妊娠期铁缺乏和缺铁性贫血诊治指南

探讨总铁、补充剂铁、膳食总铁、血红素铁等不同来源铁摄入水平与妊娠期糖尿病（GDM）的关联，进一步为指导孕期合理膳食及含铁补充剂选用提供科学依据。

采用回顾性队列研究，选取2020年1月—2021年7月上海某医院分娩的668例孕中期女性为研究对象，采用自行设计的调查表，通过电子病历系统收集研究对象基本信息及孕中期含铁补充剂使用情况，应用简化的膳食频率问卷量化研究对象孕中期膳食摄入情况。确定总铁及不同来源铁摄入量，并根据摄入量五分位数和中位数进行分组，采用logistic回归分析孕中期总铁及不同来源铁摄入量对GDM发生风险的影响。

校正高龄、糖尿病家族史、孕前超重/肥胖、孕早期血红蛋白（Hb）、能量、碳水化合物供能比、蛋白质、游离糖后发现总铁摄入量与GDM风险无关（P>0.05）。与低剂量补充剂铁摄入组相比，高剂量补充剂铁摄入组GDM发生风险上升（OR=1.65，95%CI：1.14~2.39）。与低剂量膳食总铁摄入组相比，高剂量膳食总铁摄入组GDM发生风险降低（OR=0.53，95%CI：0.35~0.81），膳食血红素铁的摄入与GDM风险无关（P>0.05）。

高膳食总铁摄入水平可能是GDM的保护因素，而高补充剂铁摄入水平则可能是GDM的危险因素，提示在无妊娠期铁缺乏的情况下，妊娠期女性宜谨慎选用高剂量含铁补充剂，建议优先保证膳食铁摄入。

Iron metabolism in obesity and metabolic syndrome

To explore the association between total iron， iron supplements， dietary total iron， heme iron intake and the risk of gestational diabetes mellitus（GDM）.A total of 668 pregnant women who gave birth in one hospital in Shanghai during January 2020 to July 2021 were included in a retrospective cohort study. Baseline characteristics and data of iron supplements in second trimester were collected through a questionnaire. A simplified dietary frequency questionnaire was used to quantify the food intake in second trimester. Total iron， iron supplements， dietary total iron， and heme iron intake was classified into groups by quintile and median. The association between iron intake from different sources and risk of GDM was determined using logistic regression analysis.After correction for age， family history of diabetes， overweight / obesity before pregnancy， hemoglobin（Hb）in first trimester， energy， carbohydrate energy， protein， and free sugar， it showed no association between total iron intake and risk of GDM （P>0.05）， while elevated risk of GDM among women with high iron supplements intake （OR=1.65； 95%CI： 1.14‒2.39）， and decreased risk of GDM among those with high dietary total iron intake （OR=0.53； 95%CI： 0.35‒0.81）. However， no association was found between heme iron intake and risk of GDM （P>0.05）.High dietary total iron intake may be a protective factor， while high iron supplements may be a risk factor for GDM. It suggests that pregnant women should carefully choose high-dose iron-containing supplements in the absence of iron deficiency， as dietary iron intake should be the priority.