Objective: To investigate the relationship between dietary vitamin A intake and its sources in the first trimester and gestational diabetes mellitus (GDM). Methods: A prospective study was conducted to select women at 6-14 weeks of gestation in an obstetric clinic of a maternal and child health care medical institution in Chengdu in 2017. The types and quantities of food during the first trimester were collected by 3-day 24-hour dietary recalls. Dietary vitamin A intake was calculated based on the Chinese Food Composition Table (2018), and it was divided into animal and plant vitamin A intakes according to its food sources. An oral glucose tolerance test was performed at 24-28 weeks of gestation to diagnose GDM according to the Chinese guidelines for diagnosis and treatment of gestational diabetes mellitus (2014). According to the estimated average requirement (EAR) and recommended nutrient intake (RNI), dietary vitamin A intake was divided into low-level group (<EAR), medium-level group (EAR-RNI) and high-level group (>RNI). Animal and plant vitamin A intakes were divided into four groups (Q1-Q4) according to the quartile method, respectively. The association between dietary vitamin A intake, its different sources of vitamin A intake and GDM in the first trimester was analyzed by log-binomial regression models. Results: A total of 1 298 valid samples were finally included. The average dietary vitamin A intake, animal and plant vitamin A intakes in the first trimester were 341.1 (227.8-501.0) μgRAE/d, 139.3 (69.6-195.3) μgRAE/d and 184.2 (99.4-301.1) μgRAE/d, respectively. After adjusting for confounding factors, log-binomial regression analysis showed that the risk of GDM in high-level group of dietary vitamin A intake was lower than that in low-level group [RR (95%CI):0.53 (0.36-0.80)]. Pregnant women in the highest quartile of animal vitamin A intake had a lower risk of GDM than those in the lowest quartile [RR (95%CI):0.66 (0.47-0.95)]. No relationship between plant vitamin A intake and GDM was found. Conclusion: Dietary vitamin A intake in the first trimester is associated with the occurrence of GDM, and higher intake than RNI may reduce the risk of GDM. Higher vitamin A intake from animal-derived food is associated with decreased risk of GDM.
目的： 探讨孕妇孕早期膳食维生素A摄入量及其来源与妊娠期糖尿病（GDM）的关联。 方法： 采用前瞻性队列研究，选取2017年成都市某三甲妇幼医疗机构产前门诊孕6~14周妇女作为研究对象。采用3 d 24 h膳食回顾法收集孕妇孕早期摄入的所有食物种类及数量，参照《中国食物成分表（2018）》计算膳食维生素A摄入量，并按其来源分为动物性及植物性维生素A摄入量。按孕早期维生素A平均需要量（EAR）、推荐摄入量（RNI）将膳食维生素A摄入量分为低水平组（<EAR）、中水平组（EAR~RNI）和高水平组（>RNI），按四分位数法分别将动物性及植物性维生素A摄入量由低到高分为4组（Q1~Q4）。采用log-binomial回归模型分析孕早期膳食维生素A摄入量及其来源与GDM的相关性。 结果： 共纳入1 298例研究对象。孕妇孕早期膳食维生素A摄入量中位数和四分位数间距为341.1（227.8，501.0）μgRAE/d，动物性及植物性维生素A摄入量分别为139.3（69.6，195.3）μgRAE/d、184.2（99.4，301.1）μgRAE/d。调整混杂因素后，log-binomial回归分析显示，膳食维生素A摄入量高水平组孕妇GDM发生风险较低水平组降低［RR（95%CI）：0.53（0.36~0.80）］；动物性维生素A摄入量在Q4组孕妇GDM发生风险较Q1组降低［RR（95%CI）：0.66（0.47~0.95）］。未发现植物性维生素A摄入量对GDM的影响。 结论： 孕妇孕早期膳食维生素A摄入量及其来源与GDM发生有关，膳食维生素A尤其是动物性维生素A摄入充足可能降低GDM发生风险。.