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It was previously observed that in a population of a high-income country, dietary multiple micronutrient supplementation in pregnancy was associated with an increased risk of gestational diabetes (GDM) and increased offspring size at birth. In this follow-up study, we investigated whether similar changes are observed with dietary iron supplementation. For this we used the prospective Cambridge Baby Growth Study with records of maternal GDM status, nutrient supplementation, and extensive offspring birth size measurements. Maternal iron supplementation in pregnancy was associated with GDM development (risk ratio 1.67 (1.01–2.77),  p  = 0.048,  n  = 677) as well as offspring size and adiposity ( n  = 844–868) at birth in terms of weight (β’ = 0.078 (0.024–0.133);  p  = 0.005), head circumference (β’ = 0.060 (0.012–0.107);  p  = 0.02), body mass index (β’ = 0.067 (0.014–0.119);  p  = 0.01), and various skinfold thicknesses (β’ = 0.067–0.094;  p  = 0.03–0.003). In a subset of participants for whom GDM statuses were available, all these associations were attenuated by adjusting for GDM. Iron supplementation also attenuated the associations between multiple micronutrient supplementation and these same measures. These results suggest that iron supplementation may mediate the effects associated with multiple micronutrient supplementation in pregnancy in a high-income country, possibly through the increased risk of developing GDM.

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Associations between Maternal Iron Supplementation in Pregnancy and Changes in Offspring Size at Birth Reflect Those of Multiple Micronutrient Supplementation