Evaluating pre-pregnancy dietary diversity vs. dietary quality scores as predictors of gestational diabetes and hypertensive disorders of pregnancy

Abstract

BackgroundDietary diversity scores (DDS) are considered as metrics for monitoring the implementation of the UN’s Sustainable Development Goals, but they need to be rigorously evaluated.ObjectiveTo examine two DDS, the Food Groups Index (FGI), and the Minimum Dietary Diversity-Women (MDD-W), alongside two dietary quality scores, the Alternate Healthy Eating Index (AHEI-2010) and the Prime Diet Quality Score (PDQS), with risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs).DesignThe analysis included 21,312 (GDM) and 19,917 (HDPs) singleton births reported in the Nurses’ Health Study II cohort (1991–2001), among women without major chronic disease or GDM/HDPs. Scores were derived using prepregnancy diet collected by a comprehensive food frequency questionnaire. Multivariable models were utilized to calculate relative risks (RR) and confidence intervals (95%CIs).ResultsIncident GDM (n = 916) and HDPs (n = 1,421) were reported. The MDD-W and FGI were not associated with risk of GDM or HDPs, but the AHEI-2010 and PDQS were associated with a lower risk of GDM and marginally lower risk of HDP. The RR’s of GDM comparing the highest vs. lowest quintiles were 1.00 (95%CI: 0.79, 1.27; p-trend = 0.82) for MDD-W, 0.96 (95%CI: 0.76, 1.22; p-trend = 0.88) for FGI, 0.63 (95%CI: 0.50, 0.81; p-trend <0.0001) for the AHEI-2010 and 0.68 (95%CI: 0.54, 0.86; p-trend = 0.003) for the PDQS. Similarly, the RR’s of HDPs were 0.92 (95%CI: 0.75, 1.12, p-trend = 0.94) for MDD-W, 0.97 (95%CI: 0.79, 1.17; p-trend = 0.83) for FGI, 0.84 (95%CI: 0.70, 1.02; p-trend = 0.07) for AHEI-2010 and 0.89 (95%CI: 0.74, 1.09; p-trend = 0.07) for PDQS.ConclusionsMDD-W and FGI did not predict the risk of GDM and HDPs. These DDS should not be widely used as metrics for achieving dietary goals in their present form. The Prime Diet Quality Score warrants further testing as a promising measure of a sustainable and healthy diet on a global scale.

Demographic and socio-economic predictors of diet quality among adults in Bosnia and Herzegovina

“…Prime Diet Quality Score The Prime Diet Quality Score (PDQS) (23,24) is a food-based, twenty-one-component, dietary score consisting of twelve 'adequacy', seven 'moderation' and two populationspecific components (for adults, only low-fat dairy foods are coded as an adequacy component, while high-fat dairy and eggs are not coded). The score was developed and successfully evaluated by comparison with a comprehensive FFQ in a high-income country setting (23,24) . In two studies of US women, higher score on the PDQS was found to predict lower risk of CHD (23) and gestational diabetes mellitus (24) .…”

Dietary Patterns and Dietary Adaptations in Women With and Without Gestational Diabetes: Evidence From the Growing Up in New Zealand Study

“…Dietary pattern analysis has become a popular tool for exploring dietary associations with GDM, as it is thought to better reflect real eating behaviours by considering the eating pattern as a whole [24]. A number of studies have found dietary patterns characterised by high intakes of red and processed meats, fried foods and added sugars to be associated with an increased risk of GDM, while dietary patterns characterised by high consumption of fruit, vegetables, wholegrains and nuts or 'Mediterranean'-style dietary patterns to be associated with a lower risk of developing GDM [25][26][27][28][29][30][31][32][33][34][35]. Nonetheless, research of dietary patterns and risk of GDM has primarily been conducted in largely Caucasian populations [11,25,30,34,36], with many using data from the same cohort of women from the Nurses' Health Study II [25,28,36].…”

Pre-Pregnancy Adherence to the Mediterranean Diet and Gestational Diabetes Mellitus: A Case-Control Study

“…Previous studies have analyzed the association between adherence to a MD, or other dietary compositions during pregnancy, and GDM development [19,20,21,22,23,24], yet few have assessed the relationship between pre-pregnancy adherence to a MD and the development of GDM. Those that do have inconsistent results and show a less clear association, which may be due to the fact that some of these studies have been carried out on the MD in non-Mediterranean populations [25,26,27] or with different anthropometric, sociodemographic characteristics and culinary habits [19,20,21,22,23,24,25,26,27,28]. Thus, this association has not yet been demonstrated consistently or conclusively.…”