Aromatic amino acids and their interactions with gut microbiota related metabolites for risk of gestational diabetes: a prospective nested case-control study in a Chinese cohort

Introduction: To explore associations of aromatic amino acids (AAA) in early pregnancy with gestational diabetes mellitus (GDM), and whether high AAA and gut microbiota-related metabolites had interactive effects on GDM risk.Methods: We conducted a 1:1 case-control study (n=486) nested in a prospective cohort of pregnant women from 2010 to 2012. According to the International Association of Diabetes and Pregnancy Study Group's criteria, 243 women were diagnosed with GDM. Binary conditional logistic regression was performed to examine associations of AAA with GDM risk. Interactions between AAA and gut microbiota-related metabolites for GDM were examined using additive interaction measures.Results: High phenylalanine and tryptophan were associated with increased GDM risk (OR: 1.72, 95%CI: 1.07-2.78 & 1.66, 1.02-2.71). The presence of high trimethylamine (TMA) markedly increased the OR of high phenylalanine alone up to 7.95 (2.79-22.71), while the presence of low glycoursodeoxycholic acid (GUDCA) markedly increased the OR of high tryptophan alone up to 22.88 (5.28-99.26), both with significant additive interactions. Furthermore, high lysophosphatidylcholines (LPC18:0) mediated both interactive effects.Conclusions: High phenylalanine may have an additive interaction with high TMA while high tryptophan may have an additive interaction with low GUDCA towards increased risk of GDM, both being mediated via LPC18:0.