Subscribe to RSS
DOI: 10.1055/s-0042-1755460
Iron Salts, High Levels of Hemoglobin and Ferritin in Pregnancy, and Development of Gestational Diabetes: A Systematic Review
Sais de ferro, níveis elevados de hemoglobina e ferritina na gravidez e o desenvolvimento de diabetes gestacional: Uma revisão sistemáticaAbstract
Objective The aim of this study was to systematically review literature on the use of iron supplements (not including iron derived from diet), increased levels of hemoglobin and/or ferritin, and the risk of developing gestational diabetes mellitus (GDM).
Data source The following databases were searched, from the study's inception to April 2021: PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl and Lilacs.
Selection of studies A total of 6,956 titles and abstracts were reviewed, 9 of which met the final inclusion criteria, with 7,560 women in total.
Data collection Data extraction was performed by two independent reviewers and disagreements were resolved by a third researcher.
Data synthesis Methodological quality in controlled trials were assessed according to the Cochrane Collaboration tools (ROB-2 and ROBINS-1) and for the observational studies, the National Institutes of Health's (NIH) quality assessment tool was used. Among the 5 observational studies, women with a higher hemoglobin or ferritin level were more likely to develop GDM when compared with those with lower levels of these parameters. Among the 3 randomized clinical trials, none found a significant difference in the incidence of GDM among women in the intervention and control groups. However, we identified many risks of bias and great methodological differences among them.
Conclusion Based on the studies included in this review, and due to the important methodological problems pointed out, more studies of good methodological quality are needed to better establish the association between iron supplementation and GDM.
Resumo
Objetivo O objetivo deste estudo foi revisar sistematicamente a literatura sobre o uso de suplementos de ferro (não incluindo o ferro derivado da dieta), aumento dos níveis de hemoglobina e/ou ferritina e o risco de desenvolver diabetes mellitus gestacional (DMG).
Fontes dos dados as bases de dados PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl e Lilacs foram pesquisadas até abril de 2021.
Seleção dos estudos Foram revisados 6.956 títulos e resumos, dos quais 9 preencheram os critérios finais de inclusão, totalizando 7.560 mulheres.
Coleta de dados A extração de dados foi realizada por dois revisores independentes e as divergências foram resolvidas por um terceiro revisor.
Síntese dos dados A qualidade metodológica dos ensaios controlados foi avaliada de acordo com as ferramentas da Colaboração Cochrane (ROB-2 e ROBINS-1) e para os estudos observacionais, foi utilizada a ferramenta de avaliação de qualidade do National Institutes of Health (NIH). Entre os 5 estudos observacionais, as mulheres com maiores níveis de hemoglobina ou ferritina apresentaram maior probabilidade de desenvolver DMG quando comparadas àquelas com níveis mais baixos nesses parâmetros. Entre os 3 ensaios clínicos randomizados, nenhum deles encontrou diferença significativa na incidência de DMG entre as mulheres dos grupos de intervenção e controle. No entanto, identificamos muitos riscos de viés e enormes diferenças metodológicas entre eles.
Conclusão Com base nos estudos incluídos nesta revisão e devido aos importantes problemas metodológicos apontados, são necessários mais estudos de boa qualidade metodológica para melhor estabelecer a associação entre suplementação de ferro e DMG.
Publication History
Received: 11 February 2022
Accepted: 03 June 2022
Article published online:
06 September 2022
© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract 2014; 103 (03) 341-363 DOI: 10.1016/j.diabres.2013.10.012.
- 2 Hod M, Kapur A, Sacks DA. et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet 2015; 131 (Suppl 3): S173-S211 DOI: 10.1016/S0020-7292(15)30033-3.
- 3 Reece EA, Leguizamón G, Wiznitzer A. Gestational diabetes: the need for a common ground. Lancet 2009; 373 (9677): 1789-1797 DOI: 10.1016/S0140-6736(09)60515-8.
- 4 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014; 37 (Suppl 1): S81-S90 DOI: 10.2337/dc14-S081.
- 5 Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2014; 103 (02) 176-185 DOI: 10.1016/j.diabres.2013.11.003.
- 6 Quan W, Zeng M, Jiao Y. et al. Western dietary patterns, foods, and risk of gestational diabetes mellitus: a systematic review and meta-analysis of prospective cohort studies. Adv Nutr 2021; 12 (04) 1353-1364 DOI: 10.1093/advances/nmaa184.
- 7 Feig DS, Berger H, Donovan L. et al; Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes and Pregnancy. Can J Diabetes 2018; 42 (Suppl 1): S255-S282 DOI: 10.1016/j.jcjd.2017.10.038.
- 8 Afkhami-Ardekani M, Rashidi M. Iron status in women with and without gestational diabetes mellitus. J Diabetes Complications 2009; 23 (03) 194-198 DOI: 10.1016/j.jdiacomp.2007.11.006.
- 9 Amiri FN, Basirat Z, Omidvar S, Sharbatdaran M, Tilaki KH, Pouramir M. 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 2013; 4 (02) 302-305 DOI: 10.4103/0976-9668.116977.
- 10 Lao TT, Chan PL, Tam KF. Gestational diabetes mellitus in the last trimester - a feature of maternal iron excess?. Diabet Med 2001; 18 (03) 218-223 DOI: 10.1046/j.1464-5491.2001.00453.x.
- 11 Casanueva E, Viteri FE. Iron and oxidative stress in pregnancy. J Nutr 2003; 133 (05, Suppl 2): 1700S-1708S DOI: 10.1093/jn/133.5.1700S.
- 12 Behboudi-Gandevani S, Safary K, Moghaddam-Banaem L, Lamyian M, Goshtasebi A, Alian-Moghaddam N. The relationship between maternal serum iron and zinc levels and their nutritional intakes in early pregnancy with gestational diabetes. Biol Trace Elem Res 2013; 154 (01) 7-13 DOI: 10.1007/s12011-013-9703-y.
- 13 Chan KK, Chan BC, Lam KF, Tam S, Lao TT. Iron supplement in pregnancy and development of gestational diabetes–a randomised placebo-controlled trial. BJOG 2009; 116 (06) 789-797 , discussion 797–798 DOI: 10.1111/j.1471-0528.2008.02014.x.
- 14 Chen X, Scholl TO, Stein TP. Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: The Camden study. Diabetes Care 2006; 29 (05) 1077-1082 DOI: 10.2337/diacare.2951077.
- 15 Helin A, Kinnunen TI, Raitanen J, Ahonen S, Virtanen SM, Luoto R. Iron intake, haemoglobin and risk of gestational diabetes: a prospective cohort study. BMJ Open 2012; 2 (05) e001730 DOI: 10.1136/bmjopen-2012-001730.
- 16 Milman N. Iron prophylaxis in pregnancy–general or individual and in which dose?. Ann Hematol 2006; 85 (12) 821-828 DOI: 10.1007/s00277-006-0145-x.
- 17 Page MJ, Moher D, Bossuyt PM. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372 (160) n160 DOI: 10.1136/bmj.n160.
- 18 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016; 5 (01) 210 DOI: 10.1186/s13643-016-0384-4.
- 19 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898 DOI: 10.1136/bmj.l4898.
- 20 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919 DOI: 10.1136/bmj.i4919.
- 21 National Heart, Lung, and Blood Institute. Study quality assessment tools [Internet]. 2021 [2022 Jan 26]. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
- 22 McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 2021; 12 (01) 55-61 DOI: 10.1002/jrsm.1411.
- 23 Liu XN, Pang J. A retrospective study of supplemental iron intake in singleton pregnancy women with risk of developing gestational diabetes mellitus. Medicine (Baltimore) 2018; 97 (26) e10819 DOI: 10.1097/MD.0000000000010819.
- 24 Si S, Shen Y, Xin X. et al. Hemoglobin concentration and iron supplement during pregnancy were associated with an increased risk of gestational diabetes mellitus. J Diabetes 2021; 13 (03) 211-221 DOI: 10.1111/1753-0407.13101.
- 25 Zhu B, Liang C, Xia X. et al. Iron-Related Factors in Early Pregnancy and Subsequent Risk of Gestational Diabetes Mellitus: the Ma'anshan Birth Cohort (MABC) Study. Biol Trace Elem Res 2019; 191 (01) 45-53 DOI: 10.1007/s12011-018-1595-4.
- 26 Özyiğit EA, Uğur M, Ünlü S, Özakşiï TG, Avşar F. The effect of oral iron supplementation on the glucose metabolism in non-anemic pregnant women: a prospective case-control study. UHOD 2008; 18 (03) 155-162
- 27 Rawal S, Hinkle SN, Bao W. et al. A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: findings from a prospective, multiracial cohort. Diabetologia 2017; 60 (02) 249-257 DOI: 10.1007/s00125-016-4149-3.
- 28 Asadi N, Vafaei H, Kasraeian M, Yoosefi S, Faraji A, Abbasi L. Effects of prophylactic iron supplementation on outcome of nonanemic pregnant women: A non-randomized clinical trial. J Chin Med Assoc 2019; 82 (11) 840-844 DOI: 10.1097/JCMA.0000000000000184.
- 29 Kinnunen TI, Luoto R, Helin A, Hemminki E. Supplemental iron intake and the risk of glucose intolerance in pregnancy: re-analysis of a randomised controlled trial in Finland. Matern Child Nutr 2016; 12 (01) 74-84 DOI: 10.1111/mcn.12139.
- 30 Ouladsahebmadarek E, Sayyah-Melli M, Abbasalizadeh S, Seyedhejazie M. The effect of supplemental iron elimination on pregnancy outcome. Pak J Med Sci 2011; 27 (03) 641-645
- 31 Fernández-Real JM, López-Bermejo A, Ricart W. Cross-talk between iron metabolism and diabetes. Diabetes 2002; 51 (08) 2348-2354 DOI: 10.2337/diabetes.51.8.2348.
- 32 Swaminathan S, Fonseca VA, Alam MG, Shah SV. The role of iron in diabetes and its complications. Diabetes Care 2007; 30 (07) 1926-1933 DOI: 10.2337/dc06-2625.
- 33 Fernández-Cao JC, Aranda N, Ribot B, Tous M, Arija V. Elevated iron status and risk of gestational diabetes mellitus: A systematic review and meta-analysis. Matern Child Nutr 2017; 13 (04) e12400 DOI: 10.1111/mcn.12400.
- 34 Fu S, Li F, Zhou J, Liu Z. The relationship between body iron status, iron intake and gestational diabetes: a systematic review and meta-analysis. Medicine (Baltimore) 2016; 95 (02) e2383 DOI: 10.1097/MD.0000000000002383.