High maternal iron status, dietary iron intake and iron supplement use in pregnancy and risk of gestational diabetes mellitus: a prospective study and systematic review

Aim High iron measured using dietary intake and biomarkers is associated with Type 2 diabetes. It is uncertain whether a similar association exists for gestational diabetes mellitus. The aim of this systematic review was to conduct a cohort study examining first trimester body iron stores and subseq...

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Published in:	Diabetic medicine Vol. 33; no. 9; pp. 1211 - 1221
Main Authors:	Khambalia, A. Z., Aimone, A., Nagubandi, P., Roberts, C. L., McElduff, A., Morris, J. M., Powell, K. L., Tasevski, V., Nassar, N.
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-09-2016 Wiley Subscription Services, Inc
Subjects:	Adult Antiretroviral drugs Biomarkers C-Reactive Protein - metabolism Diabetes Diabetes, Gestational - epidemiology Diabetes, Gestational - metabolism Dietary Supplements Female Ferritins - metabolism Health risk assessment Humans Iron Iron, Dietary - therapeutic use Logistic Models Multivariate Analysis New South Wales - epidemiology Odds Ratio Pregnancy Prospective Studies Receptors, Transferrin - metabolism Risk Factors Young Adult
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Summary:	Aim High iron measured using dietary intake and biomarkers is associated with Type 2 diabetes. It is uncertain whether a similar association exists for gestational diabetes mellitus. The aim of this systematic review was to conduct a cohort study examining first trimester body iron stores and subsequent risk of gestational diabetes, and to include these findings in a systematic review of all studies examining the association between maternal iron status, iron intake (dietary and supplemental) and the risk of gestational diabetes. Methods Serum samples from women with first trimester screening were linked to birth and hospital records for data on maternal characteristics and gestational diabetes diagnosis. Blood was analysed for ferritin, soluble transferrin receptor and C–reactive protein. Associations between iron biomarkers and gestational diabetes were assessed using multivariate logistic regression. A systematic review and meta‐analysis, registered with PROSPERO (CRD42014013663) included studies of all designs published in English from January 1995 to July 2015 that examined the association between iron and gestational diabetes and included an appropriate comparison group. Results Of 3776 women, 3.4% subsequently developed gestational diabetes. Adjusted analyses found increased odds of gestational diabetes for ferritin (OR 1.41; 95% CI 1.11, 1.78), but not for soluble transferrin receptor (OR 1.00; 95% CI 0.97, 1.03) per unit increase of the biomarker. Two trials of iron supplementation found no association with gestational diabetes. Increased risk of gestational diabetes was associated with higher levels of ferritin and serum iron and dietary haem iron intakes. Conclusions Increased risk of gestational diabetes among women with high serum ferritin and iron levels and dietary haem iron intakes warrants further investigation.
Bibliography:	National Health and Medical Research Council - No. #632653 istex:48288ED2E3924071D870CDC26A6E40968374BC2F NHMRC Career Development Fellowship - No. #APP1067066 ArticleID:DME13056 NHMRC Senior Research Fellowship - No. #APP1021025 ark:/67375/WNG-6T61237V-W Figure S1. Flowchart of selection procedureFigure S2. Forest plot of all studies reporting on transferrin concentrations (μmol/l) among women with and without gestational diabetes mellitus.Figure S3. Forest plot of all studies reporting on transferrin saturation concentrations (%) among women with and without gestational diabetes mellitus.Figure S4. Forest plot of all studies reporting on total iron binding capacity concentrations (μg/dl) among women with and without gestational diabetes mellitus.Figure S5. Funnel plots for studies reporting on iron biomarkers.Table S1. Search strategies in electronic databases Table S2a. Characteristics of studies identified in the systematic review examining association between iron supplement use in pregnancy and gestational diabetes mellitus. Table S2b. Characteristics of studies identified in the systematic review examining dietary iron intakes in pregnant women and gestational diabetes mellitus. Table S2c. Characteristics of studies identified in the systematic review examining serum iron biomarkers in pregnant women and gestational diabetes mellitus. Table S3a. Cumulative meta-analysis of studies sorted chronologically reporting on serum iron concentrations (μg/l) among women with and without gestational diabetes mellitus. Table S3b. Cumulative meta-analysis of studies sorted by total sample size reporting on serum iron concentrations (μg/l) among women with and without gestational diabetes mellitus. Australian NHMRC Centers for Research Excellence - No. APP1001066 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0742-3071 1464-5491
DOI:	10.1111/dme.13056