Association between pre-conceptional carbohydrate quality index and the incidence of gestational diabetes: the SUN cohort study

Abstract

The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of Gestational Diabetes Mellitus (GDM). Data from the “Seguimiento Universidad de Navarra” (SUN) cohort were used, which includes 3,827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semi-quantitative 136-item food frequency questionnaire (FFQ) to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/ total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalized estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6,869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: Odds Ratio (OR) the highest vs. the lowest CQI category: 0.67, 95% confidence interval (CI) 0.40-1.10, p for trend = 0.10. Participants at the highest CQI category and with daily carbohydrate amounts ≥50% of total energy intake had the lowest incidence of GDM (OR= 0.29 (95% CI 0.09-0.89)) compared to those with the lowest quality (lowest CQI) and quantity (≤40%). Pre-conceptional quality of carbohydrate was not significantly associated with GDM. Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.

Índice de qualidade de carboidrato dietético de pacientes com Diabetes Tipo 2 e sua associação com estado nutricional

“…Em Os resultados de uma coorte avaliando o IQC e a relação com o diabetes gestacional (DMG), sugeriram que uma maior qualidade de carboidratos na dieta pode estar associada à menor incidência de DMG (39).…”

The Role of the Glycemic Index and Glycemic Load in the Dietary Approach of Gestational Diabetes Mellitus

“…These situations elevate the risk of IR and chronic inflammation, predisposing GDM to manifest earlier in pregnancy. Prospective observational studies have also discovered a link between prenatal high-GL diets and a higher incidence of GDM in US women [40]. Prepregnancy maternal obesity triggers a systemic inflammatory response [40][41][42], which may lead to downstream metabolic effects such as IR and glucose dysregulation, contributing to gestational hyperglycemia [41].…”

“…Regardless of maternal BMI, specific inflammatory markers have been found elevated during pregnancy in women with a history of GDM and those who later develop GDM. Circulating tumor necrosis factor-alpha (TNF-α), as a biomarker of inflammation, decreases in early pregnancy, accompanied by an increase in insulin sensitivity [40]. In a study by Challier et al, obese women exhibited a 2-3-fold increase in placental macrophages along with elevated mRNA expressions of interleukin-1 (IL-1), TNF-α, and interleukin-6 (IL-6) [73].…”