Association between assisted reproductive technology and gestational diabetes mellitus: the role of serum folate and triglycerides.

Abstract

Background: Women conceiving via assisted reproductive technology (ART) may have a higher risk of developing gestational diabetes mellitus (GDM) compared to those who conceive spontaneously. However, the underlying factors associated with this relationship are not fully understood. This study aimed to investigate the association between ART conception and GDM prevalence and to explore related maternal serum biomarkers.

Methods: In an observational cohort of 11,563 singleton pregnancies, GDM was diagnosed at 24-28 weeks. We compared maternal characteristics, GDM prevalence, and late-pregnancy serum levels of folate, vitamin B12, and lipids between ART and spontaneously conceived women. Multivariable logistic regression assessed the independent association between ART and GDM.

Results: Among the participants, 2.3% conceived through ART. The overall GDM prevalence was 8.4%, but significantly higher in the ART group (15.0%). Within the ART group, GDM was more common among women with advanced age (23.2%), obesity (21.8%), or multiparity (25.0%). After adjustment for confounders, ART conception remained independently associated with an increased prevalence of GDM (adjusted OR: 1.49, 95% CI: 1.03-2.15). Furthermore, women in the ART group had significantly higher adjusted serum levels of folate (adjusted β = 3.58, 95% CI: 1.96-5.21) and triglycerides (adjusted β = 0.25, 95% CI: 0.13-0.37) compared to the spontaneous conception group. In the entire cohort, higher levels of both folate (adjusted OR = 2.21, 95% CI: 1.71-2.85) and triglycerides (adjusted OR = 1.70, 95% CI: 1.31-2.22) were independently associated with an increased GDM prevalence.

Conclusions: Our study confirms that ART pregnancies are associated with a higher risk of GDM and with elevated circulating folate and triglyceride concentrations at delivery. These findings highlight the importance of monitoring GDM risk and metabolic profiles in pregnancies achieved through ART. Future studies with biomarker assessments earlier in gestation are needed to clarify whether maternal folate and lipid metabolism contribute causally to the excess risk of GDM in ART pregnancies.