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Gestational diabetes mellitus in the last trimester – a feature of maternal iron excess?
Abstract
SUMMARY Aim To determine whether non‐anaemic women with gestational diabetes mellitus (GDM) diagnosed in third trimester pregnancy have evidence of increased iron stores compared with matched non‐diabetic controls. Methods In a prospective study, women who had antenatal booking before 20 weeks' gestation and without anaemia or diabetes mellitus were recruited at the time of the oral glucose tolerance test (OGTT) at 28–31 weeks' gestation for the study of serum ferritin, iron and transferrin concentrations. The results were blinded to the managing obstetricians. After delivery, the records were reviewed. The cases diagnosed as GDM were compared with a control group (two controls for each index case matched for parity) selected at random from the at‐risk but nondiabetic cases. Results GDM was diagnosed in 97 of the 401 women recruited. Compared with the 194 controls, there was no difference in the weight, body mass index, booking and third trimester haemoglobin, or third trimester red cell indices, but concentrations of serum ferritin, iron, transferrin saturation, and the post‐natal haemoglobin were significantly higher. On multiple regression analysis, maternal BMI and the log‐transformed ferritin concentration remained significant determinants of the OGTT 2‐h glucose value. Conclusion The results suggest an association between increased iron stores and glucose intolerance at the third trimester in non‐anaemic women. The role of iron excess in the pathogenesis of GDM needs to be examined.
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“Iron 'excess' is also a known feature of gestational diabetes [591-593], and is a clear risk factor for the disease even in 'normal' populations [594-603], and indeed diabetes is a classical consequence of iron overloading as seen in hereditary haemochromatosis [604].”
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“Pregnant women with GDM with an increased ferritin concentration and it was therefore logical to hypothesize that pregnant women with anemia would have a reduced likelihood of GDM (50).”
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“Studies examining serum iron concentration in relation to GDM risk have also been conflicting with mixed reports of positive (31, 41, 45, 47), negative (68), or no association (59, 69, 70) with GDM status.”
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“Similarly, it has been reported that increased serum iron levels might be related to GDM risk in pregnant women(14,15).”
BackgroundSeven-Year Surveillance of the Clinical Performance of a Blood Glucose Test Strip Product
Setford, S. J., Grady, M., Phillips, S., Miller, L., Mackintosh, S., Cameron, H., & Corrigall, K. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817703133 · Cited by 15
“Another report has shown that Hct of pregnant women averaged 35%, equivalent to a similar group of women with gestational diabetes.(18) Providing consistent accuracy across the glucose range at these lower Hct levels is therefore important throughout pregnancy.”
ResultWu, Y., Zhang, Q., & Xiao, X. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.763809 · Cited by 20
“Pregnant women with increased Fe stores are at higher risk of developing gestational diabetes mellitus (90).”
BackgroundSerum Elemental Analysis of Type 2 Diabetes Patients Using SRXRF
Rao, N. S., Raju, G. J. N., Tiwari, M. K., Naidu, B. G., & Sarita, P. (2021) · Biological Trace Element Research · doi:10.1007/s12011-021-02762-7 · Cited by 12
Anémie par carence martiale et grossesse. Prévention et traitement
Beucher, G., Grossetti, E., Simonet, T., Leporrier, M., & Dreyfus, M. (2011) · Sages-Femmes · doi:10.1016/j.sagf.2011.07.005 · Cited by 12
Iron regulatory protein 2 deficiency may correlate with insulin resistance
Zhou, Y., Wu, W., Xu, Z., Liu, Y., Chang, H., Yu, P., Zhang, X., Yu, Y., Liu, K., & Chang, Y. (2019) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2019.01.022 · Cited by 12
Does high maternal first trimester iron status have an effect on the 50 g oral glucose test?
Yeniel, A. Ö., Ergenoğlu, A. M., Sanhal, C. Y., Şahin, Ç., Ulukuş, M., & Öztekin, K. (2012) · Journal of Obstetrics and Gynaecology · doi:10.3109/01443615.2012.658894 · Cited by 10
“In another study, which was done by the same investigators, it was also reported that mean ferritin levels were higher among women with GDM compared to those without GDM (Lao et al. 2001).”
ResultHIGH SERUM FERRITIN CONCENTRATIONS IN POLYCYSTIC OVARY SYNDROME IS NOT RELATED TO INSULIN RESISTANCE
Sharifi, F., Mazloomi, S., & Mousavinasab, N. (2011) · Iranian journal of diabetes and obesity · Cited by 10
Current literature in diabetes
Nazlıel, B., Yetkin, İ., İrkeç, C., & Koçer, B. (2001) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.173 · Cited by 10
Lin, Y., Wu, C., An, R., Liu, H., Chen, M., Tan, H., Chen, L., & Deng, J. (2022) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.15509 · Cited by 9
Akinbami, A., Gbadegesin, A., John‐Olabode, S., Adediran, A., Dosunmu, A. O., Sobande, A. A., & Uche, E. I. (2015) · HIV/AIDS - Research and Palliative Care · doi:10.2147/hiv.s80137 · Cited by 10
Zhang, Z., Li, X., Zhou, X., Zhang, Y., Gan, X.-P., Xu, X., & Wu, H. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1067655 · Cited by 9
“Furthermore, our findings are also in accordance with results from previously published prospective studies in non-pregnant individuals on iron store and type 2 diabetes (16) (17) (18).”
ResultPrasad, D. K. V. (2013) · Journal of Diabetes & Metabolism · doi:10.4172/2155-6156.1000269 · Cited by 10
“Women with body mass index >26 kg/m2 has shown that who developed World Health Organization category of impaired glucose tolerance, with the 2-hr glucose values of the 75 g OGTT between 144 mg to 196 mg/dL (WHO, 1980) during pregnancy has significantly increased hemoglobin concentration compared with body mass index m…”
BackgroundIron Biomarker in Gestational Diabetes Pathogenesis
xiao, P. X. (2014) · Journal of Molecular Biomarkers & Diagnosis · doi:10.4172/2155-9929.1000205 · Cited by 9
“Unadjusted concentrations of serum ferritin, iron, transferrin saturation, and the post-natal hemoglobin were significantly higher at 28–31 wk gestation in cases with GDM compared with controls [35].”
BackgroundNovel Iron Parameters in Patients with Type 2 Diabetes Mellitus in Relation to Kidney Function
Zapora-Kurel, A., Kuźma, Ł., Zakrzewska, M., Żórawski, M., Dobrzycki, S., Twardowska-Kawalec, M., & Małyszko, J. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10163732 · Cited by 8
Epidemiology of gestational diabetes mellitus
Yogev, Y., Haroush, A. B., Hod, M., & Oats, J. J. N. (2018) · CRC Press eBooks · doi:10.1201/9781315382104-8 · Cited by 8
Maternal micronutrient disturbance as risks of offspring metabolic syndrome
Shi, Y., Zhong, H., & Pang, L. (2023) · Journal of Trace Elements in Medicine and Biology · doi:10.1016/j.jtemb.2022.127097 · Cited by 10
The Role of Ferroptosis in Women's Health and Diseases
Xu, Q., Zhu, C., Lin, L., Li, J., An, Z., & Tang, C. K. (2025) · MedComm · doi:10.1002/mco2.70296 · Cited by 7
Role of Maternal Iron Status in the Pathogenesis Of Gestational Diabetes Mellitus
Sarker, M. R., Jebunnesa, F., Khatun, T., Helal, R., Ali, L., & Rahim, A. T. M. (2014) · Bangladesh Medical Journal · doi:10.3329/bmj.v40i3.18678 · Cited by 7
Yong, H. Y., Shariff, Z. M., Yusof, B. N. M., Rejali, Z., Tee, Y. Y. S., Bindels, J., & van der Beek, E. M. (2022) · British Journal Of Nutrition · doi:10.1017/s000711452100502x · Cited by 7
“Previous retrospective and prospective studies found that high maternal Hb (more than 13 g/dl) in the first trimester(8), and at 28–30thweeks of gestation(9) are independent risk factors for GDM.”
ResultEbinç, H., Ebinç, F. A., & Özkurt, Z. N. (2007) · Saudi Medical Journal · doi:10.15537/1658-3175.3837 · Cited by 5
HFE Gene Mutation Associated with the Severity of Gestational Diabetes Mellitus in Belarusian Women
Sivitskaya, L. N., Даниленко, Н. Г., Zabarouskaya, Z., & Davydenko, O. G. (2013) · Open Journal of Endocrine and Metabolic Diseases · doi:10.4236/ojemd.2013.31002 · Cited by 4
“Free radicals synthesized in reactions with iron injure cells [23,24].”
BackgroundAigner, E. S., & Datz, C. (2008) · Cited by 4
Misra, S., Yew, Y. W., & Shin, T. S. (2019) · AIMS Medical Science · doi:10.3934/medsci.2019.1.76 · Cited by 3
“Hong Kong Lao, Chan, & Tam, 2001 Prospective cohort study [32] Fe Association of non-anaemic GDM diagnosed in third trimester and their Fe stores compared with matched non-GDM controls.”
Hemoglobin and Ferritin Concentrations in Subjects with Metabolic Syndrome
Adediran, A., Uche, E. I., Akinbami, A., Dada, A., Wakama, T. T., Damulak, D. O., John‐Olabode, S., & Okwegbuna, O. (2015) · Nutrition and Metabolic Insights · doi:10.4137/nmi.s23302 · Cited by 2
Metadata
- Authors
- Lao, T. T., Chan, P. L., & Tam, K. F.
- Affiliations
- Tsan Yuk Hospital (CN)
- Corresponding author
- Lao, T. T.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2001-03
- Volume
- 18
- Issue
- 3
- Pages
- 218-223
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W1988582933
- Cited by
- 137
- References
- 35
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 11 · 2015: 5 · 2014: 11 · 2013: 9 · 2012: 7
- FWCI
- 6.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
- Keywords
- gestational diabetes mellitus, iron overload, iron stores, serum ferritin, transferrin saturation, third trimester, impaired glucose tolerance, body mass index
- MeSH terms
- Adult, Birth Weight, Cross-Sectional Studies, Female, Ferritins, Gestational Age, Glucose Tolerance Test, Hemoglobins, Humans, Infant, Newborn, Iron, Maternal Age, Pregnancy, Pregnancy Trimester, Third, Reference Values, Transferrin, Diabetes, Gestational, Dietary Supplements
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