Objective:To explore the relationship between serum soluble myeloid cell trigger receptor-1(sTREM-1)messenger RNA(mRNA),high mobility group protein B1(HMGB1)mRNA levels and intestinal flora and the occurrence of preterm premature rupture of membranes(PPROM)in gestational diabetes mellitus(GDM)patients.Methods:98 GDM pregnant women with GDM combined with PPROM who underwent regular prenatal check ups and delivered at the First Hospital Affiliated to Hebei North University from June 2022 to May 2024 were selected as the GDM combined with PPROM group,102 GDM pregnant women without PPROM were selected as the GDM without PPROM group,and 108 normal pregnant women were selected as the control group.Intestinal flora,serum sTREM-1 mRNA,HMGB1 mRNA levels of the three groups of pregnant women were collected and compared;the correlation between serum sTREM-1 mRNA and HMGB1 mRNA levels and intestinal flora in GDM pregnant women,the factors affecting the occurrence of PPROM in pregnant women with GDM,and the predictive value of serum sTREM-1 mRNA and HMGB1 mRNA in the occurrence of PPROM in GDM pregnant women were analyzed.Results:Compared with control group,colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM without PPROM group and GDM combined with PPROM group(P＜0.05),the colony number of Bifidobacterium and Lactobacillus was significantly de-creased(P＜0.05).The gestational age at delivery of GDM combined with PPROM group was significantly lower than that of control group and GDM without PPROM group(P＜0.05).Compared with GDM without PPROM group,the colony number of Bifidobacterium and Lactobacillus were significantly decreased(P＜0.05),colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM com-bined with PPROM group(P＜0.05).The serum levels of sTREM-1 mRNA and HMGB1 mRNA in control group,GDM without PPROM group,GDM combined with PPROM group were increased sequentially(P＜0.05).Serum sTREM-1 mRNA was positively correlated with HMGB1 mRNA in GDM pregnant women(r＞0,P＜0.05);serum sTREM-1 mRNA and HMGB1 mRNA were positively correlated with the colony numbers of Enterococcus,Enter-obacter,Bacteroides and Fusobacterium(r＞0,P＜0.05),and negatively correlated with the colony numbers of Bifidobacterium and Lactobacillus(r＜0,P＜0.05).Enterococcus,Enterobacter,Bacteroides,Fusobacterium,sTREM-1 mRNA and HMGB1 mRNA were independent risk factors for PPROM in GDM pregnant women(OR＞1,P＜0.05),while Bifidobacterium and Lactobacillus were independent protective factors for PPROM in GDM pregnant women(OR＜1,P＜0.05).The area under curve(AUC)of predicting PPROM in GDM pregnant women by combining serum sTREM-1 mRNA and HMGB1 mRNA(0.922)was higher than the AUC predicted by serum sTREM-1 mRNA and HMGB1 mRNA alone(0.829,0.841)(P＜0.05).Conclusions:Serum sTREM-1 mRNA and HMGB1 mRNA were highly expressed in GDM pregnant women,and the increase trend of serum both was more obvious in GDM pregnant women with PPROM,both of which were related to intestinal flora imbalance and the occurrence of PPROM.The combination of sTREM-1 mRNA and HMGB1 mRNA has high efficacy in predicting the occurrence of PPROM.

Objective:To explore the relationship between serum soluble myeloid cell trigger receptor-1(sTREM-1)messenger RNA(mRNA),high mobility group protein B1(HMGB1)mRNA levels and intestinal flora and the occurrence of preterm premature rupture of membranes(PPROM)in gestational diabetes mellitus(GDM)patients.Methods:98 GDM pregnant women with GDM combined with PPROM who underwent regular prenatal check ups and delivered at the First Hospital Affiliated to Hebei North University from June 2022 to May 2024 were selected as the GDM combined with PPROM group,102 GDM pregnant women without PPROM were selected as the GDM without PPROM group,and 108 normal pregnant women were selected as the control group.Intestinal flora,serum sTREM-1 mRNA,HMGB1 mRNA levels of the three groups of pregnant women were collected and compared;the correlation between serum sTREM-1 mRNA and HMGB1 mRNA levels and intestinal flora in GDM pregnant women,the factors affecting the occurrence of PPROM in pregnant women with GDM,and the predictive value of serum sTREM-1 mRNA and HMGB1 mRNA in the occurrence of PPROM in GDM pregnant women were analyzed.Results:Compared with control group,colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM without PPROM group and GDM combined with PPROM group(P＜0.05),the colony number of Bifidobacterium and Lactobacillus was significantly de-creased(P＜0.05).The gestational age at delivery of GDM combined with PPROM group was significantly lower than that of control group and GDM without PPROM group(P＜0.05).Compared with GDM without PPROM group,the colony number of Bifidobacterium and Lactobacillus were significantly decreased(P＜0.05),colony number of Enterococcus,Enterobacter,Bacteroides and Fusobacterium were significantly increased in GDM com-bined with PPROM group(P＜0.05).The serum levels of sTREM-1 mRNA and HMGB1 mRNA in control group,GDM without PPROM group,GDM combined with PPROM group were increased sequentially(P＜0.05).Serum sTREM-1 mRNA was positively correlated with HMGB1 mRNA in GDM pregnant women(r＞0,P＜0.05);serum sTREM-1 mRNA and HMGB1 mRNA were positively correlated with the colony numbers of Enterococcus,Enter-obacter,Bacteroides and Fusobacterium(r＞0,P＜0.05),and negatively correlated with the colony numbers of Bifidobacterium and Lactobacillus(r＜0,P＜0.05).Enterococcus,Enterobacter,Bacteroides,Fusobacterium,sTREM-1 mRNA and HMGB1 mRNA were independent risk factors for PPROM in GDM pregnant women(OR＞1,P＜0.05),while Bifidobacterium and Lactobacillus were independent protective factors for PPROM in GDM pregnant women(OR＜1,P＜0.05).The area under curve(AUC)of predicting PPROM in GDM pregnant women by combining serum sTREM-1 mRNA and HMGB1 mRNA(0.922)was higher than the AUC predicted by serum sTREM-1 mRNA and HMGB1 mRNA alone(0.829,0.841)(P＜0.05).Conclusions:Serum sTREM-1 mRNA and HMGB1 mRNA were highly expressed in GDM pregnant women,and the increase trend of serum both was more obvious in GDM pregnant women with PPROM,both of which were related to intestinal flora imbalance and the occurrence of PPROM.The combination of sTREM-1 mRNA and HMGB1 mRNA has high efficacy in predicting the occurrence of PPROM.

Objective To investigate the correlation between vitamin A,E,D and folic acid levels and concomitant preeclampsia(PE)in patients with gestational diabetes mellitus(GDM).Methods A total of 108 patients with GDM complicated with PE were used as the PE group,and another 108 GDM patients without PE were used as the GDM group.A total of 108 normal pregnant women with normal pregnancy test were used as the normal control group.The general information and vitamin A,E,D and folic acid levels were compared between the three groups.According to the severity of the disease,the PE group was subdivided into the mild-moderate PE group(62 cases)and the severe PE group(46 cases),and vitamin A,E,D and folic acid levels were compared between these two groups.Results Systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),fasting insulin(FINS)were increased in turn in the normal control group,the GDM group and the PE groups(P＜0.05),and vitamins A,E,D and folic acid levels were decreased in turn(P＜0.05).Triglyceride,total cholesterol and glycated haemoglobin were higher in the PE group than those in the GDM group and the normal control,and high density lipoprotein(HDL)cholesterol was lower than that in the GDM group and the normal control group(P＜0.05).Vitamin A,vitamin E,vitamin D and folic acid levels were lower in the severe PE group than those in the mild to moderate PE group(P＜0.05).Higher levels of vitamin A,vitamin E,vitamin D and folate were protective factors for GDM patients with severe PE.Folic acid showed higher predictive efficacy and specificity in single indicator analysis.Vitamin A showed high predictive specificity.The combined prediction of four indicators for severe PE in GDM patients was more effective than each individual indicator.Conclusion Serum vitamin A,E,D and folate levels are significantly lower in patients with GDM complicated with PE,and the combination of all four may improve the predictive value of severe PE complicated with GDM.

Objective:To investigate the relationship between the duration of folic acid supplementation,gesta-tional diabetes mellitus(GDM)and adverse perinatal outcomes based on generalized linear mixed model.Meth-ods:Clinical data was collected of 759 pairs of mothers and children who delivered at the First Affiliated Hospital of Hebei North University from January 2021 to December 2022.The adverse perinatal outcomes of this study in-cluded cesarean section,premature birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),and small for gestational age infant(SGA).Generalized linear mixed model was used to analyze the impact of GDM and supplementation with folic acid for a duration of ≥3 months on the risk of adverse perinatal outcomes.A stratified analysis of the duration of folic acid supplementation was conducted to determine whether it was a con-founding factor or influencing factor of GDM and adverse birth outcomes.Results:A total of 748 patients(98.55％)received folic acid supplementation before and during pregnancy,with a total of 743 patients(97.89％)receiving folic acid supplementation during pregnancy and 496 patients(65.35％)receiving folic acid supplementation before pregnancy.77 mothers were diagnosed with GDM,with an incidence rate of 10.14％.Compared with those who received folic acid supplementation before pregnancy for＜3 months,those who re-ceived folic acid supplementation before pregnancy for ≥ 3 months were associated with an increased risk of GDM.The adjusted RR(aRR)was 1.72(95％CI 1.17-2.53).The GDM patients who received folic acid sup-plementation for≥3 months before pregnancy was associated with a reduced risk of SGA,with an aRR of 0.40(95％CI 0.18-0.89).In the subgroup of pregnant women who received folic acid supplementation for≥3 months,GDM was associated with an increased risk of cesarean section(aRR 1.36,95％CI 1.06-1.75))and macrosomia(aRR2.11,95％CI 1.06-4.20),but both aRR were lower than fixed effect RR of 1.53(95％CI 1.01-2.34)and 2.43(95％CI 12.7-4.66),respectively.and the above differences were statistically signifi-cant(P＜0.01).Conclusions:Supplementing folic acid for≥3 months before pregnancy increases the risk of GDM,but reduces the risk of SGA birth in patients with GDM.Supplementing folic acid during pregnancy for≥3 months has a reducing effect on the risk of adverse perinataloutcomes of cesarean section and macrosomia in women with GDM.

Objective:To investigate the relationship between the duration of folic acid supplementation,gesta-tional diabetes mellitus(GDM)and adverse perinatal outcomes based on generalized linear mixed model.Meth-ods:Clinical data was collected of 759 pairs of mothers and children who delivered at the First Affiliated Hospital of Hebei North University from January 2021 to December 2022.The adverse perinatal outcomes of this study in-cluded cesarean section,premature birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),and small for gestational age infant(SGA).Generalized linear mixed model was used to analyze the impact of GDM and supplementation with folic acid for a duration of ≥3 months on the risk of adverse perinatal outcomes.A stratified analysis of the duration of folic acid supplementation was conducted to determine whether it was a con-founding factor or influencing factor of GDM and adverse birth outcomes.Results:A total of 748 patients(98.55％)received folic acid supplementation before and during pregnancy,with a total of 743 patients(97.89％)receiving folic acid supplementation during pregnancy and 496 patients(65.35％)receiving folic acid supplementation before pregnancy.77 mothers were diagnosed with GDM,with an incidence rate of 10.14％.Compared with those who received folic acid supplementation before pregnancy for＜3 months,those who re-ceived folic acid supplementation before pregnancy for ≥ 3 months were associated with an increased risk of GDM.The adjusted RR(aRR)was 1.72(95％CI 1.17-2.53).The GDM patients who received folic acid sup-plementation for≥3 months before pregnancy was associated with a reduced risk of SGA,with an aRR of 0.40(95％CI 0.18-0.89).In the subgroup of pregnant women who received folic acid supplementation for≥3 months,GDM was associated with an increased risk of cesarean section(aRR 1.36,95％CI 1.06-1.75))and macrosomia(aRR2.11,95％CI 1.06-4.20),but both aRR were lower than fixed effect RR of 1.53(95％CI 1.01-2.34)and 2.43(95％CI 12.7-4.66),respectively.and the above differences were statistically signifi-cant(P＜0.01).Conclusions:Supplementing folic acid for≥3 months before pregnancy increases the risk of GDM,but reduces the risk of SGA birth in patients with GDM.Supplementing folic acid during pregnancy for≥3 months has a reducing effect on the risk of adverse perinataloutcomes of cesarean section and macrosomia in women with GDM.

Objective:To investigate the relationship between the duration of folic acid supplementation,gesta-tional diabetes mellitus(GDM)and adverse perinatal outcomes based on generalized linear mixed model.Meth-ods:Clinical data was collected of 759 pairs of mothers and children who delivered at the First Affiliated Hospital of Hebei North University from January 2021 to December 2022.The adverse perinatal outcomes of this study in-cluded cesarean section,premature birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),and small for gestational age infant(SGA).Generalized linear mixed model was used to analyze the impact of GDM and supplementation with folic acid for a duration of ≥3 months on the risk of adverse perinatal outcomes.A stratified analysis of the duration of folic acid supplementation was conducted to determine whether it was a con-founding factor or influencing factor of GDM and adverse birth outcomes.Results:A total of 748 patients(98.55％)received folic acid supplementation before and during pregnancy,with a total of 743 patients(97.89％)receiving folic acid supplementation during pregnancy and 496 patients(65.35％)receiving folic acid supplementation before pregnancy.77 mothers were diagnosed with GDM,with an incidence rate of 10.14％.Compared with those who received folic acid supplementation before pregnancy for＜3 months,those who re-ceived folic acid supplementation before pregnancy for ≥ 3 months were associated with an increased risk of GDM.The adjusted RR(aRR)was 1.72(95％CI 1.17-2.53).The GDM patients who received folic acid sup-plementation for≥3 months before pregnancy was associated with a reduced risk of SGA,with an aRR of 0.40(95％CI 0.18-0.89).In the subgroup of pregnant women who received folic acid supplementation for≥3 months,GDM was associated with an increased risk of cesarean section(aRR 1.36,95％CI 1.06-1.75))and macrosomia(aRR2.11,95％CI 1.06-4.20),but both aRR were lower than fixed effect RR of 1.53(95％CI 1.01-2.34)and 2.43(95％CI 12.7-4.66),respectively.and the above differences were statistically signifi-cant(P＜0.01).Conclusions:Supplementing folic acid for≥3 months before pregnancy increases the risk of GDM,but reduces the risk of SGA birth in patients with GDM.Supplementing folic acid during pregnancy for≥3 months has a reducing effect on the risk of adverse perinataloutcomes of cesarean section and macrosomia in women with GDM.

Objective:To investigate the relationship between the duration of folic acid supplementation,gesta-tional diabetes mellitus(GDM)and adverse perinatal outcomes based on generalized linear mixed model.Meth-ods:Clinical data was collected of 759 pairs of mothers and children who delivered at the First Affiliated Hospital of Hebei North University from January 2021 to December 2022.The adverse perinatal outcomes of this study in-cluded cesarean section,premature birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),and small for gestational age infant(SGA).Generalized linear mixed model was used to analyze the impact of GDM and supplementation with folic acid for a duration of ≥3 months on the risk of adverse perinatal outcomes.A stratified analysis of the duration of folic acid supplementation was conducted to determine whether it was a con-founding factor or influencing factor of GDM and adverse birth outcomes.Results:A total of 748 patients(98.55％)received folic acid supplementation before and during pregnancy,with a total of 743 patients(97.89％)receiving folic acid supplementation during pregnancy and 496 patients(65.35％)receiving folic acid supplementation before pregnancy.77 mothers were diagnosed with GDM,with an incidence rate of 10.14％.Compared with those who received folic acid supplementation before pregnancy for＜3 months,those who re-ceived folic acid supplementation before pregnancy for ≥ 3 months were associated with an increased risk of GDM.The adjusted RR(aRR)was 1.72(95％CI 1.17-2.53).The GDM patients who received folic acid sup-plementation for≥3 months before pregnancy was associated with a reduced risk of SGA,with an aRR of 0.40(95％CI 0.18-0.89).In the subgroup of pregnant women who received folic acid supplementation for≥3 months,GDM was associated with an increased risk of cesarean section(aRR 1.36,95％CI 1.06-1.75))and macrosomia(aRR2.11,95％CI 1.06-4.20),but both aRR were lower than fixed effect RR of 1.53(95％CI 1.01-2.34)and 2.43(95％CI 12.7-4.66),respectively.and the above differences were statistically signifi-cant(P＜0.01).Conclusions:Supplementing folic acid for≥3 months before pregnancy increases the risk of GDM,but reduces the risk of SGA birth in patients with GDM.Supplementing folic acid during pregnancy for≥3 months has a reducing effect on the risk of adverse perinataloutcomes of cesarean section and macrosomia in women with GDM.

Objective:To investigate the relationship between the duration of folic acid supplementation,gesta-tional diabetes mellitus(GDM)and adverse perinatal outcomes based on generalized linear mixed model.Meth-ods:Clinical data was collected of 759 pairs of mothers and children who delivered at the First Affiliated Hospital of Hebei North University from January 2021 to December 2022.The adverse perinatal outcomes of this study in-cluded cesarean section,premature birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),and small for gestational age infant(SGA).Generalized linear mixed model was used to analyze the impact of GDM and supplementation with folic acid for a duration of ≥3 months on the risk of adverse perinatal outcomes.A stratified analysis of the duration of folic acid supplementation was conducted to determine whether it was a con-founding factor or influencing factor of GDM and adverse birth outcomes.Results:A total of 748 patients(98.55％)received folic acid supplementation before and during pregnancy,with a total of 743 patients(97.89％)receiving folic acid supplementation during pregnancy and 496 patients(65.35％)receiving folic acid supplementation before pregnancy.77 mothers were diagnosed with GDM,with an incidence rate of 10.14％.Compared with those who received folic acid supplementation before pregnancy for＜3 months,those who re-ceived folic acid supplementation before pregnancy for ≥ 3 months were associated with an increased risk of GDM.The adjusted RR(aRR)was 1.72(95％CI 1.17-2.53).The GDM patients who received folic acid sup-plementation for≥3 months before pregnancy was associated with a reduced risk of SGA,with an aRR of 0.40(95％CI 0.18-0.89).In the subgroup of pregnant women who received folic acid supplementation for≥3 months,GDM was associated with an increased risk of cesarean section(aRR 1.36,95％CI 1.06-1.75))and macrosomia(aRR2.11,95％CI 1.06-4.20),but both aRR were lower than fixed effect RR of 1.53(95％CI 1.01-2.34)and 2.43(95％CI 12.7-4.66),respectively.and the above differences were statistically signifi-cant(P＜0.01).Conclusions:Supplementing folic acid for≥3 months before pregnancy increases the risk of GDM,but reduces the risk of SGA birth in patients with GDM.Supplementing folic acid during pregnancy for≥3 months has a reducing effect on the risk of adverse perinataloutcomes of cesarean section and macrosomia in women with GDM.

Objective:To investigate the relationship between the duration of folic acid supplementation,gesta-tional diabetes mellitus(GDM)and adverse perinatal outcomes based on generalized linear mixed model.Meth-ods:Clinical data was collected of 759 pairs of mothers and children who delivered at the First Affiliated Hospital of Hebei North University from January 2021 to December 2022.The adverse perinatal outcomes of this study in-cluded cesarean section,premature birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),and small for gestational age infant(SGA).Generalized linear mixed model was used to analyze the impact of GDM and supplementation with folic acid for a duration of ≥3 months on the risk of adverse perinatal outcomes.A stratified analysis of the duration of folic acid supplementation was conducted to determine whether it was a con-founding factor or influencing factor of GDM and adverse birth outcomes.Results:A total of 748 patients(98.55％)received folic acid supplementation before and during pregnancy,with a total of 743 patients(97.89％)receiving folic acid supplementation during pregnancy and 496 patients(65.35％)receiving folic acid supplementation before pregnancy.77 mothers were diagnosed with GDM,with an incidence rate of 10.14％.Compared with those who received folic acid supplementation before pregnancy for＜3 months,those who re-ceived folic acid supplementation before pregnancy for ≥ 3 months were associated with an increased risk of GDM.The adjusted RR(aRR)was 1.72(95％CI 1.17-2.53).The GDM patients who received folic acid sup-plementation for≥3 months before pregnancy was associated with a reduced risk of SGA,with an aRR of 0.40(95％CI 0.18-0.89).In the subgroup of pregnant women who received folic acid supplementation for≥3 months,GDM was associated with an increased risk of cesarean section(aRR 1.36,95％CI 1.06-1.75))and macrosomia(aRR2.11,95％CI 1.06-4.20),but both aRR were lower than fixed effect RR of 1.53(95％CI 1.01-2.34)and 2.43(95％CI 12.7-4.66),respectively.and the above differences were statistically signifi-cant(P＜0.01).Conclusions:Supplementing folic acid for≥3 months before pregnancy increases the risk of GDM,but reduces the risk of SGA birth in patients with GDM.Supplementing folic acid during pregnancy for≥3 months has a reducing effect on the risk of adverse perinataloutcomes of cesarean section and macrosomia in women with GDM.

Objective:To investigate the relationship between the duration of folic acid supplementation,gesta-tional diabetes mellitus(GDM)and adverse perinatal outcomes based on generalized linear mixed model.Meth-ods:Clinical data was collected of 759 pairs of mothers and children who delivered at the First Affiliated Hospital of Hebei North University from January 2021 to December 2022.The adverse perinatal outcomes of this study in-cluded cesarean section,premature birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),and small for gestational age infant(SGA).Generalized linear mixed model was used to analyze the impact of GDM and supplementation with folic acid for a duration of ≥3 months on the risk of adverse perinatal outcomes.A stratified analysis of the duration of folic acid supplementation was conducted to determine whether it was a con-founding factor or influencing factor of GDM and adverse birth outcomes.Results:A total of 748 patients(98.55％)received folic acid supplementation before and during pregnancy,with a total of 743 patients(97.89％)receiving folic acid supplementation during pregnancy and 496 patients(65.35％)receiving folic acid supplementation before pregnancy.77 mothers were diagnosed with GDM,with an incidence rate of 10.14％.Compared with those who received folic acid supplementation before pregnancy for＜3 months,those who re-ceived folic acid supplementation before pregnancy for ≥ 3 months were associated with an increased risk of GDM.The adjusted RR(aRR)was 1.72(95％CI 1.17-2.53).The GDM patients who received folic acid sup-plementation for≥3 months before pregnancy was associated with a reduced risk of SGA,with an aRR of 0.40(95％CI 0.18-0.89).In the subgroup of pregnant women who received folic acid supplementation for≥3 months,GDM was associated with an increased risk of cesarean section(aRR 1.36,95％CI 1.06-1.75))and macrosomia(aRR2.11,95％CI 1.06-4.20),but both aRR were lower than fixed effect RR of 1.53(95％CI 1.01-2.34)and 2.43(95％CI 12.7-4.66),respectively.and the above differences were statistically signifi-cant(P＜0.01).Conclusions:Supplementing folic acid for≥3 months before pregnancy increases the risk of GDM,but reduces the risk of SGA birth in patients with GDM.Supplementing folic acid during pregnancy for≥3 months has a reducing effect on the risk of adverse perinataloutcomes of cesarean section and macrosomia in women with GDM.