{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T01:19:15Z","timestamp":1787966355924,"version":"build-2784847793"},"reference-count":67,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009086","name":"Medical University of Sofia","doi-asserted-by":"publisher","award":["D-63"],"award-info":[{"award-number":["D-63"]}],"id":[{"id":"10.13039\/100009086","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Gestational diabetes mellitus (GDM) is considered the most common metabolic disorder of the pregnancy period. It is characterized by pancreatic beta-cell dysfunction in the setting of chronic insulin resistance. Zinc is a nutrient involved in numerous metabolic processes and shows a relationship with glycometabolic disorders and GDM. The latest data have demonstrated the association of zinc with insulin sensitivity and resistance. The exact role of zinc in the connection with indexes of insulin resistance and insulin sensitivity is still not fully clarified. The aim of the study is to analyze the newly calculated indexes Glu\/Zn, Ins\/Zn, and HOMA-IR\/Zn as surrogate markers to explore the correlation between serum zinc status and some indexes of insulin sensitivity and insulin resistance. The possible role of these indexes as markers of insulin resistance in pregnant women was analyzed too. An ROC analysis demonstrated that HOMA-IR\/Zn with AUC 0.989, p &lt; 0.001 (95% CI 0.967\u20131.000) and Ins\/Zn with AUC 0.947, p &lt; 0.001 (95% CI 0.889\u20131.000) in the GDM group, and only HOMA-IR\/Zn index with AUC 0.953, p &lt; 0.001 (95% CI 0.877\u20131.000) in healthy pregnant women, have good power as markers of insulin resistance in both groups. We speculate that these new ratios could be suitable for the assessment of pregnant women at high risk of insulin resistance development and, probably, for the evaluation of the specific pathophysiologic characteristics of women with GDM.<\/jats:p>","DOI":"10.3390\/ijms252212193","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T08:09:28Z","timestamp":1731485368000},"page":"12193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association Between Zinc Status and Insulin Resistance\/Sensitivity Check Indexes in Gestational Diabetes Mellitus"],"prefix":"10.3390","volume":"25","author":[{"given":"Mariana P.","family":"Genova","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Medical University of Sofia, Alexander University Hospital, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2369-0182","authenticated-orcid":false,"given":"Irena","family":"Ivanova","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, UH St. Ivan Rilski, 1606 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1282-8441","authenticated-orcid":false,"given":"Emilia","family":"Naseva","sequence":"additional","affiliation":[{"name":"Department of Health Management and Health Economics, Faculty of Public Health \u201cProf. Tsekomir Vodenicharov, MD, DSc\u201d, Medical University of Sofia, 1524 Sofia, Bulgaria"},{"name":"Medical Faculty, Sofia University St. Kliment Ohridski, 1504 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6384-4882","authenticated-orcid":false,"given":"Bisera","family":"Atanasova","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Medical University of Sofia, Alexander University Hospital, 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"ref_1","unstructured":"International Diabetes Federation (2024, September 17). IDF Diabetes ATLAS 9th Edition 2019. Available online: https:\/\/idf.org\/about-diabetes\/gestational-diabetes."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2018). 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes\u20142018. Diabetes Care, 41, S13\u2013S27.","DOI":"10.2337\/dc18-S002"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1210\/endrev\/bnac003","article-title":"A clinical update on gestational diabetes mellitus","volume":"43","author":"Sweeting","year":"2022","journal-title":"Endocr. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"109050","DOI":"10.1016\/j.diabres.2021.109050","article-title":"IDF Diabetes Atlas Committee Hyperglycaemia in Pregnancy Special Interest Group. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group\u2019s Criteria","volume":"183","author":"Wang","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_5","first-page":"568","article-title":"Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus","volume":"86","author":"Homko","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1385\/BTER:79:3:205","article-title":"Concentrations of seven trace elements in different hematological matrices in patients with type 2 diabetes as compared to healthy controls","volume":"79","author":"Ekmekcioglu","year":"2001","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_7","first-page":"45","article-title":"Trace elements and vitamin D in gestational diabetes","volume":"45","author":"Genova","year":"2018","journal-title":"Acta Med. Bulg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2922","DOI":"10.1016\/j.clnu.2018.12.032","article-title":"Association between plasma concentration of copper and gestational diabetes mellitus","volume":"38","author":"Li","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_9","unstructured":"Maxfield, L., Shukla, S., and Crane, J.S. (2024, September 17). Zinc Deficiency, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK493231."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1023\/A:1012905406548","article-title":"Functions of zinc in signaling, proliferation and differentiation of mammalian cells","volume":"14","author":"Beyersmann","year":"2001","journal-title":"Biometals"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Banaszak, M., G\u00f3rna, I., and Przys\u0142awski, J. (2021). Zinc and the Innovative Zinc-\u03b12-Glycoprotein Adipokine Play an Important Role in Lipid Metabolism: A Critical Review. Nutrients, 13.","DOI":"10.3390\/nu13062023"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.2337\/db16-1099","article-title":"Hyperglycemia-Induced Changes in ZIP7 and ZnT7 Expression Cause Zn2+ Release from the Sarco(endo)plasmic Reticulum and Mediate ER Stress in the Heart","volume":"66","author":"Tuncay","year":"2017","journal-title":"Diabetes"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1017\/S0007114511003114","article-title":"Poor zinc status is associated with increased risk of insulin resistance in Spanish children","volume":"107","author":"Ortega","year":"2012","journal-title":"Br. J. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Cao, J.C., Warthon-Medina, M., Moran, H.V., Arija, V., Doepking, C., Serra-Majem, L., and Lowe, N.M. (2019). Zinc intake and status and risk of type 2 diabetes mellitus: A systematic review and meta-analysis. Nutrients, 11.","DOI":"10.3390\/nu11051027"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jtemb.2015.11.001","article-title":"Serum zinc and risk of type 2 diabetes incidence in men: The Kuopio Ischaemic Heart Disease Risk Factor Study","volume":"33","author":"Yary","year":"2016","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.orcp.2023.06.003","article-title":"Effect of zinc supplementation on blood sugar control in the overweight and obese population: A systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Yang","year":"2023","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1334S","DOI":"10.1093\/ajcn\/71.5.1334s","article-title":"Determinants of maternal zinc status during pregnancy","volume":"71","author":"King","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1002\/jtra.10042","article-title":"Zinc is essential for brain development and function","volume":"16","author":"Sandstead","year":"2003","journal-title":"J. Trace Elem. Exp. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1139\/apnm-2017-0521","article-title":"Magnesium-zinc-calcium-vitamin D co-supplementation improves glycemic control and markers of cardiometabolic risk in gestational diabetes: A randomized, double-blind, placebo-controlled trial","volume":"43","author":"Karamali","year":"2018","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Li, D., Cai, Z., Pan, Z., Yang, Y., and Zhang, J. (2021). The effects of vitamin and mineral supplementation on women with gestational diabetes mellitus. BMC Endocr. Disord., 21.","DOI":"10.1186\/s12902-021-00712-x"},{"key":"ref_21","first-page":"157","article-title":"Estimation of serum zinc, copper and magnesium levels in bangladeshi women with gestational diabetes mellitus attending in a tertiary care hospital","volume":"28","author":"Mishu","year":"2019","journal-title":"Mymensingh Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e13239","DOI":"10.1111\/mcn.13239","article-title":"Is serum zinc status related to gestational diabetes mellitus? A meta-analysis","volume":"17","author":"Fan","year":"2021","journal-title":"Matern. Child. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.3892\/etm.2021.10829","article-title":"Zinc status, insulin resistance and glycoxidative stress in elderly subjects with type 2 diabetes mellitus","volume":"22","author":"Ungurianu","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Dubey, P., Thakur, V., and Chattopadhyay, M. (2020). Role of minerals and trace elements in diabetes and insulin resistance. Nutrients, 12.","DOI":"10.3390\/nu12061864"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/2251-6581-13-16","article-title":"Metals in the pathogenesis of type 2 diabetes","volume":"13","author":"Khan","year":"2014","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"567","DOI":"10.3109\/01443615.2014.919576","article-title":"Zinc and selenium levels in women with gestational diabetes mellitus at Medani Hospital, Sudan","volume":"34","author":"Hamdan","year":"2014","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wilson, R.L., Grieger, J.A., Bianco-Miotto, T., and Roberts, C.T. (2016). Association between maternal zinc status, dietary zinc intake and pregnancy complications: A systematic review. Nutrients, 8.","DOI":"10.3390\/nu8100641"},{"key":"ref_29","first-page":"661","article-title":"Plasma and Intracellular Erythocyte Zinc Levels during Pregnancy in Bulgarian Females with and without Gestational Diabetes","volume":"2","author":"Genova","year":"2014","journal-title":"Int. J. Adv. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Deng, G., Chen, H., Liu, Y., Zhou, Y., Lin, X., Wei, Y., Sun, R., Zhang, Z., and Huang, Z. (2023). Combined exposure to multiple essential elements and cadmium at early pregnancy on gestational diabetes mellitus: A prospective cohort study. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1278617"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1385\/BTER:88:2:113","article-title":"Elemental contents in serum of pregnant women with gestational diabetes mellitus","volume":"88","author":"Wang","year":"2002","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lewandowska, M., Wi\u0119ckowska, B., Sajdak, S., and Lubi\u0144ski, J. (2020). First trimester microelements and their relationships with pregnancy outcomes and complications. Nutrients, 12.","DOI":"10.3390\/nu12041108"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s12011-009-8482-y","article-title":"Blood copper, zinc, calcium, and magnesium levels during different duration of pregnancy in Chinese","volume":"135","author":"Liu","year":"2010","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"679S","DOI":"10.3945\/ajcn.110.005744","article-title":"Zinc: An essential but elusive nutrient","volume":"94","author":"King","year":"2011","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Grieger, J.A., Grzeskowiak, L.E., Wilson, R.L., Bianco-Miotto, T., Leemaqz, S.Y., Jankovic-Karasoulos, T., Perkins, A.V., Norman, R.J., Dekker, G.A., and Roberts, C.T. (2019). Maternal Selenium, Copper and Zinc Concentrations in Early Pregnancy, and the Association with Fertility. Nutrients, 11.","DOI":"10.3390\/nu11071609"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Liu, X.B., Lu, J.X., Wang, L.J., Hu, Y.C., Wang, R., Mao, D.Q., Huang, J., Zhao, L.Y., Yang, X.G., and Yang, L.C. (2021). Evaluation of Serum Zinc Status of Pregnant Women in the China Adult Chronic Disease and Nutrition Surveillance (CACDNS) 2015. Nutrients, 13.","DOI":"10.3390\/nu13041375"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Liu, X., Zhang, Y., Piao, J., Mao, D., Li, Y., Li, W., Yang, L., and Yang, X. (2017). Reference Values of 14 Serum Trace Elements for Pregnant Chinese Women: A Cross-Sectional Study in the China Nutrition and Health Survey 2010\u20132012. Nutrients, 9.","DOI":"10.3390\/nu9030309"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"109208","DOI":"10.1016\/j.envres.2020.109208","article-title":"Characterization of trace elements exposure in pregnant women in the United States, NHANES 1999\u20132016","volume":"183","author":"Watson","year":"2020","journal-title":"Environ. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jtemb.2007.09.023","article-title":"Updating of normal levels of copper, zinc and selenium in serum of pregnant women","volume":"21","author":"Ruata","year":"2007","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1017\/S000711452000255X","article-title":"Plasma mineral (selenium, zinc or copper) concentrations in the general pregnant population, adjusted for supplement intake, in relation to thyroid function","volume":"125","author":"Pop","year":"2021","journal-title":"Br. J. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Choi, R., Sun, J., Yoo, H., Kim, S., Cho, Y.Y., Kim, H.J., Kim, S.W., Chung, J.H., Oh, S.Y., and Lee, S.Y. (2016). A prospective study of serum trace elements in healthy Korean pregnant women. Nutrients, 8.","DOI":"10.3390\/nu8110749"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jtemb.2012.04.003","article-title":"The relationship between zinc intake and serum\/plasma zinc concentration in pregnant and lactating women: A systematic review with dose-response meta-analyses","volume":"26","author":"Moran","year":"2012","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.abb.2016.05.022","article-title":"Zinc and diabetes","volume":"611","author":"Chabosseau","year":"2016","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s12011-018-1611-8","article-title":"Nutritional effects of zinc on metabolic syndrome and type 2 diabetes: Mechanisms and main findings in human studies","volume":"188","author":"Ruz","year":"2019","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Norouzi, S., Adulcikas, J., Sohal, S.S., and Myers, S. (2018). Zinc stimulates glucose oxidation and glycemic control by modulating the insulin signaling pathway in human and mouse skeletal muscle cell lines. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0191727"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1089\/met.2010.0020","article-title":"Effect of zinc supplementation on markers of insulin resistance, oxidative stress, and inflammation among prepubescent children with metabolic syndrome","volume":"8","author":"Kelishadi","year":"2010","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s40199-015-0127-4","article-title":"Zinc and diabetes mellitus: Understanding molecular mechanisms and clinical implications","volume":"23","author":"Ranasinghe","year":"2015","journal-title":"DARU J. Pharm. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jinorgbio.2012.11.006","article-title":"Insulino-mimetic and anti-diabetic effects of zinc","volume":"120","author":"Vardatsikos","year":"2013","journal-title":"J. Inorg. Biochem."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"6376","DOI":"10.1074\/jbc.M114.623736","article-title":"Zinc finger protein 407 (ZFP407) regulates insulin-stimulated glucose uptake and glucose transporter 4 (Glut4) mRNA","volume":"290","author":"Buchner","year":"2015","journal-title":"J. Biol. Chem."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Vashum, K.P., McEvoy, M., Milton, A.H., Islam, M.R., Hancock, S., and Attia, J. (2014). Is Serum Zinc Associated with Pancreatic Beta Cell Function and Insulin Sensitivity in Pre-Diabetic and Normal Individuals? Findings from the Hunter Community Study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0083944"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s13098-024-01366-0","article-title":"Diabetology Metabolic Syndrome","volume":"16","author":"Daneshvar","year":"2024","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1080\/14767058.2019.1659769","article-title":"The influence of zinc supplementation on metabolic status in gestational diabetes: A meta-analysis of randomized controlled studies","volume":"34","author":"Li","year":"2021","journal-title":"J. Matern. -Fetal Neonatal Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/advances\/nmaa087","article-title":"Effects of dose and duration of zinc interventions on risk factors for type 2 diabetes and cardiovascular disease: A systematic review and meta-analysis","volume":"12","author":"Pompano","year":"2021","journal-title":"Adv. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s12011-019-01870-9","article-title":"Effects of zinc supplementation on cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled trials","volume":"195","author":"Khazdouz","year":"2020","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2966","DOI":"10.1007\/s12011-023-03895-7","article-title":"Zinc supplementation in individuals with pre\u2013diabetes and type 2 diabetes: A GRADE-assessed systematic review and dose-response meta-analysis","volume":"202","author":"Nazari","year":"2023","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1017\/S0007114522002616","article-title":"Triangulating evidence for the causal impact of single-intervention zinc supplement on glycaemic control for type 2 diabetes: Systematic review and meta-analysis of randomised controlled trial and two-sample Mendelian randomisation","volume":"129","author":"Wang","year":"2023","journal-title":"Br. J. Nutr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"108627","DOI":"10.1016\/j.diabres.2020.108627","article-title":"Effect of serum zinc and copper levels on insulin secretion, insulin resistance and pancreatic \u03b2 cell dysfunction in US adults: Findings from the National Health and Nutrition Examination Survey (NHANES) 2011\u20132012","volume":"172","author":"Kant","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/ajcn\/nqz041","article-title":"Zinc supplementation improves glycemic control for diabetes prevention and management: A systematic review and meta-analysis of randomized controlled trials","volume":"110","author":"Wang","year":"2019","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jtemb.2016.12.017","article-title":"Alterations of serum trace elements in patients with type 2 diabetes","volume":"40","author":"Zhang","year":"2017","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_60","first-page":"357","article-title":"Relationship of Serum Glycemic Status with Serum Zinc Level in Type 2 Diabetes Mellitus","volume":"29","author":"Eva","year":"2020","journal-title":"Mymensingh Med. J."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Zhu, G., Zheng, T., Xia, C., Qi, L., Papandonatos, G.D., Ming, Y., Zeng, Z., Zhang, X., Zhang, H., and Li, Y. (2021). Plasma levels of trace element status in early pregnancy and the risk of gestational diabetes mellitus: A nested case-control study. J. Trace Elem. Med. Biol., 68.","DOI":"10.1016\/j.jtemb.2021.126829"},{"key":"ref_62","first-page":"CD000230","article-title":"Zinc supplementation for improving pregnancy and infant outcome","volume":"3","author":"Carducci","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_63","first-page":"191","article-title":"Zinc and insulin resistance in pregnancy complicated with gestational diabetes","volume":"6","author":"Genova","year":"2016","journal-title":"Int. J. Health Sci. Res."},{"key":"ref_64","first-page":"231","article-title":"A Study on the Association of Copper and Zinc Serum Levels with Insulin Resistance Indices in Gestational Diabetes","volume":"10","author":"Moghaddam","year":"2020","journal-title":"Int. J. Pharm. Phytopharm. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.3945\/jn.117.248013","article-title":"Zinc Supplementation Does Not Alter Indicators of Insulin Secretion and Sensitivity in Black and White Female Adolescents","volume":"147","author":"Lobene","year":"2017","journal-title":"J. Nutr."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. J. Am. Med. Assoc., 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"318","DOI":"10.4093\/dmj.2016.40.4.318","article-title":"Comparison of the Usefulness of the Updated Homeostasis Model Assessment (HOMA2) with the Original HOMA1 in the Prediction of Type 2 Diabetes Mellitus in Koreans","volume":"40","author":"Song","year":"2016","journal-title":"Diabetes Metab. J."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/22\/12193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:31:35Z","timestamp":1760113895000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/22\/12193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,13]]},"references-count":67,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["ijms252212193"],"URL":"https:\/\/doi.org\/10.3390\/ijms252212193","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,13]]}}}