Association of Folic Acid Supplementation in Early Pregnancy with Risk of Gestational Diabetes Mellitus: A Longitudinal Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Measurement of Folic Acid Supplementation, Blood Glucose, and Diagnosis of GDM
2.3. Covariates
2.4. Statistical Analysis
3. Results
3.1. Demographic Characteristics of the Participants
3.2. Folic Acid Supplementation and the Risk of GDM
3.3. Dose and Duration of Folic Acid Supplementation and the Risk of GDM
3.4. Sensitivity Analyses
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Subgroups | OR (95% CI) | p Value | ||
---|---|---|---|---|
Total GDM | Age (years) | <35 | 0.89 (0.73~1.09) | 0.268 |
≥35 | 0.82 (0.64~1.04) | 0.103 | ||
BMI (kg/m2) | <25 | 0.78 (0.66~0.93) | 0.006 | |
≥25 | 1.07 (0.75~1.52) | 0.713 | ||
Pregnancy | Singleton | 0.87 (0.74~1.02) | 0.084 | |
Multiple | 0.75 (0.38~1.51) | 0.422 | ||
FBG diagnosed GDM | Age (years) | <35 | 1.03 (0.75~1.41) | 0.856 |
≥35 | 1.31 (0.87~1.98) | 0.195 | ||
BMI (kg/m2) | <25 | 1.00 (0.75~1.33) | 0.980 | |
≥25 | 1.37 (0.85~2.23) | 0.196 | ||
Pregnancy | Singleton | 1.13 (0.87~1.46) | 0.351 | |
Multiple | 1.20 (0.36~4.00) | 0.765 | ||
1-h PBG diagnosed GDM | Age (years) | <35 | 0.90 (0.70~1.14) | 0.390 |
≥35 | 0.80 (0.61~1.06) | 0.118 | ||
BMI (kg/m2) | <25 | 0.78 (0.63~0.95) | 0.016 | |
≥25 | 1.04 (0.70~1.54) | 0.847 | ||
Pregnancy | Singleton | 0.86 (0.71~1.04) | 0.117 | |
Multiple | 0.82 (0.35~1.91) | 0.647 | ||
2-h PBG diagnosed GDM | Age (years) | <35 | 0.84 (0.66~1.12) | 0.168 |
≥35 | 0.65 (0.50~0.85) | 0.001 | ||
BMI (kg/m2) | <25 | 0.73 (0.60~0.90) | 0.002 | |
≥25 | 0.72 (0.49~1.05) | 0.089 | ||
Pregnancy | Singleton | 0.75 (0.62~0.89) | 0.001 | |
Multiple | 0.93 (0.40~2.15) | 0.866 |
References
- Juan, J.; Yang, H. Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China. Int. J. Environ. Res. Public Health 2020, 17, 9517. [Google Scholar] [CrossRef] [PubMed]
- Nguyen, C.L.; Pham, N.M.; Binns, C.W.; Duong, D.V.; Lee, A.H. Prevalence of Gestational Diabetes Mellitus in Eastern and Southeastern Asia: A Systematic Review and Meta-Analysis. J. Diabetes Res. 2018, 2018, 6536974. [Google Scholar] [CrossRef] [PubMed]
- Zhu, Y.; Zhang, C. Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: A Global Perspective. Curr. Diab. Rep. 2016, 16, 7. [Google Scholar] [CrossRef] [PubMed]
- Silva-Zolezzi, I.; Samuel, T.M.; Spieldenner, J. Maternal nutrition: Opportunities in the prevention of gestational diabetes. Nutr. Rev. 2017, 75 (Suppl. 1), 32–50. [Google Scholar] [CrossRef]
- Bianco, M.E.; Josefson, J.L. Hyperglycemia During Pregnancy and Long-Term Offspring Outcomes. Curr. Diab. Rep. 2019, 19, 143. [Google Scholar] [CrossRef]
- Eshak, E.S.; Iso, H.; Muraki, I.; Tamakoshi, A. Among the water-soluble vitamins, dietary intakes of vitamins C, B2 and folate are associated with the reduced risk of diabetes in Japanese women but not men. Br. J. Nutr. 2019, 121, 1357–1364. [Google Scholar] [CrossRef]
- Li, S.; Tian, X.; Wang, Y.; Zhang, X.; Zhang, L.; Li, C.; Li, J.; Wang, C.; Liu, H.; Liu, J.; et al. Associations of Maternal rs1801131 Genotype in MTHFR and Serum Folate and Vitamin B12 with Gestational Diabetes Mellitus in Chinese Pregnant Women. Nutrients 2022, 14, 1169. [Google Scholar] [CrossRef]
- van Weelden, W.; Seed, P.T.; Antoun, E.; Godfrey, K.M.; Kitaba, N.T.; Lillycrop, K.A.; Dalrymple, K.V.; Sobczynska-Malefora, A.; Painter, R.C.; Poston, L.; et al. Folate and vitamin B12 status: Associations with maternal glucose and neonatal DNA methylation sites related to dysglycaemia, in pregnant women with obesity. J. Dev. Orig. Health. Dis. 2022, 13, 168–176. [Google Scholar] [CrossRef]
- Frigerio, B.; Bizzoni, C.; Jansen, G.; Leamon, C.P.; Peters, G.J.; Low, P.S.; Matherly, L.H.; Figini, M. Folate receptors and transporters: Biological role and diagnostic/therapeutic targets in cancer and other diseases. J. Exp. Clin. Cancer Res. 2019, 38, 125. [Google Scholar] [CrossRef]
- Li, Z.; Mei, Z.; Zhang, L.; Li, H.; Zhang, Y.; Li, N.; Ye, R.; Ren, A.; Liu, J.M.; Serdula, M.K. Effects of Prenatal Micronutrient Supplementation on Spontaneous Preterm Birth: A Double-Blind Randomized Controlled Trial in China. Am. J. Epidemiol. 2017, 186, 318–325. [Google Scholar] [CrossRef] [Green Version]
- Zhang, Q.; Wang, Y.; Xin, X.; Zhang, Y.; Liu, D.; Peng, Z.; He, Y.; Xu, J.; Ma, X. Effect of folic acid supplementation on preterm delivery and small for gestational age births: A systematic review and meta-analysis. Reprod. Toxicol. 2017, 67, 35–41. [Google Scholar] [CrossRef] [PubMed]
- Imdad, A.; Yakoob, M.Y.; Bhutta, Z.A. The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths. BMC Public Health 2011, 11 (Suppl. 3), S4. [Google Scholar] [CrossRef] [PubMed]
- MRC Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991, 338, 131–137. [Google Scholar] [CrossRef]
- US Preventive Services Task Force (USPSTF). Folic Acid Supplementation for the Prevention of Neural Tube Defects: US Preventive Services Task Force Recommendation Statement. JAMA 2017, 317, 183–189. [Google Scholar] [CrossRef]
- Wang, H.; De Steur, H.; Chen, G.; Zhang, X.; Pei, L.; Gellynck, X.; Zheng, X. Effectiveness of Folic Acid Fortified Flour for Prevention of Neural Tube Defects in a High Risk Region. Nutrients 2016, 8, 152. [Google Scholar] [CrossRef]
- Cui, M.; Lu, X.L.; Lyu, Y.Y.; Wang, F.; Xie, X.L.; Cheng, X.Y.; Zhang, T. Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: A cross-sectional study. BMC Pregnancy Childbirth 2021, 21, 1–9. [Google Scholar] [CrossRef]
- Chen, X.; Zhang, Y.; Chen, H.; Jiang, Y.; Wang, Y.; Wang, D.; Li, M.; Dou, Y.; Sun, X.; Huang, G.; et al. Association of Maternal Folate and Vitamin B12 in Early Pregnancy with Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care 2021, 44, 217–223. [Google Scholar] [CrossRef]
- Liu, P.J.; Liu, Y.; Ma, L.; Yao, A.M.; Chen, X.Y.; Hou, Y.X.; Wu, L.P.; Xia, L.Y. Associations Between Gestational Diabetes Mellitus Risk and Folate Status in Early Pregnancy and MTHFR C677T Polymorphisms in Chinese Women. Diabetes Metab. Syndr. Obes. 2020, 13, 1499–1507. [Google Scholar] [CrossRef]
- Li, M.; Li, S.; Chavarro, J.E.; Gaskins, A.J.; Ley, S.H.; Hinkle, S.N.; Wang, X.; Ding, M.; Bell, G.; Bjerregaard, A.A.; et al. Prepregnancy Habitual Intakes of Total, Supplemental, and Food Folate and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care 2019, 42, 1034–1041. [Google Scholar] [CrossRef]
- Li, Q.; Zhang, Y.; Huang, L.; Zhong, C.; Chen, R.; Zhou, X.; Chen, X.; Li, X.; Cui, W.; Xiong, T.; et al. High-Dose Folic Acid Supplement Use From Prepregnancy Through Midpregnancy Is Associated With Increased Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care 2019, 42, e113–e115. [Google Scholar] [CrossRef] [Green Version]
- Machairiotis, N.; Vasilakaki, S.; Minns, L.; Malakasis, A. Nutrients that modulate gestational diabetes mellitus: A systematic review of cohort studies Jan 2019–Jan 2020. Int. J. Clin. Pract. 2021, 75, e14033. [Google Scholar] [CrossRef] [PubMed]
- Zhu, B.; Ge, X.; Huang, K.; Mao, L.; Yan, S.; Xu, Y.; Huang, S.; Hao, J.; Zhu, P.; Niu, Y.; et al. Folic Acid Supplement Intake in Early Pregnancy Increases Risk of Gestational Diabetes Mellitus: Evidence from a Prospective Cohort Study. Diabetes Care 2016, 39, e36–e37. [Google Scholar] [CrossRef] [PubMed]
- Chen, H.; He, Y.; Zeng, X.; Chen, Q.; Zhou, N.; Yang, H.; Zhou, W.; Zhang, L.; Yang, R.; Huang, Q.; et al. Sleep Quality is an Independent Predictor of Blood Glucose and Gestational Diabetes Mellitus: A Longitudinal Study of 4550 Chinese Women. Nat. Sci. Sleep 2022, 14, 609–620. [Google Scholar] [CrossRef] [PubMed]
- Li, S.; Hou, Y.; Yan, X.; Wang, Y.; Shi, C.; Wu, X.; Liu, H.; Zhang, L.; Zhang, X.; Liu, J.; et al. Joint effects of folate and vitamin B12 imbalance with maternal characteristics on gestational diabetes mellitus. J. Diabetes 2019, 11, 744–751. [Google Scholar] [CrossRef]
- Cheng, G.; Sha, T.; Gao, X.; He, Q.; Wu, X.; Tian, Q.; Yang, F.; Tang, C.; Wu, X.; Xie, Q.; et al. The Associations between the Duration of Folic Acid Supplementation, Gestational Diabetes Mellitus, and Adverse Birth Outcomes based on a Birth Cohort. Int. J. Environ. Res. Public Health 2019, 16, 4511. [Google Scholar] [CrossRef]
- Cueto, H.T.; Riis, A.H.; Hatch, E.E.; Wise, L.A.; Rothman, K.J.; Mikkelsen, E.M. Predictors of preconceptional folic acid or multivitamin supplement use: A cross-sectional study of Danish pregnancy planners. Clin. Epidemiol. 2012, 4, 259–265. [Google Scholar] [CrossRef]
- Page, K.A.; Buchanan, T.A. The vicious cycle of maternal diabetes and obesity: Moving from “what” to “how” and “why”. J. Pediatr. 2011, 158, 872–873. [Google Scholar] [CrossRef]
- Xia, P.F.; Pan, X.F.; Li, Y.; Guo, K.; Yang, K.; Tu, Z.Z.; Zhang, Y.B.; Geng, T.T.; Liu, G.; Pan, A. Trends in Diagnosed and Undiagnosed Diabetes Among Adults in the U.S., 2005–2016. Diabetes Care 2021, 44, e175–e177. [Google Scholar] [CrossRef]
- Xia, P.F.; Tian, Y.X.; Geng, T.T.; Li, Y.; Tu, Z.Z.; Zhang, Y.B.; Guo, K.; Yang, K.; Liu, G.; Pan, A. Trends in Prevalence and Awareness of Prediabetes Among Adults in the U.S., 2005–2020. Diabetes Care 2022, 45, e21–e23. [Google Scholar] [CrossRef]
- Maher, A.; Sobczynska-Malefora, A. The Relationship Between Folate, Vitamin B12 and Gestational Diabetes Mellitus with Proposed Mechanisms and Foetal Implications. J. Family Reprod. Health 2021, 15, 141–149. [Google Scholar] [CrossRef]
- Obeid, R.; Herrmann, W. Homocysteine and lipids: S-adenosyl methionine as a key intermediate. FEBS Lett. 2009, 583, 1215–1225. [Google Scholar] [CrossRef] [PubMed]
- Da Silva, R.P.; Kelly, K.B.; Al Rajabi, A.; Jacobs, R.L. Novel insights on interactions between folate and lipid metabolism. Biofactors 2014, 40, 277–283. [Google Scholar] [CrossRef] [PubMed]
- Lind, M.V.; Lauritzen, L.; Kristensen, M.; Ross, A.B.; Eriksen, J.N. Effect of folate supplementation on insulin sensitivity and type 2 diabetes: A meta-analysis of randomized controlled trials. Am. J. Clin. Nutr. 2019, 109, 29–42. [Google Scholar] [CrossRef] [PubMed]
- Pravenec, M.; Kozich, V.; Krijt, J.; Sokolova, J.; Zidek, V.; Landa, V.; Simakova, M.; Mlejnek, P.; Silhavy, J.; Oliyarnyk, O.; et al. Folate deficiency is associated with oxidative stress, increased blood pressure, and insulin resistance in spontaneously hypertensive rats. Am. J. Hypertens. 2013, 26, 135–140. [Google Scholar] [CrossRef]
- Sid, V.; Wu, N.; Sarna, L.K.; Siow, Y.L.; House, J.D.; Karmin, O. Folic acid supplementation during high-fat diet feeding restores AMPK activation via an AMP-LKB1-dependent mechanism. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2015, 309, R1215–R1225. [Google Scholar] [CrossRef]
- Sarna, L.K.; Wu, N.; Wang, P.; Hwang, S.Y.; Siow, Y.L.; Karmin, O. Folic acid supplementation attenuates high fat diet induced hepatic oxidative stress via regulation of NADPH oxidase. Can. J. Physiol. Pharmacol. 2012, 90, 155–165. [Google Scholar] [CrossRef]
- Zhao, M.; Zhou, J.; Chen, Y.H.; Yuan, L.; Yuan, M.M.; Zhang, X.Q.; Hu, Y.; Yu, H. Folic Acid Promotes Wound Healing in Diabetic Mice by Suppression of Oxidative Stress. J. Nutr. Sci. Vitaminol. 2018, 64, 26–33. [Google Scholar] [CrossRef]
- Zhao, Y.; Hao, L.; Zhang, L.; Tian, Y.; Cao, Y.; Xia, H.; Deng, Y.; Wang, T.; Yu, M.; Li, Z. Plasma folate status and dietary folate intake among Chinese women of childbearing age. Matern. Child. Nutr. 2009, 5, 104–116. [Google Scholar] [CrossRef]
- Yang, M.; Cai, C.; Dong, H.; Wang, P.; Sun, H.; Pang, X.; Bai, D.; Chen, C.; Pu, S.; Zeng, G. Influencing factors of insufficient and excessive folate intake in early pregnancy in Chengdu in 2017. Wei Sheng Yan Jiu 2021, 50, 919–925. [Google Scholar] [CrossRef]
- Guo, H.; Mao, B.; Wang, M.; Liu, Q.; Yang, L.; Xie, Y.; Wang, Y.; He, X.; Cui, H.; Lin, X.; et al. Folic acid supplementation, dietary folate intake and risk of small for gestational age in China. Public Health Nutr. 2020, 23, 1965–1973. [Google Scholar] [CrossRef]
- McNulty, H.; Pentieva, K. Folate bioavailability. Proc. Nutr. Soc. 2004, 63, 529–536. [Google Scholar] [CrossRef] [PubMed]
- Lai, J.S.; Pang, W.W.; Cai, S.; Lee, Y.S.; Chan, J.K.Y.; Shek, L.P.C.; Yap, F.K.P.; Tan, K.H.; Godfrey, K.M.; van Dam, R.M.; et al. High folate and low vitamin B12 status during pregnancy is associated with gestational diabetes mellitus. Clin. Nutr. 2018, 37, 940–947. [Google Scholar] [CrossRef] [PubMed]
- Saravanan, P.; Sukumar, N.; Adaikalakoteswari, A.; Goljan, I.; Venkataraman, H.; Gopinath, A.; Bagias, C.; Yajnik, C.S.; Stallard, N.; Ghebremichael-Weldeselassie, Y.; et al. Association of maternal vitamin B12 and folate levels in early pregnancy with gestational diabetes: A prospective UK cohort study (PRiDE study). Diabetologia 2021, 64, 2170–2182. [Google Scholar] [CrossRef] [PubMed]
- Owen, M.D.; Baker, B.C.; Scott, E.M.; Forbes, K. Interaction between Metformin, Folate and Vitamin B12 and the Potential Impact on Fetal Growth and Long-Term Metabolic Health in Diabetic Pregnancies. Int. J. Mol. Sci. 2021, 22, 5759. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Total | GDM | Non-GDM | χ2/t | p | |
---|---|---|---|---|---|---|
N (%) | N (%) | |||||
Age (years) | Mean ± SD | 32.35 ± 4.69 | 33.27 ± 4.73 | 32.02 ± 4.63 | 18.45 | <0.001 |
<25 | 592 (2.42) | 81 (1.27) | 511 (2.83) | 333.94 | <0.001 | |
25~30 | 5964 (24.41) | 1152 (18.01) | 4812 (26.68) | |||
30~35 | 10,367 (42.44) | 2747 (42.95) | 7620 (42.26) | |||
≥35 | 7506 (30.73) | 2416 (37.77) | 5090 (28.23) | |||
Pre-pregnancy BMI (kg/m2) | Mean ± SD | 21.44 ± 3.50 | 22.50 ± 3.33 | 21.06 ± 3.49 | 28.72 | <0.001 |
<18.5 | 5648 (23.12) | 605 (9.46) | 5043 (27.97) | 1024.49 | <0.001 | |
18.5~23.9 | 13,689 (56.04) | 3934 (61.51) | 9755 (54.10) | |||
24.0~27.9 | 4147 (16.98) | 1512 (23.64) | 2635 (14.61) | |||
≥28 | 945 (3.87) | 345 (5.39) | 600 (3.33) | |||
Gravidity | 1 | 8072 (33.05) | 2135 (33.39) | 5937 (32.93) | 0.92 | 0.631 |
2 | 6668 (27.30) | 1718 (26.86) | 4950 (27.46) | |||
≥3 | 9684 (39.65) | 2542 (39.75) | 7142 (39.61) | |||
Parity | 0 | 15,332 (62.77) | 4056 (63.42) | 11,276 (62.54) | 1.58 | 0.209 |
≥1 | 9093 (37.32) | 2339 (36.58) | 6754 (37.46) | |||
Smoking | Yes | 696 (2.90) | 199 (3.19) | 497 (2.80) | 2.45 | 0.117 |
No | 23,273 (97.10) | 6039 (96.81) | 17,234 (97.20) | |||
Drinking | Yes | 3458 (14.37) | 873 (13.84) | 2585 (14.55) | 1.91 | 0.1467 |
No | 20,612 (85.63) | 5434 (86.16) | 15,178 (85.45) | |||
Folic acid supplementation | Yes | 23,606 (96.63) | 6148 (96.12) | 17,458 (96.81) | 6.88 | 0.009 |
No | 823 (3.37) | 248 (3.88) | 575 (3.19) | |||
Number of pregnancies | Singleton | 22,897 (93.73) | 6044 (94.50) | 16,853 (93.46) | 8.69 | 0.003 |
Multiple | 1532 (6.27) | 352 (5.50) | 1180 (6.54) | |||
Macrosomia history | Yes | 28 (0.11) | 2 (0.03) | 26 (0.14) | 5.26 | 0.022 |
No | 24,401 (99.89) | 6394 (99.97) | 18,007 (99.86) | |||
FBG | Mean ± SD | 4.48 ± 0.43 | 4.83 ± 0.54 | 4.35 ± 0.0.30 | 85.88 | <0.001 |
1-h PBG | Mean ± SD | 8.04 ± 1.89 | 10.12 ± 1.55 | 7.30 ± 1.38 | 136.05 | <0.001 |
2-h PBG | Mean ± SD | 6.90 ± 1.57 | 8.63 ± 1.52 | 6.29 ± 1.03 | 136.98 | <0.001 |
Model | OR (95% CI) | p Value | |
---|---|---|---|
Total GDM (n = 6396) | 1 | 0.82 (0.70~0.95) | 0.009 |
2 | 0.82 (0.71~0.96) | 0.012 | |
3 | 0.86 (0.74~1.01) | 0.063 | |
FBG diagnosed GDM (n = 2154) | 1 | 1.00 (0.79~1.25) | 0.965 |
2 | 1.05 (0.82~1.34) | 0.706 | |
3 | 1.13 (0.88~1.46) | 0.327 | |
1-h PBG diagnosed GDM (n = 3920) | 1 | 0.80 (0.67~0.95) | 0.012 |
2 | 0.81 (0.68~0.96) | 0.017 | |
3 | 0.86 (0.72~1.03) | 0.101 | |
2-h PBG diagnosed GDM (n = 3857) | 1 | 0.71 (0.60~0.85) | <0.001 |
2 | 0.72 (0.60~0.85) | <0.001 | |
3 | 0.75 (0.63~0.90) | 0.002 |
Folic Acid Supplementation | N (%) | OR | 95% CI | p |
---|---|---|---|---|
Average intake, μg/day | ||||
<400 | 62 (4.75) | 1.29 | 0.72~2.33 | 0.389 |
400–800 | 283 (21.69) | 1.32 | 0.97~1.82 | 0.081 |
≥800 | 960 (73.56) | reference | ||
Duration, months | ||||
<3 | 1111 (85.66) | 0.93 | 0.61~1.42 | 0.742 |
≥3 | 186 (14.34) | reference | ||
Average intake and duration | ||||
<400 | 62 (4.76) | 1.24 | 0.60~2.57 | 0.557 |
400–800, <3 | 235 (18.04) | 1.30 | 0.74~2.28 | 0.361 |
400–800, ≥3 | 48 (3.68) | 1.15 | 0.51~2.61 | 0.735 |
≥800, <3 | 834 (64.01) | 0.95 | 0.58~1.56 | 0.847 |
≥800, ≥3 | 124 (9.52) | reference |
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Chen, H.; Hu, Y.; Li, Y.; Zhou, W.; Zhou, N.; Yang, H.; Chen, Q.; Li, Y.; Huang, Q.; Chen, Z. Association of Folic Acid Supplementation in Early Pregnancy with Risk of Gestational Diabetes Mellitus: A Longitudinal Study. Nutrients 2022, 14, 4061. https://doi.org/10.3390/nu14194061
Chen H, Hu Y, Li Y, Zhou W, Zhou N, Yang H, Chen Q, Li Y, Huang Q, Chen Z. Association of Folic Acid Supplementation in Early Pregnancy with Risk of Gestational Diabetes Mellitus: A Longitudinal Study. Nutrients. 2022; 14(19):4061. https://doi.org/10.3390/nu14194061
Chicago/Turabian StyleChen, Hongyan, Yaqiong Hu, Yannan Li, Wenzheng Zhou, Niya Zhou, Huan Yang, Qing Chen, Yawen Li, Qiao Huang, and Zhen Chen. 2022. "Association of Folic Acid Supplementation in Early Pregnancy with Risk of Gestational Diabetes Mellitus: A Longitudinal Study" Nutrients 14, no. 19: 4061. https://doi.org/10.3390/nu14194061
APA StyleChen, H., Hu, Y., Li, Y., Zhou, W., Zhou, N., Yang, H., Chen, Q., Li, Y., Huang, Q., & Chen, Z. (2022). Association of Folic Acid Supplementation in Early Pregnancy with Risk of Gestational Diabetes Mellitus: A Longitudinal Study. Nutrients, 14(19), 4061. https://doi.org/10.3390/nu14194061