A Vitamin Pattern Diet Is Associated with Decreased Risk of Gestational Diabetes Mellitus in Chinese Women: Results from a Case Control Study in Taiyuan, China

Abstract

Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM. Therefore, we examined the dietary nutrient patterns and evaluated their relationship with GDM risk in a Chinese population using a case control study design. A total of 1,464 GDM cases and 8,092 non-GDM controls were included in the final analysis. Dietary intake was assessed using a 33-item food frequency questionnaire, and nutrients were estimated using the Chinese Standard Tables of Food Consumption. Dietary nutrient patterns were identified using factor analysis, and their associations with GDM risk were evaluated using unconditional logistic regression models adjusting for total energy intake, maternal age, high blood pressure, education, maternal body mass index (BMI), parity, and family history of diabetes. A “vitamin” nutrient pattern was characterized as the consumption of diet rich in vitamin A, carotene, vitamin B2, vitamin B6, vitamin C, dietary fiber, folate, calcium, and potassium. For every quartile increase in the vitamin factor score during one year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk decreased by 9% (OR: 0.91, 95%CI: 0.86-0.96), 9% (OR: 0.91, 95%CI: 0.86-0.96), and 10% (OR: 0.90, 95%CI: 0.85-0.95), respectively. The significant reduced GDM risk was seen in women regardless of age and parity, and slightly stronger effect was found in women whose age≤30 and women who are nulliparous across the three time periods. The significant association was also found in women whose BMI≤24 with similar effect size across the three time periods. Our study suggests that the vitamin nutrient pattern diet is associated with decreased GDM risk. Additional studies are necessary to explore the underlying mechanism of this relationship.

Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China

“…According to a systematic review and meta-analysis of longitudinal or cohort studies with 30,871 pregnant women, diets such as Mediterranean Diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH) diet and Alternate Healthy Eating Index diet (AHEI) were associated with 15–38% reduced relative risk of GDM [ 44 ]. A case-control study conducted in Taiyuan, China reported that a vitamin pattern diet (characterized as consumption of diet rich in vitamin A, carotene, vitamin B2, vitamin B6, vitamin C, dietary fiber, folate, calcium, and potassium) is associated with decreased risk of GDM in Chinese women [ 70 ]. Evidence from the Chinese Prospective Birth Cohort Study showed that dietary pattern with high vegetable, fruit, and rice intake was associated with a lower GDM risk among Chinese pregnant women [ 45 ].…”

Gestational Diabetes Mellitus and Folic Acid Supplementation in Pregnant Women: A Systematic Review

“…7 were cohort [13] [23], one had a case-control design [24] and only one was an interventional randomized controlled trial (RCT) [23]. 8 studies were conducted in China [13] [17] [19]- [24], and only one in USA [25]. All studies were published and written in English.…”

“…The eligible studies included a minimum of 326 pregnant women [14] and a maximum of 20,199 [25] with a mean of 5626 participants. Participants were diagnosed to have GDM based on different validated criteria: National diabetes data group and 3 rd International workshop conference [25], Carpenter Coustan [19] [24], International association of diabetes and pregnancy study groups […”

“…Zhu et al reported a proportional correlation between the risk of GDM and daily folic acid (FA) consumption during the first trimester (adjusted odds ratio (aOR) 2.25 [95% CI 1.35 -3.76]); in addition, pre-pregnancy body mass index (BMI) with folic acid play a role in increasing GDM risk (a pre-pregnancy BMI > 25 kg/m 2 with daily FA supplementation in the first trimester had a much higher risk of GDM (odds ratio OR = 5.63 [95% CI 2.77 -11.46]) compared to a pre-pregnancy BMI < 25 kg/m 2 and no FA supplements [19]. One study found that larger folate and potassium levels in the vitamin supplements used by pregnant ladies increased the risk of GDM [24]. It explained this finding by the hypothesis that higher FA level worsened the effects of vitamin B12 deficiency as well as insulin resistance.…”

A Review of the Potential Interaction of Selenium and Iodine on Placental and Child Health

“…There is a clear role for an optimal diet both before and during pregnancy to support the health of the mother and offspring [ 8 , 9 , 10 , 11 , 12 ]. Higher dietary scores for a high-protein/fruit pattern before pregnancy, was associated with decreased likelihood of preterm birth (adjusted odds ratio; 95% confidence interval, OR: 0.31; 95% CI: 0.13, 0.72), whereas the reverse direction was apparent for the high-fat/sugar/takeaway pattern (adjusted OR: 1.54; 95% CI: 1.10, 2.15) [ 13 ].…”