Circulating fatty acids and risk of gestational diabetes mellitus: prospective analyses in China

in European Journal of Endocrinology
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  • 1 Department of Epidemiology & Biostatistics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
  • 2 Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
  • 3 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  • 4 Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  • 5 School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
  • 6 National Center for Pediatric Cancer Surveillance, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
  • 7 China Academy of Chinese Medical Sciences, Guang’anmen Hospital, Xicheng District, Beijing, China
  • 8 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  • 9 Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China
  • 10 Department of Obstetrics and Gynecology, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
  • 11 Department of Nutrition, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
  • 12 Department of Gynecology and Obstetrics, West China Second Hospital, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
  • 13 Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
  • 14 Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  • 15 Obstetrics Department, The Third Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

Correspondence should be addressed to A Pan, Y Li or Z Mei; Email: panan@hust.edu.cn or liyuanyuan@hust.edu.cn or meizhx@mail.sysu.edu.cn

*(X Pan, Y Huang and X Li contributed equally to this work)

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Objective

We aimed to examine prospective associations between circulating fatty acids in early pregnancy and incident gestational diabetes mellitus (GDM) among Chinese pregnant women.

Methods

Analyses were based on two prospective nested case-control studies conducted in western China (336 GDM cases and 672 matched controls) and central China (305 cases and 305 matched controls). Fasting plasma fatty acids in early pregnancy (gestational age at enrollment: 10.4 weeks(s.d., 2.0)) and 13.2 weeks (1.0), respectively) were determined by gas chromatography-mass spectrometry, and GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Groups criteria during 24–28 weeks of gestation. Multiple metabolic biomarkers (HOMA-IR (homeostatic model assessment for insulin resistance), HbA1c, c-peptide, high-sensitivity C-reactive protein, adiponectin, leptin, and blood lipids) were additionally measured among 672 non-GDM controls at enrollment.

Results

Higher levels of saturated fatty acids (SFAs) 14:0 (pooled odds ratio, 1.41 for each 1-s.d. increase; 95% CI: 1.25, 1.59) and 16:0 (1.19; 1.05, 1.35) were associated with higher odds of GDM. Higher levels of n-6 polyunsaturated fatty acid (PUFA) 18:2n-6 were strongly associated with lower odds of GDM (0.69; 0.60, 0.80). In non-GDM pregnant women, higher SFAs 14:0 and 16:0 but lower n-6 PUFA 18:2n-6 were generally correlated with unfavorable metabolic profiles.

Conclusions

We documented adverse associations of 14:0 and 16:0 but a protective association of 18:2n-6 with GDM among Chinese pregnant women. Our findings highlight the distinct roles of specific fatty acids in the onset of GDM.

Supplementary Materials

    • Supplementary Figure 1 Flowchart of participant selection and exclusion for two nested case-control studies. Abbreviations: GDM, gestational diabetes mellitus; SD, standard deviation; TSBC, Tongji-Shuangliu Birth Cohort; WWC, Wuhan Women and Children Medical and Healthcare Center.
    • Supplementary Figure 2 Heat map for the correlations of identified fatty acids and metabolic biomarkers in non-GDM pregnant women in the TSBC study Abbreviations: FDR, false discovery rate; GDM, gestational diabetes mellitus; HDL-C, high-density lipoprotein cholesterol; HOMA-IR, homeostatic model assessment for insulin resistance; hs-CRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol; TC, total cholesterol; TG, triglycerides; TSBC, Tongji-Shuangliu Birth Cohort. Partial Spearman’s correlation coefficients of four fatty acids with multiple metabolic biomarkers were estimated in 672 non-GDM pregnant women (mean gestational age, 10.5 weeks [standard deviation, 1.9]) in the TSBC study after adjusting for covariates. Covariates included maternal age, education, gestational age, parity, cigarette smoking, alcohol drinking, physical activity, pre-pregnancy BMI, family history of diabetes, and history of GDM. Statistical significance was indicated by FDR-adjusted P values less than 0.05.
    • Supplementary Methods Eligibility criteria for TSBC and WWC studies
    • Supplementary Table 1 GC-MS acquisition settings for FAMEs
    • Supplementary Table 2 List of fatty acids and their intra-assay and inter-assay CVs
    • Supplementary Table 3 Distribution of circulating fatty acids among GDM cases and non-GDM controls in two nested case-control studies
    • Supplementary Table 4 Multivariable-adjusted ORs (95% CIs) for GDM comparing quartiles of circulating fatty acids in the TSBC study
    • Supplementary Table 5 Multivariable-adjusted OR (95% CIs) for GDM comparing quartiles of circulating fatty acids in the WWC study
    • Supplementary Table 6 Multivariable-adjusted ORs (95% CIs) for GDM in relation to each 1-SD increase in circulating fatty acids after adjusting for additional covariates in the TSBC study 1
    • Supplementary Table 7 Pooled ORs (95% CIs) for GDM in relation to each 1-SD increase in circulating fatty acids from two nested case-control studies: subgroup analyses by baseline age of the pregnant women
    • Supplementary Table 8 Pooled ORs (95% CIs) for GDM in relation to each 1-SD increase in circulating fatty acids from two nested case-control studies: subgroup analyses by baseline BMI of the pregnant women
    • Supplementary Table 9 ORs (95% CIs) for GDM in relation to each 1-SD increase in circulating fatty acids in the TSBC study: subgroup analyses by alcohol drinking status in the past year
    • Supplementary Table 10 Adjusted Spearman correlation coefficients of four selected fatty acids with metabolic biomarkers among 672 non-GDM pregnant women in the TSBC study
    • Supplementary Table 11 Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) of two risk prediction models for GDM in the TSBC study

 

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