April 30, 2019
2 min read

Folic acid supplements show potential as ‘novel’ protective measure for gestational diabetes

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Women who take at least 400 µg per day of folic acid supplements before they become pregnant may be at lower risk for the development of gestational diabetes, according to findings published in Diabetes Care.

“Emerging evidence suggests that low folate intake and high homocysteine levels may play a role in metabolic disturbances, including insulin resistance, dyslipidemia and liver damage,” Cuilin Zhang, MD, MPH, PhD, a senior investigator in the epidemiology branch of the division of intramural population health research at Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, and colleagues wrote. “These metabolic disturbances have been implicated in the pathogenesis of [gestational diabetes].”

Zhang and colleagues assessed the effect of folate intake on gestational diabetes development in 14,553 women and 20,199 pregnancies from the Nurses’ Health Study between 1991 and 2001. Folate intake, both in food and via supplement, was evaluated via questionnaires, and gestational diabetes status was self-reported every 2 years.

There were 824 reported cases of gestational diabetes in the cohort, and the researchers found an inverse association between folate consumption and the risk for the condition. The risk for gestational diabetes was lower for women who consumed at least 400 µg per day of folate (RR = 0.83; 95% CI, 0.72-0.95) compared with women who consumed less than 400 µg per day.

Women who take at least 400 µg per day of folic acid supplements before they become pregnant may be at lower risk for the development of gestational diabetes.
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The researchers noted that the risk reduction was “entirely driven by supplemental folate.” When examining only supplemental folate, the researchers found that those who took at least 600 µg per day were at lower risk for gestational diabetes (RR = 0.7; 95% CI, 0.52-0.94) compared with those who took between 400 µg per day and 599 µg per day (RR = 0.77; 95% CI, 0.64-0.93), but that both of these groups had lower risks compared with those who took between 1 µg per day and 399 µg per day (RR = 0.83; 95% CI, 0.71-0.98) and those who did not consume any folate, who were used as reference. Additionally, the researchers observed an association between adding 100 µg per day of folate consumption with lowering gestational diabetes risk (RR = 0.95; 95% CI, 0.92-0.98).

To ensure that multivitamin use did not affect the results, the researchers adjusted for this factor but still found that supplemental folate consumption of 1 µg per day to 399 µg per day (RR = 0.81; 95% CI, 0.66-1), 400 µg per day to 599 µg per day (RR = 0.73; 95% CI, 0.52-1.02) and at least 600 µg per day (RR = 0.65; 95% CI, 0.42-1.01) decreased the risk for gestational diabetes.


“Given that pregnancy concerns both women and their fetus and that [gestational diabetes] is only one such relevant outcome, future data both from animal models and human epidemiological studies are warranted to determine the appropriate supplementation dose,” the researchers wrote. “If confirmed, our findings indicate that prepregnancy folic acid supplementation could offer a feasible, novel and low-cost avenue to reduce the risk of [gestational diabetes].” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.