The Relationship Between Vitamin B12 and Gestational Diabetes in Pregnant Women With and Without Gestational Diabetes Mellitus

Micronutrients (folate and vitamin B12) and homocysteine are key components of the one-carbon metabolism and literature on the associations of these micronutrients with the pathophysiology of gestational diabetes mellitus (GDM) is unclear. The current study aims to examine the levels of these micronutrients across pregnancy in women who develop GDM and compare them with non-GDM women. A total of 200 pregnant women (100 Non-GDM and 100 GDM) were included in the study and blood samples were collected at 4 different time intervals throughout pregnancy (Visit-1 = 11-14 weeks, Visit-2 = 18-22 weeks, Visit-3 = 26-28 weeks, and Visit-4 = at delivery). Vitamin B12 levels at V3 and V4 (p = 0.031 and p = 0.001) and folate levels from V2, till delivery (p < 0.01 for V2, V3 and p = 0.025 for V4) were higher in GDM as compared to non-GDM. However, homocysteine levels were lower at all time points across gestation (p < 0.01 for all) in women with GDM. Intake of vitamin B12 & folate rich foods was comparable in GDM and Non-GDM women. Also, the percentage of GDM women who took vitamin B12 supplements was comparable between groups, while folate supplements were higher V1 (p < 0.01) in GDM women. Elevated micronutrients and lower homocysteine levels in GDM women necessitate more research for better understanding the role of these one carbon nutrients in the etiology of GDM and emphasizes the need to establish the optimum maternal vitamin B12 and folate levels for fetal development.

Aim: Our aim is to study the behavior, diet, and physical activity patterns among gestational diabetes mellitus (GDM) and non-GDM women. Materials and Methods: A survey was conducted among GDM and non-GDM women from multispeciality hospitals and maternal clinics using a purposive sampling criterion. A validated interview schedule was used to obtain details of readiness for pregnancy, perception of managing pregnancy, concerns in pregnancy, degree of depression, food preferences, shopping of food, eating out, cooking, current nutrient intake, food consumption pattern, type, duration and frequency of physical activity, and rest periods of GDM and non-GDM women. Results: Majority of GDM and non-GDM women showed readiness for motherhood. GDM women exhibited greater confidence and importance toward making lifestyle changes during pregnancy. The pregnancy-related concerns were more common among GDM women. The mean energy and protein intake was lower than the recommended dietary allowance (RDA) among GDM women compared to their counterparts. On the contrary, carbohydrate consumption exceeded RDA among both groups. The total fat intake, including visible and invisible fat among GDM women, met the RDA; however, it exceeded the RDA among non-GDM women. The RDA for calcium, iron, and fiber showed significant difference compared to RDA among both groups. Physical activity patterns did not show any significant difference among GDM and non-GDM women and were unsatisfactory in both groups. Conclusion: The study recommends the need for psychological support, proper medical nutrition therapy, and adequate physical activity for GDM and non-GDM women.

Background: Gestational diabetes mellitus (GDM) is one of the most common complications in pregnant women. Vitamin B12 serves in synthesis of methionine from homocysteine. Low vitamin B12 inhibits DNA synthesis and elevates homocysteine. Elevated homocysteine level linked with insulin resistance that is associated with GDM. Various researchers suggested an association of serum vitamin B12 concentration with GDM. Estimation of serum vitamin B12 may be helpful in management of GDM. Objective: To observe the association of vitamin B12 concentration with risk of developing GDM. Methods: This cross-sectional study was carried out at the Department of Laboratory Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh between March 2021 and February 2022. A total of 86 women were enrolled; of them 43 were GDM women selected as cases and 43 were normal pregnant women taken as control group. Their demographic profile, relevant medical history with clinical examination findings were recorded. Serum vitamin B12 concentrations of the study population were estimated following standard procedure. Results: The mean serum vitamin B12 concentration was found significantly low in GDM women (158.7±91.8 pmol/L versus 264.5±100.9 pmol/L, p= 0.001). Pearson’s correlation coefficient test between serum vitamin B12 concentration with fasting plasma glucose level, plasma glucose level 1 hours after 75 gm glucose and plasma glucose level 2 hours after 75 gm glucose showed a significantly negative correlation (r= -0.432, p= 0.004; r= -0.519, p&lt;0.001 and r= -0.687, p&lt;0.001). In multivariate logistic regression analysis, the odd ratio of vitamin B12 concentration with GDM was 1.997 (95% CI; p= 0.042). Conclusion: Serum vitamin B12 concentration is significantly low in GDM women, which is negatively correlated with plasma glucose levels among GDM women. Serum vitamin B12 concentration may be used as a predictive tool to identify risk of developing GDM.

Environmental rather than genetic fetal overgrowth: defining the difference and hints for diagnosis and management

Residual risk associations between initial hyperglycemia and adverse pregnancy outcomes in a large cohort including 6709 women with gestational diabetes

Objective To investigate the relationship between fasting plasma glucose (FPG) in early pregnancy and diagnosis of gestational diabetes mellitus (GDM) and to confirm the rationality of the new standard for GDM diagnosis in early pregnancy set by the International Association of Diabetes and Pregnancy Study Groups (IADPSG).Methods Clinical materials of 2761 pregnant women without diabetes mellitus,who accepted prenatal cares in Peking University First Hospital from April 1,2011 to December 31,2011,were collected and analyzed.The difference between FPG levels of GDM and non-GDM women was compared.According to the early pregnancy FPG level,the subjects were divided into group A (FPG＜5.1 mmol/L,n=2431) and B (FPG≥5.1 mmol/L,n=330).The incidence of GDM and pregnant outcomes of the two groups were compared with t or Chi-square test.Relationship between FPG and GDM was analyzed by Logistic regression and receiver operating characteristic curve.Results (1) Among the 2761 subjects,515 were diagnosed as GDM (18.7％) and the early pregnancy FPG level in GDM group was significantly higher than that in non-GDM group [(4.84±0.46) mmol/L vs (4.57 ± 0.35) mmol/L,t =11.924,P =0.000].In early pregnancy,the risk of GDM increased by 7.984-fold (OR=8.984,95％CI:6.605-12.220) with every 1 mmol/L increase of the FPG level.(2) The diagnostic rate of GDM during mid-and last-trimester in group A (15.2％,370/2431) was lower than that of group B (43.9％,145/330),x2 =123.976,P =0.000.(3) Receiver operating characteristic curve analysis of FPG in early pregnancy and diagnosis of GDM:The largest area under the curve was 0.718 (95％ CI:0.690-0.747).The sensitivity and specificity were 0.600 and 0.612,or 0.735 and 0.726 respectively,when 4.795 mmol/L or 4.785 mmol/L were set as the cut-off value.(4) Among the 1208 cases delivered,GDM was diagnosed in 227 cases.The cesarean section rate (54.2％,123/227) of GDM women was higher than that (39.2％,385/981) of non-GDM women (x2 =16.884,P=0.000).There were no differences in the incidences of macrosomia,neonatal hyperbilirubinemia,low birthweight infant,premature delivery,fetal growth restriction and preeclampsia between GDM and non-GDM group (all P＞0.05).The incidence of premature birth in GDM women with FPG＜ 5.1 mmol/L was lower (5.8％,10/173) than that (14.8％,8/54) of women with FPG≥5.1 mmol/L (x2=4.601,P＜0.05).The incidence of cesarean section,insulin administration,macrosomia and preeclampsia increased from low FPG group to high FPG group,however there was no statistical significances.Conclusions Diagnosing GDM with FPG≥5.1 mmol/L in early pregnancy is not recommended as over diagnosis might happen.But this cut-off value might indicate that the patient are at risk of GDM,and this population should not be ignored. Key words: Pregnancy trimester, first; Diabetes, gestational; Blood glucose

BackgroundGestational diabetes is a risk factor for perinatal complications; include shoulder dystocia, birth injuries such as bone fractures and nerve palsies. It is associated with later development of type 2 diabetes, the risk of macrosomia and other long-term health effects of infants born to diabetic mothers. The study assesses placental peptides and maternal factors as potential predictors of gestational diabetes among pregnant women.Material and methodsA total of 200 pregnant women were recruited for the study, 150 pregnant women without pre gestational diabetes including 50 women with low risk factors of diabetes as controls and 50 other pregnant women with pregestational diabetes as control. Fasting blood glucose and the lipid profile were determined by enzymatic methods using Envoy® 500 reagents (Vital Diagnostics, USA). Glycated haemoglobin was assessed using the Cation Exchange resin method. Leptin and the Human Placenta Lactogen were assayed using the Sandwich-ELISA technique. Beta chorionic gonadotrophin, insulin, progesterone and estradiol were determined using chemilumiscence imunoassay technique on MAGLUMI 600 analyzer. Anthropometry, including BMI and blood pressure were also measured.ResultsFasting plasma glucose (FBG), insulin, insulin resistance, glycated haemoglobin and Human Placenta Lactogen(HPL)were significantly (p<0.0001) increased in the pregestational diabetic women whereas progesterone and estradiol were significantly decreased. In the second trimester however, there was no significant difference (p>0.05) in estradiol, insulin, insulin resistance and HPL between the pregnant women who developed gestational diabetes and those who did not. Leptin, progesterone and FBG were significantly increased in those who developed GDM. The risk of developing gestational diabetes increased with overweight (OR = 1.76, P = 0.370) and family history of diabetes (OR = 2.18, P = 0.282).ConclusionLeptin, progesterone, estradiol estimated in this study were increased in the gestational diabetes mellitus women and fairly predicted gestational diabetes in the non-diabetics pregnant women. Obesity, aging and family history of diabetes were strongly predictive of gestational diabetes.

Concept of Diabetes Mellitus: Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long‐term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder.

Aging is associated with increased incidence and prevalence of chronic diseases, and the role of micronutrient deficiencies in the development of diseases is important. Vitamin B12 and folic acid deficiency are often associated with increased homocysteine (Hcy) levels. In our study, we aimed to detect the relationship between Hcy levels by examining vitamin B12 and folate levels in the healthy elderly Turkish population. In our study, the levels of vitamin B12, folate, and Hcy were analyzed and examined in 657 elderly and 642 non-elderly healthy adults admitted to the Internal medicine outpatient clinic. Vitamin B12 &lt;200 pg/mL was considered to be deficient. Folic acid &lt;5 ng/mL was considered a deficiency, and Hcy&gt;15 µmol/L was considered a high concentration. Vitamin B12 levels were detected to be significantly decreased in the elderly group compared to the non-elderly group, while Hcy levels were marked to be increased (p&lt;0.05). Women had lower levels of Hcy and higher levels of vitamin B12 and folate (p&lt;0.05). There was a moderate negative correlation between Hcy and vitamin B12 levels in the elderly group (r=-0.576; p&lt;0.0001), and a moderate negative correlation between Hcy and folate (r=-0.510; p&lt;0.0001). In the elderly group, 21.5% had vitamin B12 deficiency and 21.6% had folate deficiency. An increase in Hcy level was detected in 54.8%. Those with Hcy levels &gt;15 µmol/L had vitamin B12 deficiency in 38.4%, folate deficiency in 36.0%, and both vitamin B12 and folate deficiency in 15.8%. Our results indicate that it is important to measure vitamin B12, folate, and Hcy in the elderly, given the significant growth in the elderly population. We predict that vitamin B12 and folate supplementation, when necessary, may be beneficial in preventing some common diseases in the elderly and increasing the standard of life of the elderly and their relatives.

Background: Vitamin B12 deficiency in pregnant women is an important health issue which not only affects mothers but also their infants. The aim of this study is to reveal the frequency of vitamin B12 and folic acid deficiency in pregnant women and their newborn babies, to evaluate the relationship between maternal and neonatal vitamin B12 and folic acid levels, and to determine the risk factors for vitamin B12 deficiency. Materials and Methods: This prospective study included 600 pregnant women (gestational age: 38-42 weeks) who presented to obstetrics departments in Şanlıurfa Province and their newborn infants without perinatal complication (birth weight≥2500 g). The lower limit for vitamin B12 was defined as 200 pg/mL. Data regarding age, number of child, medication, comorbid disease or being vegetarian or not were recorded in all mothers. Results: Vitamin B12 deficiency was found in 73.8% of the included pregnant women, and folic acid deficiency was found in 10.3%. Again, 70.5% of newborn babies were found to have vitamin B12 deficiency and 3.7% to have folic acid deficiency. It was concluded that vitamin B12 levels in newborn babies were related to maternal levels. Conclusions: As a result, it has been shown that a significant portion of newborns in Turkey have vitamin B12 deficiency. Vitamin B12 levels were quite low in mothers who gave birth recently. The deficiency of vitamin B12, which plays a major role in brain development upon intrauterine period, is a preventable cause of neurological deficit. Thus, it is highly important to screen and treat vitamin B12 deficiency before onset of clinical symptoms. We believe that our study is beneficial in this regard.

Aim: To assess the lipid profile and vitamin B12 levels in women having gestational diabetes mellitus.&#x0D; Study Design: Case Control study.&#x0D; Place and Duration: Department of Biochemistry and Gynecology/Obstetrics LUMHS Hospital Jamshoro total 1 year duration from January 2018 to December 2018.&#x0D; Methodology: A sample of 291 pregnant women was grouped as; 216 diagnosed gestational diabetes mellitus (GDM) and 75 non gestational diabetes mellitus were selected according to criteria. Sera were evaluated for glucose (hexokinase method), blood lipids and Vitamin B12 (ECLIA assay method) by Cobas chemistry analyzer. Triglyceride/high density lipoprotein (TAGs/HDLc) ratio was calculated as log of transformed TAGs to HDLc. TAGs/HDLc ratio was labelled as low risk (0.3 – 0.1), medium risk (0.1 – 0.24) and high risk (&gt;0.24). Statistical SPSS software 21.0 (IBM, Inc USA) was used to analyze the research variables at 95% CI (P ≤ 0.05).&#x0D; Results: Age of cases was 37.9±5.19 years (P=0.051). Fasting and random blood glucose levels were elevated significantly (P=0.0001). Vitamin B12 in cases was low noted as 155.6±71.3 ng/mL compared to 251.5±33.1 in control (P=0.0001). Any type of vitamin B12 deficiency was present in 153 (70.51%) GDM cases compared to 37 (49.4%) control (P=0.0001). Low, medium and high atherogenicity risk was found in 56.01%, 37.5% and 6.4% GDM cases and 50.5%, 36.6% and 0% in control respectively (P=0.0001).&#x0D; Conclusion: It was found in the present study that triglyceride to HDLc ratio was found elevated in Gestational Diabetes mellitus women with vitamin B12 deficiency.

Vitamin B12 deficiency has been associated with a plethora of metabolic abnormalities, such as hyperhomocysteinaemia, insulin resistance and defective synthesis of neurotransmitters and fatty acids. Inconsistency exists as to whether vitamin B12 deficiency is also associated with increased risk of gestational diabetes mellitus (GDM). The purpose of this study was to systematically review and meta-analyze the existing evidence for this association. A comprehensive search was conducted in PubMed, Scopus and Cochrane Central up to April 30, 2019. Data are expressed as odds ratio (OR) with 95% confidence interval (CI). The I2 index was employed for heterogeneity. Six studies (n = 1810 pregnant women, 309 GDM cases) fulfilled the eligibility criteria for qualitative and two studies for quantitative analysis. In five studies providing data on vitamin B12 concentrations for both groups, women with GDM had lower vitamin B12 levels when compared with non-GDM women. Women with vitamin B12 deficiency were at higher risk for developing GDM when compared with those who were vitamin B12 sufficient: OR 1.81 (95% CI, 1.25-2.63, I2: 0%). Due to the small number of studies, the role of potential confounders could not be safely estimated. Vitamin B12 deficiency seems to be associated with increased risk of GDM. More studies are needed to further strengthen this finding and to clarify possible pathogenetic mechanisms.

Utility and Patterns of Vitamin B12 and Folate Testing in Patients with Isolated Thrombocytopenia

Gestational diabetes mellitus (GDM) is associated with maternal diet, however, findings are inconsistent. The aims of the present study were to assess whether intakes of foods and beverages during pregnancy differed between women who developed GDM and non-GDM women, and to compare dietary intakes with dietary recommendations of pregnancy. This is a longitudinal study using participants of a randomized controlled trial. Women with complete measurements of a 75 g oral glucose tolerance test (OGTT) at 18–22 and 32–36 weeks gestation were included in the cohort (n = 702). Women were diagnosed for GDM according to the simplified International Association of Diabetes and Pregnancy Study Group criteria at 32–36 weeks (GDM women: n = 40; non-GDM women: n = 662). Dietary data (food frequency questionnaire) was collected at both time points and compared between GDM and non-GDM women. Variability in OGTT values was assessed in a general linear model. Marginal differences between GDM and non-GDM women in intakes of food groups were found. No associations were found between dietary variables and OGTT values. Not all dietary recommendations were followed in the cohort, with frequently reported alcohol consumption giving largest cause for concern. This study did not find dietary differences that could help explain why 40 women developed GDM.

Aims/IntroductionTo explore the relationship between plasma iron levels and gestational diabetes mellitus, as well as its impact on macrosomia.Materials and MethodsWe retrospectively compared ferritin level and other characteristics between pregnant women with gestational diabetes mellitus (GDM) and pregnant women without GDM. The correlation between the levels of plasma ferritin, glucose and hemoglobin was explored. Meanwhile, we assessed the risk factors of macrosomia. Furthermore, we explored the relationship between ferritin level and the incidence of macrosomia.ResultsA total of 793 pregnant women were enrolled in the present study, of which 92 pregnant women had GDM and 701 pregnant women were healthy. Meanwhile, 51 pregnant women gave birth to infants with macrosomia and another 742 women had normal infants. Compared with non‐GDM women, pregnant women with GDM were older, with higher pre‐pregnancy body mass index, plasma ferritin, fasting plasma glucose, 1‐h postprandial glucose, 2‐h plasma glucose and hemoglobin. In addition, our results showed a significant positive correlation between the levels of ferritin and fasting plasma glucose when ferritin levels were >70 ng/mL. Our results also showed that pre‐pregnancy overweight or obesity, a high concentration of ferritin, as well as abnormal levels of fasting plasma glucose, 1‐h plasma glucose and 2 h plasma glucose were risk factors for macrosomia. Furthermore, as the level of ferritin increased, so did the incidence of macrosomia.ConclusionsThe current study provides evidence that pregnant women with high levels of ferritin might be prone to GDM. In addition, a high level of ferritin might be an independent risk factor for macrosomia. Therefore, the negative effect of iron supplementation in non‐anemic pregnant women might be noteworthy.