Titanium exposure and gestational diabetes mellitus: associations and potential mediation by perturbation of amino acids in early pregnancy

Table 2 Mediation analyses of titanium-related metabolites on the associations between urinary titanium exposure and risk of GDM

Mediator	Dependent variable	Direct effects		Indirect effects		Proportion mediated
Mediator	Dependent variable	RR (95% CI)	P	RR (95% CI)	P	%	P
Choline	GDM	1.23 (1.00, 1.53)	0.050	1.05 (1.01, 1.10)	0.008	21.2%	0.024
Creatine	GDM	1.27 (1.03, 1.57)	0.028	1.03 (1.01, 1.07)	0.002	12.5%	0.016
L-Glutamine	GDM	1.25 (1.01, 1.55)	0.038	1.04 (1.00, 1.11)	0.088	17.5%	0.104
L-Alanine	GDM	1.22 (0.99, 1.52)	0.066	1.06 (1.02, 1.12)	0.006	25.7%	0.022
N-Acetylglutamic acid	GDM	1.29 (1.04, 1.58)	0.020	1.01 (1.00, 1.04)	0.096	5.1%	0.108

GDM gestational diabetes mellitus, RR relative risk, CI confidential interval. The covariates adjusted for in the mediation analyses included study center, maternal age at recruitment, pre-pregnancy BMI, residence area, household income, maternal education, parity

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