孕期叶酸、维生素B<sub>12</sub>与妊娠期糖尿病的关系

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摘要目的了解孕期女性叶酸和维生素B₁₂的膳食摄入和体内代谢状况,及其与妊娠期糖尿病(GDM)的关系。方法本研究为基于母子营养与健康队列的横断面研究,以山东省高密市人民医院、北京市海淀区妇幼保健院和怀柔区妇幼保健院为研究现场,遵循自愿原则募集孕24~30周的孕妇进入研究。采用3天24小时膳食回顾法进行膳食调查,计算孕妇每日叶酸、维生素B₁₂及相关营养素摄入情况;采集孕妇空腹静脉血,血清和红细胞叶酸检测采用微粒子化学发光法,血清同型半胱氨酸检测采用酶循环法,血清维生素B₁₂的检测方法为化学发光法。同期利用口服葡萄糖耐量试验进行妊娠期糖尿病的诊断。结果本研究共纳入 368 名孕妇,妊娠期糖尿病患病率为39.9%。膳食叶酸摄入、维生素B₁₂摄入在非GDM组的中位数分别为 543.00 μg DFE和3.01 μg,在GDM组的中位数分别为 360.90 μg DFE和2.58 μg;非GDM组的孕妇红细胞叶酸均值(969.64±288.57 ng/mL)高于GDM组(962.86±280.28 ng/mL),血清叶酸、血清维生素B₁₂和血清同型半胱氨酸在非GDM组的中位数分别为 14.26 ng/mL、223.00 pmol/L、4.72 μmol/L,在GDM组的中位数分别为12.93 ng/mL、233.00 pmol/L和4.89 μmol/L。多因素logistic分析结果显示,孕期膳食碳水化合物摄入不足增加GDM发生风险(OR=2.19,95% CI:1.17~4.09),血清叶酸过量(＞20 ng/mL)与GDM低风险有关(OR=0.55,95% CI:0.30~1.00)。结论血清叶酸含量较高的孕妇患妊娠期糖尿病的可能性更低。

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	鹿璐
	卢雪玲
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	曾小玲
	蒋伟
	张晓莉
	孙京
	朱文丽
	潘丽娜

关键词 ：孕期, 叶酸, 维生素B₁₂, 妊娠期糖尿病

Abstract：Objective To understand the dietary intake and metabolic status of folic acid and vitamin B₁₂ in pregnant women, and their relations with gestational diabetes mellitus(GDM).Methods This study was a cross-sectional study based on a mother-child nutrition and health cohort, and selected Beijing and Shandong as the study sites, relying on local maternal and child health care and medical institutions, and followed the principle of voluntary recruitment of pregnant women at 24 to 30 weeks of pregnancy to enter the study. Dietary survey was conducted by 3-day 24-hour dietary retrospective method to calculate the daily intake of folic acid, vitamin B₁₂ and related nutrients of pregnant women. The fasting venous blood of pregnant women was collected, Serum and red blood cell folate were detected using microparticle chemiluminescence method, serum homocysteine was detected using enzyme circulation method, and serum vitamin B12 was detected using chemiluminescence method. Oral glucose tolerance test was used to diagnose GDM at the same time.Results A total of 368 pregnant women were included in this study, and the prevalence of GDM was 39.9%. The median dietary folic acid intake and vitamin B₁₂ intake were 543.00 μgDFE and 3.01μg in the non-GDM group, and 360.90 μg DFE and 2.58 μg in the GDM group, respectively. The mean value of erythrocyte folate in the non-GDM group(969.64±288.57 ng/mL) was higher than that in the GDM group(962.86±280.28 ng/mL). The median values of serum folate, vitamin B₁₂ and homocysteine in the non-GDM group were 14.26ng/mL, 223.00 pmol/L and 4.72 μmol/L, and those in the GDM group were 12.93 ng/mL, 233.00 pmol/L and 4.89 μmol/L. Multivariate logistic analysis showed that inadequate carbohydrate intake during pregnancy was a risk factor for GDM(OR=2.19, 95%CI:1.17~4.09) and serum folate(>20 ng/mL)was associated with a low risk of GDM(OR=0.53, 95%CI:0.30~1.00).Conclusion Pregnant women with higher serum folate content were less likely to develop GDM.

Key words： pregnancy folic acid vitamin B₁₂ gestational diabetes mellitus

收稿日期: 2022-06-23

ZTFLH:

R17

基金资助:湖南省营养健康品工程技术研究中心-湖南省创新平台与人才计划(2019TP2066)

通讯作者: 朱文丽(zhuwenli@bjmu.edu.cn),潘丽娜(lina.pan@ausnutria.com)

引用本文:

鹿璐, 卢雪玲, 綦萍萍, 曾小玲, 蒋伟, 张晓莉, 孙京, 朱文丽, 潘丽娜. 孕期叶酸、维生素B₁₂与妊娠期糖尿病的关系[J]. 中国生育健康杂志, 2024, 35(1): 1-7. LU Lu, LU Xueling, QI Pingping, ZENG Xiaoling, JIANG Wei, ZHANG Xiaoli, SUN Jing, ZHU Wenli, PAN Lina. The relationship between the status of folic acid,vitamin B12 during pregnancy and gestational diabetes mellitus. Chinese Journal of Reproductive Health, 2024, 35(1): 1-7.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2024/V35/I1/1

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