant Women: a Systematic Review and Meta-analysis
Article
Full-text available
  • Jul 2023
  • REPROD SCI
We performed a systematic review and meta-analysis of studies assessing telomere length in blood leukocytes or mononuclear cells in women with gestational diabetes mellitus (GDM) and normoglycemic pregnant women (NPW) and their infants. The review protocol was registered in PROSPERO (CRD42022300950). Searches were conducted in PubMed, Embase, LILACS, CNKI, and Wang Fang, from inception through November 2022. The primary outcomes were maternal and offspring telomere length. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Random-effect meta-analyses were applied to estimate standardized mean differences (SMDs) and their 95% confidence interval (CI). The meta-analysis of four studies showed no significant maternal telomere length difference (SMD = -0.80, 95% CI: -1.66, 0.05) in women with GDM compared to NPW. In the sensibility analysis omitting one study with a small sample of women, the telomere length becomes significantly reduced in women with GDM (SMD = -1.10, 95% CI: -2.18, -0.02). GDM patients had increased glucose (SMD = 0.28, 95% CI: 0.09, 0.46) and glycosylated hemoglobin than NPW (SMD = 0.62, 95% CI: 0.23, 1.01) while total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides did not display differences between women with and without GDM. There was no significant difference in cord blood telomere length in offspring from women with GDM and NPW (SMD = 0.11, 95% CI: -0.52, 0.30). Cord blood insulin levels (SMD = 0.59, 95% CI: 0.33, 0.85) and birthweight (SMD = 0.59, 95% CI: 0.39, 0.79) were higher in offspring from pregnant women with GDM than in those from NPW. There were no significant differences in maternal and offspring telomere length between pregnancies with and without GDM.
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Prediction of gestational diabetes mellitus by different obesity indices
Article
Full-text available
  • Apr 2022
Abstract Background The incidence rates of obesity and gestational diabetes mellitus (GDM) are increasing in parallel. This study aimed to evaluate the relationship between different obesity indices, including prepregnancy body mass index (preBMI), the first-trimester abdominal circumference (AC), and first-trimester abdominal circumference/height ratio (ACHtR), and GDM, and the efficacy of these three indices in predicting GDM was assessed. Methods A total of 15,472 pregnant women gave birth to a singleton at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Prepregnancy weight was self-reported by study participants, body height and AC were measured by nurses at the first prenatal visit during weeks 11 to 13+6 of pregnancy. GDM was diagnosed through a 75-g oral glucose tolerance test at 24–28 gestational weeks. Using receiver operator characteristic (ROC) curve analysis, we evaluated the association between obesity indices and GDM. Results A total of 1912 women (12.4%) were diagnosed with GDM. Logistic regression analysis showed that AC, ACHtR, and preBMI (P
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Pathophysiological Role of Genetic Factors Associated With Gestational Diabetes Mellitus
Article
Full-text available
  • Apr 2022
Gestational Diabetes Mellitus (GDM) is a highly prevalent maternal pathology characterized by maternal glucose intolerance during pregnancy that is, associated with severe complications for both mother and offspring. Several risk factors have been related to GDM; one of the most important among them is genetic predisposition. Numerous single nucleotide polymorphisms (SNPs) in genes that act at different levels on various tissues, could cause changes in the expression levels and activity of proteins, which result in glucose and insulin metabolism dysfunction. In this review, we describe various SNPs; which according to literature, increase the risk of developing GDM. These SNPs include: (1) those associated with transcription factors that regulate insulin production and excretion, such as rs7903146 (TCF7L2) and rs5015480 (HHEX); (2) others that cause a decrease in protective hormones against insulin resistance such as rs2241766 (ADIPOQ) and rs6257 (SHBG); (3) SNPs that cause modifications in membrane proteins, generating dysfunction in insulin signaling or cell transport in the case of rs5443 (GNB3) and rs2237892 (KCNQ1); (4) those associated with enzymes such as rs225014 (DIO2) and rs9939609 (FTO) which cause an impaired metabolism, resulting in an insulin resistance state; and (5) other polymorphisms, those are associated with growth factors such as rs2146323 (VEGFA) and rs755622 (MIF) which could cause changes in the expression levels of these proteins, producing endothelial dysfunction and an increase of pro-inflammatory cytokines, characteristic on GDM. While the pathophysiological mechanism is unclear, this review describes various potential effects of these polymorphisms on the predisposition to develop GDM.
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Prevalence and Risk Factors of Gestational Diabetes Mellitus in Bangladesh: Findings from Demographic Health Survey 2017–2018
Article
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Gestational diabetes mellitus (GDM) has serious consequences for both maternal and neonatal health. The growing number of noncommunicable diseases and related risk factors as well as the introduction of new World Health Organization (WHO) diagnostic criteria for GDM are likely to impact the GDM prevalence in Bangladesh. Our study aimed to assess the national prevalence and identify the risk factors using the most recent WHO criteria. We used the secondary data of 272 pregnant women (weighted for sampling strategy) from the Bangladesh Demographic and Health Survey 2017–2018. Multivariate logistic regression was performed to determine the risk factors of GDM. The overall prevalence of GDM in Bangladesh was 35% (95/272). Increased odds of GDM were observed among women living in the urban areas (adjusted odds ratio (aOR) 2.74, 95% confidence interval (CI) 1.43–5.27) compared to rural areas and those aged ≥25 years (aOR 2.03, 95% CI 1.13–3.65). GDM rates were less prevalent in the later weeks of pregnancy compared to early weeks. Our study demonstrates that the national prevalence of GDM in Bangladesh is very high, which warrants immediate attention of policy makers, health practitioners, public health researchers, and the community. Context-specific and properly tailored interventions are needed for the prevention and early diagnosis of GDM.
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Gestational Diabetes Mellitus: The Crosslink among Inflammation, Nitroxidative Stress, Intestinal Microbiota and Alternative Therapies
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  • Jan 2022
Gestational diabetes mellitus (GDM) is characterized by a set of metabolic complications arising from adaptive failures to the pregnancy period. Estimates point to a prevalence of 3 to 15% of pregnancies. Its etiology includes intrinsic and extrinsic aspects of the progenitress, which may contribute to the pathophysiogenesis of GDM. Recently, researchers have identified that inflammation, oxidative stress, and the gut microbiota participate in the development of the disease, with potentially harmful effects on the health of the maternal-fetal binomial, in the short and long terms. In this context, alternative therapies were investigated from two perspectives: the modulation of the intestinal microbiota, with probiotics and prebiotics, and the use of natural products with antioxidant and anti-inflammatory properties, which may mitigate the endogenous processes of the GDM, favoring the health of the mother and her offspring, and in a future perspective, alleviating this critical public health problem.
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iThe Importance of Nutrition in Pregnancy and Lactation: Lifelong Consequences
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Full-text available
  • Dec 2021
  • AM J OBSTET GYNECOL
The majority of women in the United States do not meet recommendations for healthful nutrition and weight before and during pregnancy. Women and providers often ask what a healthy diet for a pregnant woman should look like. The message should be “eat better, not more.” This can be achieved by basing diet on a variety of nutrient dense, whole foods, including fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids including nuts and seeds, and fish, in place of poorer quality highly processed foods. Such a diet embodies nutritional density and is less likely to be accompanied by excessive energy intake compared to the standard American diet consisting of increased intakes of processed foods, fatty red meat, and sweetened foods and beverages. Women who report “prudent” or “health conscious” eating patterns before and/or during pregnancy may have fewer pregnancy complications and adverse child health outcomes. Comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy) among women with inadequate nutrition has been associated with improved birth outcomes, including decreased rates of low birthweight. A diet that severely restricts any macronutrient class should be avoided, specifically the ketogenic diet that lacks carbohydrates, the Paleo Diet due to dairy restriction, and any diet characterized by excess saturated fats. User-friendly tools to facilitate a quick evaluation of dietary patterns with clear guidance on how to address dietary inadequacies and embedded support from trained health care providers are urgently needed. Recent evidence has shown that although excessive gestational weight gain (GWG) predicts adverse perinatal outcomes among women with normal weight, the degree of pre-pregnancy obesity predicts adverse perinatal outcomes to a greater degree than GWG among women with obesity. Low body mass index and insufficient gestational weight gain are also associated with poor perinatal outcomes. Observational data have shown that first trimester gain is the strongest predictor of adverse outcomes. Interventions beginning in early pregnancy or pre-conception are needed to prevent downstream complications for mothers and their children. For neonates, human milk provides personalized nutrition and is associated with short- and long-term health benefits for infants and mothers. Eating a healthy diet is a way for lactating mothers to support optimal health for themselves and their infants.
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Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal ‘Teachable Moment’
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  • Sep 2021
Understanding women’s perceptions of eating behaviors and dietary patterns can inform the ‘teachable moment’ model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.
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Is serum zinc status related to gestational diabetes mellitus? A meta‐analysis
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Gestational diabetes mellitus (GDM) is a common medical disorder that begins during pregnancy. The present work aimed to investigate the relationship of maternal or foetal circulatory zinc levels with GDM. Related studies were retrieved against the PubMed/Medline, Web of Science, Scopus databases till July 2020. The overall effects were expressed as standard mean difference (SMD). Furthermore, the random effects model was used to assess the summarised risk ratios (SRRs) to determine the relationship between zinc and the risk of GDM. A total of 15 articles involving were retrieved for meta‐analysis; in the meantime, 4955 subjects including 1549 GDM cases were enrolled for quantitative analysis. Compared with normal control, GDM cases had decreased circulating zinc level on the whole, but the difference was not statistically significant (SMD = −0.40, 95%CI: −0.80 to −0.00, P = 0.05). Interestingly, upon subgroup analysis stratified by serum zinc content but not plasma zinc concentration, there was significant difference in zinc content between GDM cases and normal controls (SMD = −0.56; 95%CI: −1.07 to −0.04, P = 0.03). Meanwhile, subgroup analysis also revealed similar tendency among the Asians and during the 2nd trimester, but not among the Caucasians or during the 1st or 3rd trimester. Data extracted from four studies that compared pregnant women with GDM in the high level of zinc and GDM in the low level of zinc yielded an SRR of 0.929 (95%CI: 0.905–0.954). According to existing evidence, the serum zinc content decreases among GDM cases compared with subjects with no abnormality in glucose tolerance, in particular among the Asians and during the second trimester. Nonetheless, more well designed prospective study should be carried out for understanding the dynamic relationship of zinc level with the incidence of GDM.
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The effects of vitamin and mineral supplementation on women with gestational diabetes mellitus
Article
Full-text available
  • May 2021
  • BMC Endocr Disord
Background The effects of vitamin and mineral supplementation on women with gestational diabetes mellitus (GDM) have not been well established. We conduct a meta-analysis to evaluate the effects of vitamin and mineral supplementation on glycemic control, inflammation and oxidative stress for women with GDM. Methods A systematic search of randomized controlled trials (RCTs) was conducted from PubMed, Embase, Web of Science and Cochrane Library up to July, 2020. Various results were pooled by using Review manager 5.3 and Stata 12.0. Mean difference (MD) with 95% confidence interval (CI) was estimated. Heterogeneity between studies was assessed by I-squared ( I 2 ) tests. Results Six hundred ninety-eight patients from 12 trials were included in our meta-analysis. Magnesium, zinc, selenium, calcium, vitamin D and E (alone or in combination) were found to significantly improve glycemic control in women with GDM compared to those receiving placebos: fasting plasma glucose (FPG) (MD = - 9.02; 95% CI: - 12.09, - 5.96; P < 0.00001), serum insulin (MD = - 4.33; 95% CI: - 5.35, - 3.32; P < 0.00001), homeostasis model assessment-insulin resistance (HOMA-IR) (MD = - 1.34; 95% CI: - 1.60, - 1.07; P < 0.00001), and homeostasis model of assessment for β cell function (HOMA-B) (MD = - 15.58; 95% CI: - 23.70, - 7.46; P = 0.0002). Vitamin and mineral supplementation was found to attenuated inflammation and oxidative stress through decreasing high-sensitivity C-reactive protein (hs-CRP) (MD = - 1.29; 95% CI: - 1.82, - 0.76; P < 0.00001), malondialdehyde (MDA) (MD = - 0.71; 95% CI: - 0.97, - 0.45; P < 0.00001), and increasing total antioxidant capacity (TAC) (MD = 45.55; 95% CI: 22.02, 69.08; P = 0.0001). Conclusions This meta-analysis shows that vitamin and mineral supplementation significantly improved glycemic control, attenuated inflammation and oxidative stress in women with GDM.
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Global burden of early pregnancy gestational diabetes mellitus (eGDM): A systematic review
Article
  • Nov 2021
AimsGestational diabetes mellitus (GDM) diagnosed during the first trimester of pregnancy is called ‘early pregnancy Gestational Diabetes Mellitus’ (eGDM). The burden of eGDM has only been studied sporadically. This review aims to understand the global burden of eGDM in terms of prevalence, risk factors, pregnancy outcomes, treatment and postpartum dysglycemia. MethodsA review of epidemiologic studies reporting on early GDM screening as per Joanna Briggs Institute (JBI) methodology for prevalence reviews was conducted. A customized search strategy was used to search electronic databases namely, PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, MEDLINE, Ovid, ScienceDirect, and Google Scholar. Three independent reviewers reviewed studies using Covidence software. Observational studies irrespective of study design and regardless of diagnostic criteria were included. Quality of evidence was appraised, and findings were synthesized.ResultsOf 58 included studies, 41 reported a prevalence of eGDM, ranging from 0.7 to 36.8%. Body mass index (BMI), previous history of GDM, family history of diabetes and multiparity were reported as eGDM risk factors. Adverse pregnancy outcomes associated with eGDM were macrosomia, caesarean delivery, induction of labour, hypertension, preterm delivery, and shoulder dystocia. The incidence of postpartum dysglycemia and the need for insulin was higher in women with eGDM. The risk of bias was moderate. Heterogeneity of studies is a limitation. Meta-analysis was not performed.Conclusions There is heterogeneity in the prevalence of eGDM and intrapartum and postpartum ill effects for the mother and the offspring. There is a need to develop a universal screening protocol for eGDM.
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Plasma Levels of Trace Element Status in Early Pregnancy and the Risk of Gestational Diabetes Mellitus: A nested case-control study
Article
  • Jul 2021
  • J TRACE ELEM MED BIO
Purpose We investigated the impacts of plasma levels of magnesium (Mg), zinc (Zn), calcium (Ca), iron (Fe), copper (Cu), selenium (Se), and chromium (Cr) on GDM risk and the potential mediation effect of blood glucose levels on the relationship between trace elements and GDM risk. Methods This nested case-control study was based on data from a birth cohort study conducted in Wuhan, China in 2013-2016. A total of 305 GDM cases and 305 individually-matched controls were included in the study. Conditional logistic regression models were used to estimate the associations between plasma trace element concentrations and GDM risk. A mediation analysis was conducted to explore whether blood glucose levels act as a mediator between trace element levels and GDM risk. Results An IQR increment in plasma levels of Fe and Cu was associated with a significant increase in GDM risk [OR = 2.04 (95% CI 1.62, 2.57) and OR = 1.52 (95% CI 1.25, 1.82)], respectively. On the other hand, an IQR increment in plasma levels of Zn and Ca was associated with a significant decrease in GDM risk [OR = 0.55 (95% CI 0.43, 0.71) and OR = 0.72 (95% CI 0.56, 0.92)], respectively. The mediation analysis showed significant mediation of the association between Cu and GDM risk via the FBG (%mediated: 19.27%), 1 h-PBG (12.64%), 2h-PBG (28.44%) pathways. Conclusions Plasma levels of Zn and Ca were negatively associated with GDM risk, while Fe and Cu were positively associated. Blood glucose levels act as a mediator between plasma trace element exposures and GDM risk.
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