Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Carbohydrates, glycemic index and diabetes mellitus

Association between healthy maternal dietary pattern and risk for gestational diabetes mellitus

Abstract

Background/Objectives:

Gestational diabetes mellitus (GDM) is associated with negative health effects for mother and child. The aim was to investigate the association between maternal dietary patterns and GDM.

Subjects/Methods:

Prospective observational study including 168 pregnant women aged 18–40 years, recruited at routine 20-week ultrasound. All participants kept a 4-day weighed food record following recruitment (commencement: gestational weeks 19–24). Principal component analysis was used to extract dietary patterns from 29 food groups. A Healthy Eating Index (HEI) was constructed. All women underwent an oral glucose tolerance test in weeks 23–28.

Results:

One clear dietary pattern (Eigenvalue 2.4) was extracted with positive factor loadings for seafood; eggs; vegetables; fruits and berries; vegetable oils; nuts and seeds; pasta; breakfast cereals; and coffee, tea and cocoa powder, and negative factor loadings for soft drinks and French fries. This pattern was labeled a prudent dietary pattern. Explained variance was 8.2%. The prevalence of GDM was 2.3% among women of normal weight before pregnancy (n=86) and 18.3% among overweight/obese women (n=82). The prudent dietary pattern was associated with lower risk of GDM (OR: 0.54; 95% CI: 0.30, 0.98). When adjusting for age, parity, prepregnancy weight, energy intake, weekly weight gain and total metabolic equivalent of task the association remained (OR: 0.36; 95% CI: 0.14, 0.94). Similar results were found when only including overweight or obese women (OR: 0.31; 95% CI: 0.13, 0.75).

Conclusions:

Adhering to a prudent dietary pattern in pregnancy was clearly associated with lower risk of GDM, especially among women already at higher risk because of overweight/obesity before pregnancy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Cheung NW, Byth K . Population health significance of gestational diabetes. Diabet Care 2003; 26: 2005–2009.

    Article  Google Scholar 

  2. Buchanan TA, Xiang AH, Page KA . Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev 2012; 8: 639–649.

    CAS  Google Scholar 

  3. Ratner RE, Christophi CA, Metzger BE, Dabelea D, Bennett PH, Pi-Sunyer X et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008; 93: 4774–4779.

    Article  CAS  Google Scholar 

  4. Ben-Haroush A, Yogev Y, Hod M . Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabet Med 2004; 21: 103–113.

    Article  CAS  Google Scholar 

  5. Fadl HE, Ostlund IK, Magnuson AF, Hanson US . Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. Diabet Med 2010; 27: 436–441.

    Article  CAS  Google Scholar 

  6. Yogev Y, Visser GH . Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med 2009; 14: 77–84.

    Article  Google Scholar 

  7. Mitanchez D, Burguet A, Simeoni U . Infants born to mothers with gestational diabetes mellitus: mild neonatal effects, a long-term threat to global health. J Pediatr 2014; 164: 445–450.

    Article  Google Scholar 

  8. Negrato CA, Mattar R, Gomes MB . Adverse pregnancy outcomes in women with diabetes. Diabetol Metabol Syndr 2012; 4: 41.

    Article  Google Scholar 

  9. Boden G . Fuel metabolism in pregnancy and in gestational diabetes mellitus. Obstet Gynecol Clin North Am 1996; 23: 1–10.

    Article  CAS  Google Scholar 

  10. Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes 2000; 49: 2208–2211.

    Article  CAS  Google Scholar 

  11. Dabelea D, Knowler WC, Pettitt DJ . Effect of diabetes in pregnancy on offspring: follow-up research in the Pima Indians. J Matern-Fetal Med 2000; 9: 83–88.

    CAS  PubMed  Google Scholar 

  12. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ . Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabet Care 2007; 30: 2287–2292.

    Article  Google Scholar 

  13. Bottalico JN . Recurrent gestational diabetes: risk factors, diagnosis, management, and implications. Semin Perinatol 2007; 31: 176–184.

    Article  Google Scholar 

  14. Cypryk K, Pertynska-Marczewska M, Szymczak W, Zawodniak-Szalapska M, Wilczynski J, Lewinski A . [Overweight and obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type-2 diabetes in mothers]. Przeglad lekarski 2005; 62: 38–41.

    PubMed  Google Scholar 

  15. Olafsdottir AS, Skuladottir GV, Thorsdottir I, Hauksson A, Steingrimsdottir L . Maternal diet in early and late pregnancy in relation to weight gain. Int J Obes (Lond) 2006; 30: 492–499.

    Article  CAS  Google Scholar 

  16. Liu Z, Ao D, Yang H, Wang Y . Gestational weight gain and risk of gestational diabetes mellitus among Chinese women. Chinese Med J 2014; 127: 1255–1260.

    Google Scholar 

  17. Hedderson MM, Gunderson EP, Ferrara A . Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol 2010; 115: 597–604.

    Article  Google Scholar 

  18. Ying H, Wang DF . [Effects of dietary fat on onset of gestational diabetes mellitus]. Zhonghua fu chan ke za zhi 2006; 41: 729–731.

    PubMed  Google Scholar 

  19. Jing X, Qiao R, Li M, Liu X, Kang D, Huang C . [Gestational diabetes mellitus and the lifestyle and dietary structure of pregnant women: a case-control study]. Wei sheng yan jiu=J Hygiene Res 2010; 39: 209–211, 227.

    Google Scholar 

  20. Park S, Kim MY, Baik SH, Woo JT, Kwon YJ, Daily JW et al. Gestational diabetes is associated with high energy and saturated fat intakes and with low plasma visfatin and adiponectin levels independent of prepregnancy BMI. Eur J Clin Nutr 2013; 67: 196–201.

    Article  CAS  Google Scholar 

  21. Bo S, Menato G, Lezo A, Signorile A, Bardelli C, De Michieli F et al. Dietary fat and gestational hyperglycaemia. Diabetologia 2001; 44: 972–978.

    Article  CAS  Google Scholar 

  22. Saldana TM, Siega-Riz AM, Adair LS . Effect of macronutrient intake on the development of glucose intolerance during pregnancy. Am J Clin Nutr 2004; 79: 479–486.

    Article  CAS  Google Scholar 

  23. Chen L, Hu FB, Yeung E, Willett W, Zhang C . Prospective study of pre-gravid sugar-sweetened beverage consumption and the risk of gestational diabetes mellitus. Diabet Care 2009; 32: 2236–2241.

    Article  CAS  Google Scholar 

  24. Ley SH, Hanley AJ, Retnakaran R, Sermer M, Zinman B, O'Connor DL . Effect of macronutrient intake during the second trimester on glucose metabolism later in pregnancy. Am J Clin Nutr 2011; 94: 1232–1240.

    Article  CAS  Google Scholar 

  25. Kant AK . Dietary patterns: biomarkers and chronic disease risk. Appl Physiol Nutr Metab=Physiologie appliquee, nutrition et metabolisme 2010; 35: 199–206.

    Article  Google Scholar 

  26. Nordic Council of Ministers Nordic Nutrition Recommendations 2012. 2014.

  27. Englund-Ogge L, Brantsaeter AL, Sengpiel V, Haugen M, Birgisdottir BE, Myhre R et al. Maternal dietary patterns and preterm delivery: results from large prospective cohort study. BMJ 2014; 348: g1446.

    Article  Google Scholar 

  28. He JR, Yuan MY, Chen NN, Lu JH, Hu CY, Mai WB et al. Maternal dietary patterns and gestational diabetes mellitus: a large prospective cohort study in China. Br J Nutr 2015; 113: 1292–1300.

    Article  CAS  Google Scholar 

  29. Bai J, Wong FW, Bauman A, Mohsin M . Parity and pregnancy outcomes. Am J Obstet Gynecol 2002; 186: 274–278.

    Article  Google Scholar 

  30. Haines PS, Hama MY, Guilkey DK, Popkin BM . Weekend eating in the United States is linked with greater energy, fat, and alcohol intake. Obes Res 2003; 11: 945–949.

    Article  Google Scholar 

  31. R&D Ml-IFaB. Matís ltd. – Icelandic Food and Biotech R&D. Available from: http://www.matis.is/english/ (accessed 2 July 2015).

  32. Icelandic Directorate of Health. Dietary guidelines for adults and children from the age of two. Available from: http://www.landlaeknir.is/servlet/file/store93/item25796/radleggingar-um-mataraedi-2015.pdf (accessed 2 July 2015).

  33. Wallace TM, Levy JC, Matthews DR . Use and abuse of HOMA modeling. Diabet Care 2004; 27: 1487–1495.

    Article  Google Scholar 

  34. World Health Organization Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva, 2013.

  35. Committee IR. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ)–short and long forms. Retrieved September 2005; 17: 2008.

    Google Scholar 

  36. Newby PK, Tucker KL . Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev 2004; 62: 177–203.

    Article  CAS  Google Scholar 

  37. Asemi Z, Tabassi Z, Samimi M, Fahiminejad T, Esmaillzadeh A . Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Br J Nutr 2013; 109: 2024–2030.

    Article  CAS  Google Scholar 

  38. Bain E, Crane M, Tieu J, Han S, Crowther CA, Middleton P . Diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2015; 4: CD010443.

    Google Scholar 

  39. Crozier SR, Robinson SM, Godfrey KM, Cooper C, Inskip HM . Women's dietary patterns change little from before to during pregnancy. J Nutr 2009; 139: 1956–1963.

    Article  CAS  Google Scholar 

  40. Karamanos B, Thanopoulou A, Anastasiou E, Assaad-Khalil S, Albache N, Bachaoui M et al. Relation of the Mediterranean diet with the incidence of gestational diabetes. Eur J Clin Nutr 2014; 68: 8–13.

    Article  CAS  Google Scholar 

  41. Zhang C, Liu S, Solomon CG, Hu FB . Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabet Care 2006; 29: 2223–2230.

    Article  CAS  Google Scholar 

  42. Tobias DK, Zhang C, Chavarro J, Bowers K, Rich-Edwards J, Rosner B et al. Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus. Am J Clin Nutr 2012; 96: 289–295.

    Article  CAS  Google Scholar 

  43. Wang Y, Storlien LH, Jenkins AB, Tapsell LC, Jin Y, Pan JF et al. Dietary variables and glucose tolerance in pregnancy. Diabet Care 2000; 23: 460–464.

    Article  CAS  Google Scholar 

  44. Gillman MW, Pinto BM, Tennstedt S, Glanz K, Marcus B, Friedman RH . Relationships of physical activity with dietary behaviors among adults. Prev Med 2001; 32: 295–301.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The study was funded by the University of Iceland Research Fund and the Landspitali National University Hospital Research Fund.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E A Tryggvadottir.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tryggvadottir, E., Medek, H., Birgisdottir, B. et al. Association between healthy maternal dietary pattern and risk for gestational diabetes mellitus. Eur J Clin Nutr 70, 237–242 (2016). https://doi.org/10.1038/ejcn.2015.145

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.145

This article is cited by

Search

Quick links