铁代谢指标和高龄孕妇妊娠糖尿病的关联研究

Association between iron metabolism indexes and gestational diabetes mellitus in pregnant women with advanced age

目的探讨高龄孕妇铁代谢指标和罹患妊娠糖尿病(gestational diabetes mellitus,GDM)风险之间的关系。方法回顾性地纳入了2021年4月至2023年4月在太仓第一人民医院建卡并分娩的292例高龄孕妇,将其分成GDM组和非GDM组。比较两组孕妇在孕20~24周时铁代谢指标[血清铁蛋白(serum ferritin,SF)、血清铁(serum iron,SI)和血红蛋白(hemoglobin,Hb)]的差异;进一步采用多因素Logistic回归模型探讨SF、SI、Hb和GDM之间的关联。采用IEU OpenGWAS(http://gwas.mrcieu.ac.uk/)和FinnGen数据集,以单核苷酸多态性为工具变量,用随机效应逆方差加权法(Inverse-Variance Weighted,IVW)等方法进行两样本孟德尔随机化分析,以探究铁代谢与GDM的因果关系。结果在最大矫正的多因素Logistic模型中,孕20~24周SF和GDM发病风险的关联有统计学意义[OR(95%CI)=1.02(1.01~1.04),P=0.001],Hb和GDM发病风险呈边缘相关[OR(95%CI)=1.04(1.00~1.07),P=0.044],而SI和GDM之间无显著关联。孟德尔随机化分析结果提示,SF、Hb和GDM之间无明显因果关联。结论孕20~24周SF可以作为高龄孕妇是否罹患GDM的标志物,但尚不支持它们之间存在因果关联。

Objective To explore the association between iron metabolism indexes and the risk of gestational diabetes mellitus(GDM)in pregnant women with advanced age.Methods A total of 292 pregnant women,whose age were≥35 years old and gave birth in Taicang First People′s Hospital from April 2021 to April 2023,were retrospectively included and divided into GDM group and non-GDM group.The differences of iron metabolism indexes[serum ferritin(SF),serum iron(SI)and hemoglobin(Hb)]measured from the 20 to 24 weeks of gestation were compared between the two groups.Multivariable Logistic regression model was used to explore the association of SF,SI and Hb with GDM.Based on the data of single nucleotide polymorphism from IEU OpenGWAS(http://gwas.mrcieu.ac.uk/)and FinnGen datasets,two samples Mendelian randomization analysis were conducted to explore the causal relationship between iron metabolism indexes and GDM by using the methods of Inverse Variance Weighted(IVW).Results In the maximally adjusted multi-factor logistic models,the statistically significant association between SF measured from 20 to 24 weeks of gestation and the risk of GDM was found[odds ratio(95%confident interval)=1.02(1.01-1.04),P=0.001].The association between Hb and GDM was marginally significant[odds ratio(95%confident interval)=1.04(1.00-1.07),P=0.044],but no association between SI and GDM reached statistical significance.However,Mendelian randomization analysis showed there was no significant evidence for causal association between SF,Hb and GDM.Conclusion SF examined at 20 to 24 weeks of gestation could be used as a biomarker of GDM in the pregnant women with advanced age,but no evidence supported the causal association between SF and GDM.