Analysis of 12 Trace Elements in the Sera and Placental Tissues of Pregnant Women with Gestational Diabetes Mellitus in Beijing

doi:10.21203/rs.3.rs-1620608/v1

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Analysis of 12 Trace Elements in the Sera and Placental Tissues of Pregnant Women with Gestational Diabetes Mellitus in Beijing

https://doi.org/10.21203/rs.3.rs-1620608/v1

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The present study aimed to detect and analyze the concentrations of 12 trace elements in the sera and placental tissues of pregnant women with gestational diabetes mellitus (GDM) in Beijing, China using inductively coupled plasma mass spectrometry. Thirty pregnant women that participated in this study, and 20 matched normal controls were recruited in the study; the concentrations of trace elements were compared between these groups. The trace elements iron (Fe), copper (Cu), zinc (Zn), selenium (Se), chromium (Cr), manganese (Mn), nickel (Ni), strontium (Sr), lead (Pb), aluminum (Al), arsenic (As), and palladium (Pd) were detected in the sera and placental tissues of the pregnant women. Using a double antibody sandwich ELISA, the activity of glutathione peroxidases (GPXs), including GPX1-4, were assessed in the placental tissues. Compared with healthy pregnant women, the concentrations of Fe, Cu, Se, and Cr in the sera of pregnant women with GDM were significantly increased (P ˂ 0.05), whereas no significant differences in Al, Mn, Ni, As, Sr, Pd, and Pb sera concentrations were detected between these groups(P > 0.05); And Zn concentrations did not quite achieve acceptable levels of statistical significance (P = 0.047). Also in comparison to healthy pregnant women, Fe concentrations in the placental tissues of pregnant women with GDM were significantly increased (P ˂ 0.05), whereas Zn, Mn, Al, and As concentrations were significantly decreased (P ˂ 0.05); however, the concentrations of Cr, Ni, Se, Sr, Pd, Pb, and Cu in placental tissues did not differ between the groups. In addition, GPX1-4 activity did not differ between the GDM and healthy groups. The differences in trace element concentrations detected in pregnant patients with GDM and healthy pregnant patients suggest that some elements, such as Fe, Cu, Zn, and Se may play important roles in the disease and could be considered potential biomarkers.

gestational diabetes mellitus

sera

placental tissues

trace elements

glutathione peroxidase

Gestational diabetes mellitus (GDM) is defined as any degree of dysglycemia that occurs for the first time or is first detected during pregnancy, as well as diabetes diagnosed in the second or third trimesters of pregnancy provided that overt diabetes early in pregnancy has been excluded[¹,²]. GDM is one of the common clinical types. The prevalence of GDM may be associated with various complications in pregnancy, including increased prenatal and perinatal mortality, and perinatal complications, as well as neurodevelopmental problems in the offspring such as neurodevelopmental delay. The increased glucose levels that accompany GDM can also impair the development of the placenta and affect fetal growth. Other effects on the fetus can include increased adiposity and fetal hyperinsulinemia. Although GDM can cause intrauterine growth restriction, it is more likely to result in fetal macrosomia. Moreover, long-term problems can arise in the offspring due to insulin resistance and these may increase the risk of cardiovascular disease, hypertension, and diabetes. It is a relatively common complication during pregnancy, with current incidence rates at around 1.7%-15.7%[³].Nevertheless, the current pathogenesis of GDM is not well known[⁴]. Given the severity of these effects on mothers and offspring, GDM in pregnancy is increasingly receiving attention from researchers.

Similarly, trace elements are required in small amounts but are essential for health, development, and growth by humen. And they serve dual roles: both a deficiency and an excessive accumulation of trace elements can lead to multiple physiological dysfunctions. They are essential micronutrients required for the normal functioning of the body, i.e., nutrients that are essential for human health and development, are transported from the mother to the newborn is not well understood[⁵,⁶,⁷,⁸]. Glutathione peroxidase (GPX) is an important peroxidase enzyme, found in various tissues, cells, and body fluids, and is an important component of selenium. Subsequently, four types of GPX isozymes were identified by immunological and molecular biological methods and named GPX-1(CGPX), 2(gi-GPX), 3(eGPX or pGPX), and 4(PHGPX) in the sequence of cDNA clones. These four types of GPX are very important components of the body`s defense system against oxidative damage. But they have different levels of response to the body in different states of low or supplement selenium, i. e. different GPX and corresponding messenger RNA decrease or synthesis rate are different[⁹-¹⁰].

Therefore, in the present study, the following 12 trace elements were detected and analyzed in the sera and placental tissues of pregnant women: iron(Fe), copper(Cu), zinc(Zn), selenium(Se), chromium(Cr), manganese (Mn), nickel(Ni), strontium(Sr), lead(Pb), aluminum (Al), arsenic(As), and palladium(Pd). The concentrations of these 12 trace elements in sera and placental tissues of pregnant women with GDM were then compared with those in healthy pregnant women to estimate the possible effects of the differences detected between these subjects. Additionally, GPX activity were also determined in placental tissues.

Subjects

This was a case-control study in which data were collected from healthy pregnant women and those with GDM who were engaged in regular clinic visits to the Capital Medical University Health Center between September and Fengtai District Maternal and Child Health Hospital 2018 and September 2019. All pregnant volunteers were made aware of the objectives of the study and gave their written informed consent. This was a case-control study in which data were collected from healthy pregnant women and those with GDM who were engaged in regular clinic visits to the Capital Medical University Health Center between September and Fengtai District Maternal and Child Health Hospital 2018 and September 2019. All pregnant volunteers were made aware of the objectives of the study and gave their written informed consent. The study was carried out according to the principles of the Declaration of Helsinki and was approved by the Ethical Committee of the Institute. Thirty pregnant women that participated in this study, and 20 matched normal controls were recruited in the study.The exclusion criteria were preeclampsia, hypertension, pregestational diabetes mellitus, renal, and cardiovascular diseases, and other maternal diseases. General clinical data and related indicators, such as age, 1 h plasma glucose, and 2 h plasma glucose were collected for all women. Newborn infants were also examined in the first 24 h of life and clinical data, including weight and body length, were collected. Body mass index (BMI) data were was obtained using the self-reported weight and height recorded during the first prenatal consultation. Prepregnancy BMI was calculated using height and prepregnancy weight. BMI was calculated by dividing the weight (kg) by the height squared (m²).

For the GDM group, the inclusion criteria included a diagnosis of GDM based on a 75 goral glucose tolerance test (OGTT) at 24–28 weeks gestation, according to the International Association of Diabetes and Pregnancy Study Group’s criteria. GDM was diagnosed when one of the following plasma glucose values in the OGTT was met or exceeded[¹¹]: fasting plasma glucose of 92 mg/dL (5.1 mmol/L), 1 h plasma glucose of 180 mg/dL (10.0 mmol/L), or 2 h plasma glucose of 153 mg/dL (8.5 mmol/L).

Analytical Methods

Trace elements in sera and placental tissues

To obtain serum, blood was collected and centrifuged at 2,500 rpm and 4°C for 10 min. After collection, serum samples (200 mL) and placental tissue samples (0.3 g–0.5 g) were immediately sealed in polypropylene tubes and stored at −80°C until they were analyzed. All serum samples were analyzed according to the subjects’ identification numbers, which were labeled on the vials, and care was taken to avoid hemolysis in samples. Trace element concentrations (of those elements listed in the Introduction) were measured using inductively coupled plasma mass spectrometry with plasma collected from the serum and placental tissue samples of the pregnant women. These tests were commissioned by Zhongke Puyan Technology Co., Ltd. Following the standard GB5009.268 “Determination of Multi-Elements in Food,” ultra-high performance liquid chromatography and tandem mass spectrometry were used to detect trace element concentrations in the samples. The data are scientific, reasonable, and effective, and conform to the detection method.

GPX activity in placental tissues

Before analysis, placental tissues samples (18 × ≥50-mg samples) were defrosted. They were centrifuged at 5,000 rpm for 15 min, but there was no strict requirement that the weights of fixed samples reached the same level (±1 g). The proportion of homogenization was 10% (1:9) and PBS (pH = 7.2–7.4; 0.01 mol/L). Finally, the supernatant was collected for analysis.

GPX activity was detected in placental tissues using a Human GPX1–4 Mini Kit according to the manufacturer’s specification and double antibody sandwich ELISA. The color depth was positively correlated with GPX in the samples. The absorbance was measured using an enzyme-labeling instrument at a wavelength of 450 nm, and the concentrations of human GPX-1 (cGPX), GPX-2 (GI-GPX), GPX-3 (eGPX/pGPX), and GPX-4 (PHGPX) in the samples were calculated using a standard curve.

Statistical Analyses

All statistical analyses were performed using SPSS (version 19.0) and P < 0.05 was considered statistically significant. Shapiro–Wilk and Kolmogorov–Smirnov tests were used to verify the normality of data, and Levene’s test was used to verify the homogeneity of variance. The GDM and control groups were compared using independent sample t-tests. All data were presented as means ± standard deviation (SD) with normal distribution.

The characteristics of the women included in the study were shown in Table 1. Of the 50 pregnant women who participated in the study, the average age was 29.64 ± 3.433 (range: 23–38) and the average prepregnancy BMI was 22.92 ± 3.590 kg/m² (range: 16.20–30.50 kg/m²). The average ages in the GDM and control groups were 29.83 ± 3.705 (range: 23–38) and 29.35 ± 3.048 (range: 24–36), respectively, whereas the average prepregnancy BMI was 23.47 ± 3.343 kg/m² in the GDM group and 22.11 ± 3.875 kg/m² in the control group. There were no significant differences in the age and BMI of the two groups (P > 0.05). Furthermore, the newborn body mass did not differ between the groups (P > 0.05). In the second trimester, the pregnant women in the GDM groups had higher blood glucose at all time points of the OGTT relative to that detected in women from the control group (P < 0.05).

Table 1 The characteristics of women in the control and diabetic groups(n = 50) (x̄ ± SD)
	n	Age (years)	Height (cm)	Height (Kg)	BMI (kg/m²)
Control	20	29.35 ± 3.048	162.40 ± 5.009	58.38 ± 10.682	22.11 ± 3.875
Diabetic	30	29.83 ± 3.705	162.80 ± 3.680	62.24 ± 9.502	23.47 ± 3.343
t		- 0.484	- 0.326	- 1.342	- 1.316
P		0.63	0.76	0.19	0.19
	n	FPG (mmol/L)	1 h (mmol/L)	2 h (mmol/L)	Newborn body mass (g)
Control	20	4.55 ± 0.284	7.43 ± 1.077	6.51 ± 0.957	3421.25 ± 323.626
Diabetic	30	5.18 ± 0.988	9.53 ± 1.031	7.57 ± 1.379	3413.83 ± 299.533
t		- 2.615	- 6.142	- 2.865	0.836
P		0.01	0.00	0.01	0.93

In 50 serum samples and 50 placental tissue samples, twelve trace elements were tested (Tables 2 and 3, respectively). The data of the concentration level of the elements was not normally distributed. Therefore, a non-parametric test was used to analyse the essential trace element data. The outliers were retained, and log transformation was not performed to preserve the true findings. Compared with healthy pregnant women, Fe, Cu, Se, and Cr concentrations were significantly increased in the sera of pregnant women with GDM (P ˂ 0.05), but no significant difference in Al, Mn, Ni, As, Sr, Pd, and Pb concentrations were detected between the groups (P > 0.05); And Zn concentration did not quite achieve acceptable levels of statistical significance (P =0.047). In contrast, when compared with healthy pregnant women, Fe concentrations were significantly increased in the placental tissues of pregnant women with GDM increased (P ˂ 0.05), whereas Zn, Mn, Al, and As concentrations were significantly decreased (P ˂ 0.05). However, there were no significant differences in Cr, Ni, Se, Sr, Pd, Pb, and Cu concentrations (P > 0.05) between the two groups.

Table 2 Concentrations of trace elements in serum (mg/mL, x̄ *± SD*)
	n	Fe	Cu	Zn	Se
Control	20	1.0907 ± 0.4590	2.2360 ± 0.6209	0.7570 ± 0.2717	0.0824 ± 0.0401
Diabetic	30	2.4549 ± 2.0698	3.1643 ± 1.7357	1.0134 ± 0.6028	0.1502 ± 0.1418
t		- 3.484	- 2.683	- 2.040	- 2.078
P		.001	.011	.0475	.043
	n	Cr	Mn	Ni	Sr
Control	20	0.0006 ± 0.0029	0.0147 ± 0.0052	0.0016 ± 0.0033	0.0466 ± 0.02036
Diabetic	30	0.0067 ± 0.0093	0.0191 ± 0.0115	0.0023 ± 0.0032	0.0657 ± 0.0420
t		- 3.323	- 1.854	- .731	- 1.886
P		.002	.071	.468	.065
	n	Pb	Al	As	Pd
Control	20	0.0014 ± 0.0046	0.0977 ± 0.1193	0.0012 ± 0.0013	0.0030 ± 0.057
Diabetic	30	0.0009 ± 0.0007	0.2017 ± 0.2160	0.0031 ± 0.0106	0.0051 ± 0.0045
t		.476	- 1.960	- .826	- 1.412
P		.639	.056	.413	.164

Table 3 Concentrations of trace elements in placental tissues (mg/g, x̄ ± SD)
	n	Fe	Cu	Zn	Se
Control	20	78.760 ± 32.1357	1.1904 ± 0.5062	15.2150 ± 5.002	0.1971 ± 0.0792
Diabetic	30	110.300 ± 44.8022	0.9911 ± 0.2852	11.4420 ± 3.7632	0.1897 ± 0.0703
t		- 2.897	1.600	2.875	.349
P		0.005	0.121	0.007	0.729
	n	Cr	Mn	Ni	Sr
Control	20	0.0792 ± 0.0530	0.1576 ± 0.0717	0.0299 ± 0.0406	0.7508 ± 1.4934
Diabetic	30	0.0647 ± 0.1089	0.1108 ± 0.0373	0.0307 ± 0.0851	0.2877 ± 0.4648
t		.449	2.688	-.040	1.344
P		0.66	0.012	0.968	0.192
	n	Pb	Al	As	Pd
Control	20	0.0204 ± 0.0200	0.8657 ± 0.7952	0.0024 ± 0.0029	0.1130 ± 0.1626
Diabetic	30	0.0108 ± 0.0072	0.2213 ± 0.1460	0.0007 ± 0.0015	0.0475 ± 0.0526
t		2.062	3.535	2.291	1.741
P		0.051	0.002	0.030	0.095

GPX activity was assessed in placental tissue samples from the control (n = 9) and GDM (n = 9) groups. There were no significant differences in GPX1–4 activity between the two experimental groups. Specifically, the average GPX1 activities in the GDM and control groups were 350.68 ± 110.95 and 308.18 ± 58.11 IU/mg pro (t = − 1.018; P > 0.05). For GPX2, the average activities were 224.74 ± 59.40 and 231.28 ± 53.68 IU/mg pro for the GDM and control groups, respectively (t = 0.245; P > 0.05). The average activities of GPX3 were 205.78 ± 63.02 and 206.40 ± 30.68 IU/mg pro in the GDM and control groups, respectively (t = 0.027; P > 0.05). Finally, the GPX4 average activities of the GDM and control groups were 205.23 ± 58.22 and 198.01 ± 27.28 IU/mg pro, respectively (t = − 0.226; P > 0.05).

The present study aimed to detect and analyze the concentrations of 12 trace elements in the sera and placental tissues of pregnant women with GDM in Beijing, China using inductively coupled plasma mass spectrometry. The present results showed that Fe, Cu, Se, and Cr concentrations in the sera of pregnant women with GDM were increased relative to those in the sera of healthy pregnant women. And in placental tissues, Fe concentrations were increased in pregnant women with GDM, but Zn, Mn, Al, and As concentrations were decreased. There was past evidence that trace element status during pregnancy can have a significant impact on maternal and neonatal health outcomes. Although we didn’t have clear evidence yet, it is important to understand the mechanisms involved in these processes[5–7,]. Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin or when the body cannot make good use of the insulin it produces. It may be caused by various pathogenic factors, such as genetic factors, immune dysfunction, microbial infections, microbial toxins, free radical toxins, and mental factors, which can act on the body to cause, for example, hypofunction of islets and insulin resistance in response to sugar, protein, fat, and water, as well as causing issues with electrolytes and various metabolic disorder syndromes[]. Oxidative stress is defined as overburdening of the endogenous defense systems by the overproduction of reactive oxygen species (ROS) that threaten cell survival. Oxidative stress plays an important role in the development of complications of diabetes in pregnancy[]. During pregnancy, a condition of progressive insulin resistance occurs in the mother, triggered by placental hormones to ensure the fetus receives adequate nutrients for healthy growth and development. However, when the maternal β-cells were unable to adapt to the metabolic changes accompanying pregnancy, GDM occurs. It is caused by carbohydrate intolerance, dysfunction of beta-pancreatic and endothelial cells, and insulin resistance during pregnancy. In glucose tolerance tests, pregnant women show a large increase in blood glucose, and the decrease was delayed; consequently, glucose tolerance was impaired and the incidence of gestational diabetes was increased[]. In this study, some significant differences were found in some trace element concentrations between the GDM and control groups, which may have been caused by changes in the blood glucose levels of pregnant women.

Specifically, Zn and Cu were essential minerals for a variety of biomolecules to maintain the normal cell structure, function and proliferation. According to the results, compared with normal control, GDM cases had increased the level of Zn in the sera, but a barely detectable statistically significant difference. Interestingly, the level of Zn in the placental tissues was decreased. Zn, the IIB group metal, is the 23rd most abundant element in the Earth’s crust. The essential role of Zn in living organisms is mediated by its involvement in a plethora of physiological processes. Particularly, Zn is a component of many enzymes in the body as well as being involved in the structural components of several nucleotides, proteins, and hormones, and functioning in protein synthesis, nucleic acid metabolism, cell division, gene expression, antioxidant defense, and neurological and immune functions. Zn not only maintains the activity of insulin but also produces an insulin-like effect in the body[10]. Several scientific studies had shown that the concentration of maternal serum zinc during pregnancy was associated with GDM incidence. But the study of the correlation between serum zinc and GDM pathogenesis remains a source of controversy. For instance, certain articles report that GDM cases had decreased serum zinc levels relative to normal pregnant women, but others suggest no difference in serum zinc concentrations between GDM women and healthy pregnant women[]. Cu and Zn are antagonistic elements that competitively combine with the same carrier during intestinal absorption. Thus, Cu can inhibit the absorption of Zn, while reduced Zn levels in the body lead to the accumulation of Cu[]. Few epidemiological studies had evaluated the association between copper and glucose levels in pregnant women. Zheng et al.[] evaluated this association prospectively in a pregnant population. Some studies found higher serum copper concentrations among women with GDM, similar to our results, whereas two other case-control studies found no difference in copper concentrations. Ewelina et al. confirmed that the metabolic derangement of glucose and lipid metabolism occurring in diabetes mellitus affects Zn and Cu levels in body fluids(µg/dL) and tissues(mg/kg), which depend on the severity of glucose intolerance and accompanying complications. Also, abnormal metabolism of Zn and Cu can further accelerate diabetic complications[].

In this study, Fe concentrations in the sera and placental tissues of pregnant women with GDM were significantly increased. Greater iron stores within the placentae of women with GDM were consistent with reports that iron excess is associated with an increased risk for GDM[]. However, Controversy still exists about Fe supplementation in pregnant women. Fe is an indispensable trace element in the body; it participates in a series of biochemical activities such as the transport of oxygen, synthesis of DNA, conversion of ATP, and cell respiration. There was evidence that high Fe levels in the body were positively correlated with the occurrence of GDM[6,-]. Kataria et al. performed a meta-analysis investigating the association of Fe biomarkers and dietary Fe exposure with GDM. The findings from this suggested that differences in circulating iron, ferritin, hemoglobin, and transferrin saturation were higher in women with GDM compared to women without GDM, and increased ferritin, hemoglobin, and dietary heme intake were associated with increased odds ratios for GDM[]. In addition to the basic loss of Fe during pregnancy, Fe reserves exist in the placenta and umbilical cord. Thus, during pregnancy, the demand for Fe gradually increases over time, which reduces the Fe available in sera. Routine Fe supplementation was therefore recommended from the second trimester until full-term pregnancy. Placental tissue, which was shared by the mother and the fetus, can not only transport nutrients between the two but also acts as a protective barrier against heavy metals[]. Fe deficiency i.e., anemia, was a common disease during pregnancy; It can cause low weight and premature delivery. It can prevent maternal deficiencies and anemia, but there is little evidence of the relationship between Fe metabolism and insulin resistance[]. FAO/WHO (1988) data show that the Fe reserves required to meet the needs of fetal growth and Fe reserves in the placenta over about 93 days in early, mid, and late pregnancy were 25, 100, and 190 mg, respectively[].

Se has been found for 200 years and is an essential micronutrient for mammals; it is an important component of many enzymes in the body, and it can play an important role in antioxidation, delaying the signs of aging, and enhancing immunity. Previous studies had also found that adequate selenium intake is essential for the immune system, the endocrine system, the cardiovascular system, the reproductive system, and the nervous system[]. The lack of Se in the human body was associated with more than diseases including cancer, cardiovascular disease, liver disease, cataracts, pancreatic disease, diabetes, and reproductive system disease It should be emphasized that either too high level of selenium or its deficiency was harmful to human health. For example, Se supplementation can prevent acute Keshan disease, whereas alopecia was closely related to excessive Se intake[5–6,]. Wang et al. studied the association between serum selenium levels and type 2 diabetes mellitus and found that a positive correlation between serum selenium levels and T2DM existed in the population with relatively low and high serum selenium levels, which indicated that serum selenium was closely related to T2DM. There may be a U-shaped nonlinear dose-response relationship[]. Zeng et al. also found that a high-selenium diet did induce moderate GDM and postpartum insulin resistance in neonatal rats[]. In the USA[], Italy[], France[], and other countries, the intake of Se had also been related to the risk of diabetes, but epidemiological investigations have yet to reach a definite conclusion on this issue. Notably, the Se status is suggested to be critical in Se supplementation-mediated health effects. Accordingly, it was estimated that the beneficial effect of Se supplementation on human health should be largely seen in subjects with serum or plasma Se concentration less than 122 µg/L. In contrast, Se administration to patients with a serum or plasma Se concentration of 122 µg/L or higher has been associated with an increased risk of nonmelanoma skin cancer and type 2 diabetes[]. The CNHS 2010–2012 was a nationally representative cross-sectional study. Liu et al. studies had established reference values of 14 serum trace elements for pregnant women selected from the CNHS, the range of sera Se concentration was 0.07 (0.04–0.11) µg/mL[]. The present results also showed that serum Se levels in GDM patients were 0.15 µg/mL, and that of healthy pregnant subjects were 0.08 µg/mL, which were significantly higher in GDM groups than in healthy pregnant women. Therefore, the serum selenium level of pregnant women may be related to diabetes.

To investigate the relationship between Se concentrations and activities of GPX in the Placenta of GDM pregnant women, the activities of GPX isozymes in the Placenta of GDM pregnant women were determined. The final results showed that the activity of GPX1 groups was higher than that of the other groups, but unfortunately there was no statistically significant difference between the groups, and the activity of GPX 2–4 groups was not different between the two groups; that means, there was no difference in the level of selenium in placental tissue between the two groups. The physiological role of GPXs is mediated by its involvement in redox regulation of cell functions. Physiological functions of Se are mainly mediated through Se-containing proteins, selenoproteins, containing Se in the form of selenocysteine. More than 50 Selenoprotein families have been identified, of which only 25 exist in humans, and GPX1 is the first human selenoprotein to demonstrate its function[27].Some studies had shown that the levels of GPX and Se in patients with GDM are closely related to the occurrence and development of GDM[9][]. Perhaps because of the small sample size involved in this study, further exploration is needed.

Furthermore, pregnant women were affected by many factors other than micronutrient levels. Some studies had indicated that maternal age, obesity, number of abortions, pregnancy time, impaired carbohydrate tolerance before pregnancy, and family history of diabetes were the main risk factors for GDM, which increases maternal and fetal complications[1,4,]. If women were overweight or obese in prepregnancy, their incidence of GDM was significantly higher than that of pregnant women with low or normal weight[]. Lin’s survey of nearly 5,000 pregnant women in China showed that an increase in prepregnancy BMI led to an increase in the detection rate of GDM patients and the proportion of patients with two or more abnormalities in OGTTs []. In 2014, the Obstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association issued the “Guidelines for the Diagnosis and Treatment of Diabetes in Pregnancy." According to different BMIs before pregnancy, the recommended standards for the intake of energy and nutrients for different gestational weeks were clarified to formulate GDM nutritional treatments. The 2017 International Conference on Diabetes Mellitus in Pregnancy advocated for the need to attend to GDM and encouraged patients to receive prepregnancy consultation, pregnancy care, and postnatal follow-up sessions[]. In the present study, there were no significant differences in age, BMI, and newborn weight between pregnant women with and without GDM.

However, there were limitations to this study. First, We only compared the content of some trace elements in GDM and health pregnant women, and could not determine the nutritional and environmental factors that may affect the depth of elements in the analyzed samples. Secend, the sample size was small, and it is more convincing to expand the sample size. But our conclusion should be correct, and we can already see this trend.

In summary, the changes in trace elements found in GDM patients in the current study can help provide further guidelines for the prevention of and intervention of GDM. These findings will help researchers to understand the pathogenesis of diabetes about trace element deficiency or excess, as well as the need to further elucidate the related trace elements. the data provide support for understanding the pathogenesis and development process of diabetes, and they provide a theoretical basis for the analysis of trace elements in the prevention and control of diabetes. However, based on the risk of GDM in the pregnant population in China, it remains necessary to conduct relevant research on a much larger population.

In this study, 12 trace elements were analyzed in the sera and placental tissues of pregnant women with and without GDM. No significant differences were found in the levels of some trace elements, which may have been due to changes in the blood sugar levels of pregnant women. However, the results also show that the change in trace element concentrations in GDM patients may increase the progression of the disease; thus, these patients should receive an intervention as early as possible.

ACKNOWLEDGEMENTS

We thank the participants of the study.

Author Contribution

Sana Liu researched the data, wrote, discussed and edited the manuscript. Haiqing Fang and Aidong Liu designed reviewed the manuscript. Qihe Wang, Pengfeng Qu,Taotao Deng,Huzhong Li,and Dong Liang contributed to the discussion. Mingyuan Zhang contributed to research data. All authors read and approved the final manuscript.

Funding

This work was supported by China National Center for Food Safety Risk Assessment.

Conflict of interest

The authors declare that they have no conflict of interest.

Compliance with Ethics Guidelines

Informed consent was obtained from all individual participants included in the study.

Data Availability

The data used to support the fndings are all included in the article.The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Analysis of 12 Trace Elements in the Sera and Placental Tissues of Pregnant Women with Gestational Diabetes Mellitus in Beijing

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