Maternal serum retinol, vitamin K, and ferritin profiles during pregnancy, gestational diabetes mellitus, and offspring neurodevelopment: a prospective case-control study
- 1Department of Neonatology, Chongqing Yongchuan District Maternal and Child Health Care Hospital, Chongqing, China
- 2Department of Child Health Care, Chongqing Yongchuan District Maternal and Child Health Care Hospital, Chongqing, China
- 3Department of Pediatrics, Chongqing Yongchuan District Maternal and Child Health Care Hospital, Chongqing, China
Abstract
BackgroundGestational diabetes mellitus (GDM) is associated with adverse offspring neurodevelopment, but the role of maternal circulating biomarkers—specifically serum retinol, serum vitamin K, and serum ferritin—in relation to offspring neurodevelopmental performance remains unclear. This study examined trimester-specific levels of these biomarkers in GDM vs. participants without GDM and their associations with infant neurodevelopmental outcomes at 12 months.MethodsIn this prospective case-control study, 240 mother-infant pairs who were enrolled during pregnancy, classified according to GDM status after OGTT screening, and followed through delivery and offspring assessment at 12 months. Maternal serum retinol, serum vitamin K, and serum ferritin were measured in each trimester. Offspring neurodevelopment was assessed using the Gesell Developmental Schedules, with suboptimal neurodevelopmental performance defined as Total Gesell Score < 85. Multivariable logistic regression models were adjusted for maternal age, pre-pregnancy BMI, years of formal education, gestational age at delivery, infant sex, and maternal HbA1c. Linear regression models included the same covariates together with maternal CRP and IL-6.ResultsParticipants with GDM had significantly lower serum retinol and serum vitamin K concentrations and higher serum ferritin concentrations across all trimesters compared with control participants (all p < 0.001). Offspring in the GDM group had lower Total Gesell Scores (90.4 vs. 95.9, p < 0.001) and higher prevalence of Total Gesell Score < 85 (72.5% vs. 31.7%, p < 0.001) compared with offspring in the control group. Although the mean differences were statistically significant, the group means remained within broadly similar interpretive ranges, and the < 85 threshold includes borderline scores. In fully adjusted logistic regression, higher serum ferritin was independently associated with increased odds of suboptimal neurodevelopmental performance (OR = 1.22 per 10 ng/mL, 95% CI: 1.004–1.34, p = 0.036), while vitamin A and K were not significant. An exploratory composite Nutritional Risk Score of 1, indicating the presence of any one of the three prespecified sample-specific quartile-defined biomarker categories (serum retinol in the lowest quartile, serum vitamin K in the lowest quartile, or serum ferritin in the highest quartile), was associated with a nearly five-fold higher odds of suboptimal neurodevelopmental performance (OR = 4.92, 95% CI: 1.65–14.64, p = 0.004; however, the association was not monotonic across higher score categories. Linear regression confirmed ferritin as a significant negative predictor of Total Gesell Score (β = −0.05, p = 0.003).ConclusionsIn participants with GDM, higher maternal ferritin–but not vitamins A or K–is independently associated with offspring suboptimal neurodevelopmental performance. A simple composite nutritional risk score may help identify at-risk infants. These findings support monitoring ferritin and considering overall nutritional risk beyond glycaemic control in GDM care.
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BibTeX
@article{jiang2026maternal,
title = {{Maternal serum retinol, vitamin K, and ferritin profiles during pregnancy, gestational diabetes mellitus, and offspring neurodevelopment: a prospective case-control study}},
author = {Changke Jiang and Yulu Pang and Jinfeng Yu and Shiling Yan and Xiaoqing Liu and Tingyu Li},
journal = {Frontiers in Nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1967646},
url = {https://doi.org/10.3389/fnut.2026.1967646},
note = {CC BY},
}
RIS
TY - JOUR
TI - Maternal serum retinol, vitamin K, and ferritin profiles during pregnancy, gestational diabetes mellitus, and offspring neurodevelopment: a prospective case-control study
AU - Changke Jiang
AU - Yulu Pang
AU - Jinfeng Yu
AU - Shiling Yan
AU - Xiaoqing Liu
AU - Tingyu Li
PY - 2026
DA - 2026/10/23
JO - Frontiers in Nutrition
DO - 10.3389/fnut.2026.1967646
UR - https://doi.org/10.3389/fnut.2026.1967646
AB - BackgroundGestational diabetes mellitus (GDM) is associated with adverse offspring neurodevelopment, but the role of maternal circulating biomarkers—specifically serum retinol, serum vitamin K, and serum ferritin—in relation to offspring neurodevelopmental performance remains unclear. This study examined trimester-specific levels of these biomarkers in GDM vs. participants without GDM and their associations with infant neurodevelopmental outcomes at 12 months.MethodsIn this prospective case-control study, 240 mother-infant pairs who were enrolled during pregnancy, classified according to GDM status after OGTT screening, and followed through delivery and offspring assessment at 12 months. Maternal serum retinol, serum vitamin K, and serum ferritin were measured in each trimester. Offspring neurodevelopment was assessed using the Gesell Developmental Schedules, with suboptimal neurodevelopmental performance defined as Total Gesell Score < 85. Multivariable logistic regression models were adjusted for maternal age, pre-pregnancy BMI, years of formal education, gestational age at delivery, infant sex, and maternal HbA1c. Linear regression models included the same covariates together with maternal CRP and IL-6.ResultsParticipants with GDM had significantly lower serum retinol and serum vitamin K concentrations and higher serum ferritin concentrations across all trimesters compared with control participants (all p < 0.001). Offspring in the GDM group had lower Total Gesell Scores (90.4 vs. 95.9, p < 0.001) and higher prevalence of Total Gesell Score < 85 (72.5% vs. 31.7%, p < 0.001) compared with offspring in the control group. Although the mean differences were statistically significant, the group means remained within broadly similar interpretive ranges, and the < 85 threshold includes borderline scores. In fully adjusted logistic regression, higher serum ferritin was independently associated with increased odds of suboptimal neurodevelopmental performance (OR = 1.22 per 10 ng/mL, 95% CI: 1.004–1.34, p = 0.036), while vitamin A and K were not significant. An exploratory composite Nutritional Risk Score of 1, indicating the presence of any one of the three prespecified sample-specific quartile-defined biomarker categories (serum retinol in the lowest quartile, serum vitamin K in the lowest quartile, or serum ferritin in the highest quartile), was associated with a nearly five-fold higher odds of suboptimal neurodevelopmental performance (OR = 4.92, 95% CI: 1.65–14.64, p = 0.004; however, the association was not monotonic across higher score categories. Linear regression confirmed ferritin as a significant negative predictor of Total Gesell Score (β = −0.05, p = 0.003).ConclusionsIn participants with GDM, higher maternal ferritin–but not vitamins A or K–is independently associated with offspring suboptimal neurodevelopmental performance. A simple composite nutritional risk score may help identify at-risk infants. These findings support monitoring ferritin and considering overall nutritional risk beyond glycaemic control in GDM care.
SN - 2296-861X
ER -