Risk of gestational diabetes mellitus in relation to maternal dietary calcium intake

Abstract

Objective-In this study, sought to examine the association between dietary calcium intake and risk of gestational diabetes mellitus (GDM).Design-We assessed periconceptional (i.e., before conception and early pregnancy) calcium intake and consumption of foods rich in calcium using a food frequency questionnaire among 3,414 participants in a prospective cohort study. Diagnoses of GDM were abstracted from medical records. We used multivariable generalized linear regression models to derive estimates of relative risks (RRs) for GDM and 95% confidence intervals (95% CIs).Setting-A prospective cohort of women in Seattle and Tacoma, Washington State, USA. Subjects-3,414 womenResults-A total of 169 GDM incident cases were identified in this cohort (4.96%). Higher dietary calcium intake was inversely, although not statistically significantly, associated with GDM risk. After adjusting for confounders, the RRs (95% CI) for GDM according to successive increasing quartiles of calcium intake were 1.00, 0.63 (95% CI 0.41-0.98), 0.66 (95% CI 0.39-1.11), and 0.57 (95% CI 0.27-1.21), with the lowest quartile as the reference (P trend =0.131). Compared with women in the first quartile for calcium intake, women in the higher three quartiles (≥ 795 vs. < 795 mg/day) had a 42% (RR=0.58; 95% CI 0.38-0.90; P-value=0.015) lower GDM Conflict of InterestNo potential conflicts of interest relevant to this article were reported. Ethical Standards DisclosureThis study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the Institutional Review Boards of the study hospitals. Written informed consent was obtained from all the subjects. AuthorshipMAW designed the study and obtained funding for the study. COY, QC and MAW analyzed data and drafted the manuscript. COY, MAW, BG, QC, and DE reviewed and edited the manuscript. COY, QC, and MAW had full access to all the data in the study and take responsibility for the integrity of the data, the accuracy of data analysis, and the decision to submit for publication. Conclusions-These findings suggest that higher levels of periconceptional calcium intake, particularly intake of calcium rich low-fat dairy products and whole grains, are associated with lower GDM risk. HHS Public Access

Associations of Diet and Physical Activity with Risk for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…Of these 40 articles, 23 reported data only on dietary intake, 15 only on PA and two articles reported on both dietary intake and PA. Twenty-nine studies (72%) obtained a positive quality rating and 11 (28%) were rated neutral ( Table S2 ). All the articles reported findings from prospective cohort studies of which there were multiple publications from four major studies including Nurses’ Health Study II ( n = 14) [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], Omega ( n = 7) [ 38 , 39 , 40 , 41 , 42 , 43 , 44 ], Australian Longitudinal Study on Women’s Health ( n = 4) [ 45 , 46 , 47 , 48 ] and Project Viva ( n = 2) [ 49 , 50 ]. The most common reasons for exclusion of publications were unavailability of full texts, no relevant data collected necessary for the present review and late recruitment of study participants, consequently capturing dietary and PA information that were not reflective of the pre-pregnancy or early pregnancy period.…”

“…The review captured data on 30,871 pregnancies of which 1980 (7%) developed GDM. The studies provided information on women from multiple populations including 26 American [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 48 , 49 , 51 , 52 , 53 ], five Australian [ 45 , 46 , 47 , 48 , 54 ], two Hispanic American [ 55 , 56 ] and one each for the following: Iranian [ 57 ], Danish [ 58 ], Canadian [ 59 ], Pakistani [ 60 ], Norwegian [ 61 ], Spanish [ 62 ], and multi-centre Mediterranean Study (Algeria, France, Greece, Italy, Lebanon, Malta, Morocco, Serbia, Syria and Tunisia) [ 63 ], The number of participants per study ranged from 97 to 71,239 and were published between 1997–2016, with an age range of 16–48 years as reported in 27 studies. Of 22 studies that reported retention rate, 14 had ≥80% [ 38 , 40 , 44 , 47 , 49 , …”

“…The reported GDM diagnostic methods included a 100 g ( n = 12) [ 38 , 40 , 41 , 42 , 43 , 49 , 50 , 53 , 55 , 56 , 57 , 60 ], 75 g ( n = 5) [ 47 , 48 , 54 , 61 , 63 ], 50 g ( n = 1) [ 51 ], a combination of these ( n = 2) [ 59 , 62 ] oral glucose tolerance tests (OGTT) or were extrapolated from medical records ( n = 20) [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 44 , 45 , 46 , 52 , 58 , 64 ]. Multiple diagnostic criteria were used to ascertain GDM status and included (1) 1997 American Diabetes Association (ADA) criteria ( n = 2; fasting ≥ 105 mg·dL −1 , 1 h ≥ 190 mg·dL −1 , 2 h ≥ 165 mg·dL −1 , ≥145 mg·dL −1 ) [ 39 , 40 ], (2) 2004 ADA criteria ( n = 10; fasting ≥ 95 mg·dL −1 , 1 h ≥ 180 mg·dL −1 , 2 h ≥ 155 mg·dL −1 ≥ 140 mg·dL −1 ) [ 41 ,…”

“…Multiple diagnostic criteria were used to ascertain GDM status and included (1) 1997 American Diabetes Association (ADA) criteria ( n = 2; fasting ≥ 105 mg·dL −1 , 1 h ≥ 190 mg·dL −1 , 2 h ≥ 165 mg·dL −1 , ≥145 mg·dL −1 ) [ 39 , 40 ], (2) 2004 ADA criteria ( n = 10; fasting ≥ 95 mg·dL −1 , 1 h ≥ 180 mg·dL −1 , 2 h ≥ 155 mg·dL −1 ≥ 140 mg·dL −1 ) [ 41 , 42 , 43 , 49 , 50 , 55 , 56 , 57 , 60 , 62 ], (3) 2010 International Association of the Diabetes and Pregnancy Study Group (IADPSG) criteria ( n = 3; fasting ≥ 5.1 mmol·L −1 , 1 h ≥ 10.0 mmol·L −1 , ≥ 8.5 mmol·L −1 ) [ 54 , 61 , 63 ], (4) 1998 Australasian Diabetes in Pregnancy Society (ADIPS) criteria ( n = 3; fasting ≥ 5.6 mmol·L −1 and/or 2-h ≥ 8.0 mmol·L −1 ) [ 46 , 47 , 48 ] or were not reported ( n = 22) [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 44 , 45 , 51 , 52 , 53 , 58 , 59 ]. Thirty-six studies reported on pre-pregnancy body mass index (BMI), of which 20 were within the normal range [ …”

“…Thirty-six studies reported on pre-pregnancy body mass index (BMI), of which 20 were within the normal range [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 33 , 34 , 35 , 36 , 39 , 41 , 42 , 43 , 49 , 57 , 61 , 62 ], one overweight [ 51 ], one obese [ 54 ] and 14 were categorised into multiple groups [ 32 , 37 , 40 , 47 , 48 , 50 , 52 , 53 , 55 , 56 , 58 , 59 , 60 , 63 ] rather than providing an overall average. Twenty-two publications reported data from the pre-pregnancy period [ 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 41 , …”