Maternal early pregnancy dietary glycemic index and load, fetal growth, and the risk of adverse birth outcomes

Abstract

Purpose Maternal hyperglycemia is associated with adverse birth outcomes. Maternal dietary glycemic index and load influence postprandial glucose concentrations. We examined the associations of maternal early pregnancy dietary glycemic index and load with fetal growth and risks of adverse birth outcomes. Methods In a population-based cohort study of 3471 pregnant Dutch women, we assessed dietary glycemic index and load using a food frequency questionnaire at median 13.4 (95% range 10.6; 21.2) weeks gestation. We measured fetal growth in mid-and late-pregnancy by ultrasound and obtained birth outcomes from medical records. Results Mean maternal early pregnancy dietary glycemic index and load were 57.7 (SD 3.3, 95% range 52.8; 63.5) and 155 (SD 47, 95% range 87; 243), respectively. Maternal early pregnancy dietary glycemic index was not associated with fetal growth parameters. A higher maternal early pregnancy dietary glycemic load was associated with a higher fetal abdominal circumference and estimated fetal weight in late-pregnancy (p values < 0.05), but not with mid-pregnancy or birth growth characteristics. A higher maternal early pregnancy dietary glycemic index was associated with a lower risk of a large-forgestational-age infant (p value < 0.05). Maternal early pregnancy glycemic index and load were not associated with other adverse birth outcomes. Conclusion Among pregnant women without an impaired glucose metabolism, a higher early pregnancy dietary glycemic load was associated with higher late-pregnancy fetal abdominal circumference and estimated fetal weight. No consistent associations of maternal dietary glycemic index and load with growth parameters in mid-pregnancy and at birth were present. A higher glycemic index was associated with a lower risk of a large-for-gestational-age infant.

Epigenetic Changes in Neonates Born to Mothers With Gestational Diabetes Mellitus May Be Associated With Neonatal Hypoglycaemia

“…In this study, about half of the mothers were diagnosed with GDM after 24 gestational weeks. However, since we thought they might have had potential hyperglycaemia from the early stages of pregnancy according to previous reports (16)(17)(18), the DNA methylation status in cord blood cells was associated with neonatal PG at 1 h after birth. This is the first study investigating the possible association between the offspring epigenome with hypoglycaemia in neonates born to mothers with GDM.…”

“…It indicates that early-pregnancy high glucose (before GDM diagnosis) may be involved in neonatal hypoglycaemia and influence adverse foetal tissue development. Furthermore, higher maternal dietary glycaemic index and glycaemic load during early pregnancy are associated with a larger foetal abdominal circumference in late-pregnancy or offspring fat mass, even at the age of 4–6 years ( 16 , 17 ). Besides, fluctuating glucose and insulin concentrations during early pregnancy are associated with childhood glucose and insulin levels ( 18 ).…”

Maternal Dietary Quality and Dietary Inflammation Associations with Offspring Growth, Placental Development, and DNA Methylation

“…Special attention is warranted for the impact of carbohydrate intake in those with poor glycaemic control and at risk of gestational diabetes mellitus (GDM). During pregnancy, glucose transfer mainly occurs in the postprandial state, and glucose concentrations are determined by the carbohydrate foods [ 35 , 36 ]. The glycaemic index (GI) and glycaemic load (GL) qualify and quantify the postprandial glycaemic responses according to the dietary carbohydrate intake.…”

“…Many systematic reviews have established the links between dietary GI/GL and the risk of chronic disease (such as T2DM, CVD and various cancers) but maternal carbohydrate quality has received relatively little attention [ 38 , 39 ]. Hence, further research is required in establishing the optimum timing to start a low-glycaemic index (GI) or glycaemic load (GL) diet for maximum protection against adverse pregnancy outcomes, in terms of insulin sensitivity, for both mother and infant [ 35 , 40 ].…”

“…No differences between groups were reported in birth weight or 6-month offspring adiposity [ 81 , 113 ], whereas another RCT conducted in women with diabetes showed a trend of lower birth weight after a low GI carbohydrate intervention compared to all types of carbohydrates [ 112 ]. Other observational studies reported controversial results between GI/GL and birth outcomes [ 35 , 38 , 40 , 83 ]. A prospective cohort in Ireland evaluated the associations between maternal GI, GL, insulinemic index/load (II, IL) and offspring birth outcomes.…”