Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus

Abstract

Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16–41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003–2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: “high refined grains, fats, oils and fruit juice”, “high nuts, seeds, fat and soybean; low milk and cheese”, and “high added sugar and organ meats; low fruits, vegetables and seafood”. GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4–17.0) for “high refined grains, fats, oils and fruit juice” pattern, 7.5 (1.8–32.3) for “high nuts, seeds, fat and soybean; low milk and cheese” pattern, and 22.3 (3.9–127.4) for “high added sugar and organ meats; low fruits, vegetables and seafood” pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log-transformed CRP. These findings suggest that dietary patterns during pregnancy are associated with risk of GDM after controlling for potential confounders. The observed connection between a high consumption of refined grains, fat, added sugars and low intake of fruits and vegetables during pregnancy with higher odds for GDM, are consistent with general health benefits of healthy diets, but warrants further research to understand underlying pathophysiology of GDM associated with dietary behaviors during pregnancy.

Association of a plant‐based dietary pattern in relation to gestational diabetes mellitus

“…22,44 Although we did not find a significant association between tertiles of uPDI and GDM in the present study, elevated risk of GDM has been reported in other studies. 6,20,43 It is possible that this is because of lowest tertile of uPDI still having average fasting blood glucose above the cut-off for GDM, making it challenging to look at differences in GDM outcomes. Although the exact mechanism through which plant-based diets might affect GDM is not well understood, several suggestions have been made.…”

“…The prevalence of GDM has increased steadily, with 14% of pregnancies in USA, 5.7% of pregnancies in Australia, and 5–10% of pregnancies in Asian countries presenting with GDM. In Iran, the prevalence of GDM has been estimated at 3.4% of all annual pregnancies . GDM is considered as a significant risk factor for several other comorbidities in both mothers and their newborns …”

“…In Iran, the prevalence of GDM has been estimated at 3.4% of all annual pregnancies. 3,[6][7][8] GDM is considered as a significant risk factor for several other comorbidities in both mothers and their newborns. 9 Several genetic and environmental factors including age at pregnancy, family history of diabetes, race or ethnicity, obesity and overweight, and low physical activity are associated with GDM.…”

Risk of gestational diabetes mellitus: which lifestyle parameters should be changed?

“…Эти данные находят подтвержде-ние в ряде работ иностранных авторов [13,14]. Напри-мер, в исследовании здоровья медицинских сестер тип питания, характеризующийся наименьшим уровнем потребления фруктов и овощей, был ассоциирован с по-вышением риска развития ГСД по сравнению с женщи-нами с наибольшим уровнем потребления [15].…”

What the Health? Information Sources and Maternal Lifestyle Behaviors (Preprint)

“…Regular physical activity (PA), adequate gestational weight gain (GWG) and healthy eating may lower the incidence and severity of serious conditions associated with pregnancy, including, gestational diabetes mellitus [1][2][3], pregnancy-induced hypertension [2], macrosomia [1] and small for gestational age infants [4]. In addition, daily exercise for the pelvic floor muscles may prevent and treat urinary incontinence [5].…”