Advertisement

Association of maternal iron deficiency anemia with the risk of gestational diabetes mellitus: a meta-analysis

  • Raphael Enrique Tiongco
  • Engracia Arceo
  • Benjie Clemente
  • Maria Ruth Pineda-Cortel
Maternal-Fetal Medicine
  • 26 Downloads

Abstract

Purpose

The aim of the study was to conduct a meta-analysis investigating the association of maternal iron deficiency anemia (IDA) and risk of gestational diabetes mellitus (GDM).

Methods

Literature search was conducted in various database websites such as PubMed, Cochrane Library, and Web of Science up to 17 June 2018 for related publications written in English. Selected data were extracted from the included studies and were subjected to statistical analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed, pooled, and interpreted. Subgroup analysis by ethnicity (Asians vs. Caucasians) was also performed.

Results

Six studies with a total sample size of 15,157 from various countries were included in this meta-analysis. Pooled ORs of all publications included show that pregnant women with IDA have a reduced risk of developing GDM (OR 0.61; 95% CI 0.47–0.80; PA = 0.0003). Subgroup analysis, on the other hand, showed significant associations among Asians (OR 0.60; 95% CI 0.45–0.79; PA = 0.0003) than Caucasians (OR 0.76; 95% CI 0.32–1.76; PA = 0.52).

Conclusion

Results of this meta-analysis suggests that pregnant women with IDA are 39% less likely to develop GDM. However, more studies are needed to confirm the claims of our results.

Keywords

Maternal iron deficiency anemia Pregnancy outcomes Gestational diabetes mellitus Meta-analysis 

Notes

Author contributions

RET: Project development, data collection, data analysis, manuscript writing. EA: Data collection, data analysis, manuscript writing. BC: Data analysis, manuscript writing. MRP-C: Project development, data analysis, manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Grewal A (2010) Anaemia and pregnancy: anaesthetic implications. Indian J Anaesth 54:380–386CrossRefGoogle Scholar
  2. 2.
    Stevens GA, Finucane MM, De-Regil LM et al (2013) Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health.  https://doi.org/10.1016/s2214-109x(13)70001-9 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    McLean E, Cogswell M, Egli I et al (2009) Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 12:444–454.  https://doi.org/10.1017/S1368980008002401 CrossRefPubMedGoogle Scholar
  4. 4.
    Milman N (2006) Iron and pregnancy—a delicate balance. Ann Hematol 85:559–565CrossRefGoogle Scholar
  5. 5.
    Scholl TO (2010) Maternal nutrition and preterm delivery. Preventive nutrition. Springer, Cham, pp 673–703CrossRefGoogle Scholar
  6. 6.
    Milman N (2008) Prepartum anaemia: prevention and treatment. Ann Hematol 87:949–959CrossRefGoogle Scholar
  7. 7.
    Zhou LM, Yang WW, Hua JZ et al (1998) Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. Am J Epidemiol 148:998–1006.  https://doi.org/10.1093/oxfordjournals.aje.a009577 CrossRefPubMedGoogle Scholar
  8. 8.
    Turner S, Seybold D, Celestine C, Williams D (2012) Incidence of anemia among obstetric patients in an appalachian teaching clinic. Mil Med 177:1212–1216.  https://doi.org/10.7205/MILMED-D-11-00445 CrossRefPubMedGoogle Scholar
  9. 9.
    Bánhidy F, Ács N, Puhó EH, Czeizel AE (2011) Iron deficiency anemia: pregnancy outcomes with or without iron supplementation. Nutrition 27:65–72.  https://doi.org/10.1016/j.nut.2009.12.005 CrossRefPubMedGoogle Scholar
  10. 10.
    Lin L, Wei Y, Zhu W et al (2018) Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study. BMC Pregnancy Childbirth 18:111.  https://doi.org/10.1186/s12884-018-1739-8 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lao TT, Pun T-C (1996) Anaemia in pregnancy—is the current definition meaningful? Eur J Obstet Gynecol Reprod Biol 68:53–58.  https://doi.org/10.1016/0301-2115(96)02479-7 CrossRefPubMedGoogle Scholar
  12. 12.
    Lao TT, Chan LY, Tam KF, Ho LF (2002) Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women. Obstet Gynecol 99:807–812.  https://doi.org/10.1016/S0029-7844(02)01941-5 CrossRefPubMedGoogle Scholar
  13. 13.
    Lao TT, Ho L-F (2004) Impact of iron deficiency anemia on prevalence of gestational diabetes mellitus. Diabetes Care 27:650–656CrossRefGoogle Scholar
  14. 14.
    Wani AI, Bashir MI, Masoodi SR et al (2005) Relationship of prevalence of gestational diabetes mellitus with maternal hemoglobin. J Assoc Phys India 53:1077–1078Google Scholar
  15. 15.
    Tarim E, Kilicdag E, Bagis T, Ergin T (2004) High maternal hemoglobin and ferritin values as risk factors for gestational diabetes. Int J Gynecol Obstet 84:259–261.  https://doi.org/10.1016/S0020-7292(03)00341-2 CrossRefGoogle Scholar
  16. 16.
    Wells GA, Shea B, O’Connell D et al (2013) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hosp Res Inst.  https://doi.org/10.2307/632432 CrossRefGoogle Scholar
  17. 17.
    Pabalan N, Singh N, Pineda MR, Jarjanazi H (2014) Meta-analysis of the association between PTPN11 G/A polymorphism at intron 3 with risk of gastric atrophy among east Asians. J Gastrointest Cancer 45:319–324.  https://doi.org/10.1007/s12029-014-9608-9 CrossRefPubMedGoogle Scholar
  18. 18.
    Pabalan N, Singian E, Tabangay L et al (2015) Associations of the A66G methionine synthase reductase polymorphism in colorectal cancer : a systematic review and meta-analysis. Biomark Cancer 7:21–28.  https://doi.org/10.4137/bic.s25251.type CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Pabalan N, Pineda MR, Jarjanazi H et al (2015) Association of the +331G/A progesterone receptor gene (PgR) polymorphism with risk of endometrial cancer in Caucasian women: a meta-analysis. Arch Gynecol Obstet 291:115–122.  https://doi.org/10.1007/s00404-014-3344-z CrossRefPubMedGoogle Scholar
  20. 20.
    Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies. J Natl Cancer Inst 22:719–748.  https://doi.org/10.1093/jnci/22.4.719 CrossRefPubMedGoogle Scholar
  21. 21.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefGoogle Scholar
  22. 22.
    Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826.  https://doi.org/10.7326/0003-4819-127-9-199711010-00008 CrossRefPubMedGoogle Scholar
  23. 23.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327:557–560.  https://doi.org/10.1136/bmj.327.7414.557 CrossRefGoogle Scholar
  24. 24.
    Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558.  https://doi.org/10.1002/sim.1186 CrossRefPubMedGoogle Scholar
  25. 25.
    Ioannidis JPA, Trikalinos TA (2007) The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey. CMAJ 176:1091–1096.  https://doi.org/10.1503/cmaj.060410 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lh A (2000) Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 7:1280–1284Google Scholar
  27. 27.
    Graham JJ, Ryall RG, Wise PH (1980) Glycosylated haemoglobin and relative polycythaemia in diabetes mellitus. Diabetologia 18:205–207.  https://doi.org/10.1007/BF00251917 CrossRefPubMedGoogle Scholar
  28. 28.
    Roberts AP, Story CJ, Ryall RG (1984) Erythrocyte 2,3-bisphosphoglycerate concentrations and haemoglobin glycosylation in normoxic Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 26:389–391.  https://doi.org/10.1007/BF00266043 CrossRefPubMedGoogle Scholar
  29. 29.
    Samaja M, Melotti D, Carenini A, Pozza G (1982) Glycosylated haemoglobins and the oxygen affinity of whole blood. Diabetologia 23:399–402.  https://doi.org/10.1007/BF00260950 CrossRefPubMedGoogle Scholar
  30. 30.
    Khambalia AZ, Aimone A, Nagubandi P et al (2016) 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. Diabet Med 33:1211–1221CrossRefGoogle Scholar
  31. 31.
    Bencaiova G, Krafft A, Burkhardt T, Zimmermann R (2005) Hemoglobinopathies, body iron stores and gestational diabetes mellitus. Haematologica 90:1138–1139PubMedGoogle Scholar
  32. 32.
    Zhang C, Rawal S (2017) Dietary iron intake, iron status, and gestational diabetes. Am J Clin Nutr 106:1672S–1680SCrossRefGoogle Scholar
  33. 33.
    Black RER, Victora CCG, Walker SSP et al (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382:427–451.  https://doi.org/10.1016/S0140-6736(13)60937-X CrossRefPubMedGoogle Scholar
  34. 34.
    Thomsen JK, Prien-Larsen JC, Devantier A, Fogh-Andersen N (1993) Low dose iron supplementation does not cover the need for iron during pregnancy. Acta Obstet Gynecol Scand 72:93–98.  https://doi.org/10.3109/00016349309023419 CrossRefPubMedGoogle Scholar
  35. 35.
    Milman N, Agger AO, Nielsen OJ (1994) Iron status markers and serum erythropoietin in 120 mothers and newborn infants: effect of iron supplementation in normal pregnancy. Acta Obstet Gynecol Scand 73:200–204.  https://doi.org/10.3109/00016349409023439 CrossRefPubMedGoogle Scholar
  36. 36.
    Bothwell TH (2000) Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr 72:257S–264SCrossRefGoogle Scholar
  37. 37.
    Afkhami-Ardekani M, Rashidi M (2009) Iron status in women with and without gestational diabetes mellitus. J Diabetes Complicat 23:194–198.  https://doi.org/10.1016/j.jdiacomp.2007.11.006 CrossRefPubMedGoogle Scholar
  38. 38.
    Behboudi-Gandevani S, Safary K, Moghaddam-Banaem L et al (2013) The relationship between maternal serum iron and zinc levels and their nutritional intakes in early pregnancy with gestational diabetes. Biol Trace Elem Res 154:7–13.  https://doi.org/10.1007/s12011-013-9703-y CrossRefPubMedGoogle Scholar
  39. 39.
    Omidvar S, Sharbatdaran M, Tilaki K et al (2013) Comparison of the serum iron, ferritin levels and total iron-binding capacity between pregnant women with and without gestational diabetes. J Nat Sci Biol Med 4:302.  https://doi.org/10.4103/0976-9668.116977 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Chen X, Scholl TO, Stein TP (2006) Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: the Camden study. Diabetes Care 29:1077–1082.  https://doi.org/10.2337/dc06-0164 CrossRefPubMedGoogle Scholar
  41. 41.
    Soubasi V, Petridou S, Sarafidis K et al (2010) Association of increased maternal ferritin levels with gestational diabetes and intra-uterine growth retardation. Diabetes Metab 36:58–63.  https://doi.org/10.1016/j.diabet.2009.06.010 CrossRefPubMedGoogle Scholar
  42. 42.
    Bo S, Menato G, Villois P et al (2009) Iron supplementation and gestational diabetes in midpregnancy. Am J Obstet Gynecol.  https://doi.org/10.1016/j.ajog.2009.04.049 CrossRefPubMedGoogle Scholar
  43. 43.
    Rajpathak SN, Crandall JP, Wylie-Rosett J et al (2009) The role of iron in type 2 diabetes in humans. Biochim Biophys Acta Gen Subj 1790:671–681.  https://doi.org/10.1016/j.bbagen.2008.04.005 CrossRefGoogle Scholar
  44. 44.
    Reif DW (1992) Ferritin as a source of iron for oxidative damage. Free Radic Biol Med 12:417–427.  https://doi.org/10.1016/0891-5849(92)90091-T CrossRefPubMedGoogle Scholar
  45. 45.
    Liu Q, Sun L, Tan Y et al (2009) Role of iron deficiency and overload in the pathogenesis of diabetes and diabetic complications. Curr Med Chem 16:113–129.  https://doi.org/10.2174/092986709787002862 CrossRefPubMedGoogle Scholar
  46. 46.
    Wilson JG, Lindquist JH, Grambow SC et al (2003) Potential role of increased iron stores in diabetes. Am J Med Sci 325:332–339CrossRefGoogle Scholar
  47. 47.
    Green A, Basile R, Rumberger JM (2006) Transferrin and iron induce insulin resistance of glucose transport in adipocytes. Metabolism 55:1042–1045.  https://doi.org/10.1016/j.metabol.2006.03.015 CrossRefPubMedGoogle Scholar
  48. 48.
    Fan FS (2016) Iron deficiency anemia due to excessive green tea drinking. Clin Case Reports 4:1053–1056.  https://doi.org/10.1002/ccr3.707 CrossRefGoogle Scholar
  49. 49.
    Sharma JB, Soni D, Murthy NS, Malhotra M (2003) Effect of dietary habits on prevalence of anemia in pregnant women of Delhi. J Obstet Gynaecol Res 29:73–78CrossRefGoogle Scholar
  50. 50.
    Beck KL, Conlon CA, Kruger R et al (2014) Blood donation, being asian, and a history of iron deficiency are stronger predictors of iron deficiency than dietary patterns in premenopausal women. Biomed Res Int 2014:1–7.  https://doi.org/10.1155/2014/652860 CrossRefGoogle Scholar
  51. 51.
    McGregor J, McKie AT, Simpson RJ (2004) Of mice and men: genetic determinants of iron status. Proc Nutr Soc 63:11–20.  https://doi.org/10.1079/PNS2003312 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medical Technology, College of Allied Medical ProfessionsAngeles University FoundationAngelesPhilippines
  2. 2.Department of Medical Technology, Faculty of PharmacyUniversity of Santo TomasManilaPhilippines
  3. 3.Research Center for the Natural and Applied Sciences, University of Santo TomasManilaPhilippines
  4. 4.The Graduate SchoolUniversity of Santo TomasManilaPhilippines

Personalised recommendations