Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study

Bouthoorn, Selma H.; Silva, Lindsay M.; Murray, Sheila E.; Steegers, Eric A.P.; Jaddoe, Vincent W. V.; Moll, Henriëtte A.; Hofman, Albert; Mackenbach, Johan P.; Raat, Hein

doi:10.1007/s00592-014-0668-x

Cited by 81 publications

(70 citation statements)

References 36 publications

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“…Finally, the observed associations may be explained by residual confounding from unmeasured factors in the individual studies. Most studies adjusted for maternal age, ethnicity, parity, history of GDM, family history of diabetes, BMI, and total energy intake; however, less than one-half of the studies adjusted for other lifestyle factors, such as physical activity and smoking, and very few adjusted for gestational weight gain, previous macrosomia, polycystic ovary syndrome, or socioeconomic status, which may be important risk factors of GDM (43)(44)(45). Furthermore, because diets comprise a combination of food items, singling out the effect of an individual food item is difficult.…”

Section: Discussionmentioning

confidence: 99%

The Role of Energy, Nutrients, Foods, and Dietary Patterns in the Development of Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

et al. 2015

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OBJECTIVEDiet may influence the risk of gestational diabetes mellitus (GDM), but inconsistent findings have been reported. The purpose of this study was to synthesize evidence from observational studies on the associations between dietary factors and GDM. RESEARCH DESIGN AND METHODSMedline and Embase were searched for articles published until January 2015. We included observational studies of reproductive-aged women that reported on associations of maternal dietary intake before or during pregnancy, including energy, nutrients, foods, and dietary patterns, with GDM. All relevant results were extracted from each article. The number of comparable studies that adjusted for confounders was insufficient to perform a meta-analysis. RESULTSThe systematic review included 34 articles comprising 21 individual studies (10 prospective cohort, 6 cross-sectional, and 5 case-control). A limited number of prospective cohort studies adjusting for confounders indicated associations with a higher risk of GDM for replacing 1-5% of energy from carbohydrates with fat and for high consumption of cholesterol ( ‡300 mg/day), heme iron ( ‡1.1 mg/day), red and processed meat (increment of 1 serving/day), and eggs ( ‡7 per week). A dietary pattern rich in fruit, vegetables, whole grains, and fish and low in red and processed meat, refined grains, and high-fat dairy was found to be beneficial. The current evidence is based on a limited number of studies that are heterogeneous in design, exposure, and outcome measures. CONCLUSIONSThe findings support current dietary guidelines to limit consumption of foods containing saturated fat and cholesterol, such as processed meat and eggs, as part of an overall balanced diet. Further large prospective studies are warranted.Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition during pregnancy (1), is a common pregnancy complication affecting ;7% of pregnancies (1,2). During the past 20 years, its prevalence has increased substantially across a range of multiethnic populations and is expected to continue

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Section: Discussionmentioning

confidence: 99%

The Role of Energy, Nutrients, Foods, and Dietary Patterns in the Development of Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

et al. 2015

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“…Given that type 2 diabetes is strongly age-related (uncommon in young people), we were not able to find evidence relating specifically to women of child-bearing age. Dode and dos Santos (2009) and Bouthoorn (2015) have both recently reviewed the relationship between SEP and gestational diabetes [66,67]. Both reviews cite a number of studies in which low education is related to greater risk of gestational diabetes but also some studies in which no association is observed.…”

Section: Maternal Pre-gestational Diabetes and Gestational Diabetesmentioning

confidence: 95%

A Review of the Relationship Between Socioeconomic Position and the Early-Life Predictors of Obesity

et al. 2015

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A range of important early-life predictors of later obesity have been identified. Children of lower socioeconomic position (SEP) have a steeper weight gain trajectory from birth with a strong socioeconomic gradient in child and adult obesity prevalence. An assessment of the association between SEP and the early-life predictors of obesity has been lacking. The review involved a two-stage process: Part 1, using previously published systematic reviews, we developed a list of the potentially modifiable determinants of obesity observable in the pre-natal, peri-natal or post-natal (pre-school) periods; and part 2, conducting a literature review of evidence for socioeconomic patterning in the determinants identified in part 1. Strong evidence was found for an inverse relationship between SEP and (1) pre-natal risk factors (pre-pregnancy maternal body mass index (BMI), diabetes and pre-pregnancy diet), (2) antenatal/peri natal risk factors (smoking during pregnancy and low birth weight) and (3) early-life nutrition (including breastfeeding initiation and duration, early introduction of solids, maternal and infant diet quality, and some aspects of the home food environment), and television viewing in young children. Less strong evidence (because of a lack of studies for some factors) was found for paternal BMI, maternal weight gain during pregnancy, child sleep duration, high birth weight and lack of physical activity in young children. A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life (even pre-conception). Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing inequality. Given the likely challenges of reaching this target population, it may be that during pregnancy and their child's early years are more feasible windows for engagement.

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“…Early initial studies have shown that modifiable factors such as diet, physical activity and low socioeconomic status are independently associated with the development of GDM (6–8,10–12,24). An individual’s food environment has an influence on specific health risks.…”

Section: Commentmentioning

confidence: 99%

“…The incidence of GDM amongst women in the United States has increased in recent decades (1–4) with higher prevalence in Hispanic and African-American populations (5–12). While there are a number of recognized risk factors, the occurrence of GDM increases by virtue of maternal age, obesity (BMI>30), race/ethnicity, smoking, and familial history.…”

Section: Introductionmentioning

confidence: 99%

“…While there are a number of recognized risk factors, the occurrence of GDM increases by virtue of maternal age, obesity (BMI>30), race/ethnicity, smoking, and familial history. In addition, early initial studies have shown that potentially modifiable independent factors such as physical activity, diet, and low socioeconomic status are associated with the development of gestational diabetes (1–4,6,8–12). With respect to diet and of interest to our work reported herein, the influence of distance to food establishments on the diet quality of gravidae (independent of diabetes) has been described (5–14).…”

Section: Introductionmentioning

confidence: 99%

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Geospatial analysis of food environment demonstrates associations with gestational diabetes

Kahr

Suter

Ballas

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Gestational diabetes mellitus (GDM) is one of most common complications of pregnancy, with incidence rates varying by maternal age, race/ethnicity, obesity, parity, and family history. Given its increasing prevalence in recent decades, co-variant environmental and sociodemographic factors may be additional determinants of GDM occurrence. Objectives We hypothesized that environmental risk factors, in particular measures of the food environment, may be a diabetes contributor. We employed geospatial modeling in a populous U.S. county to characterize the association of the relative availability of fast food restaurants and supermarkets to GDM. Study Design Utilizing a perinatal database with over 4900 encoded antenatal and outcome variables inclusive of zip code data, 8912 consecutive pregnancies were analyzed for correlations between GDM and food environment based on county-wide food permit registration data. Linkage between pregnancies and food environment was achieved on the basis of validated 5 digit zip code data. The prevalence of supermarkets and fast food restaurants per 100,000 inhabitants for each zip code were gathered from publicly available food permit sources. In order to independently authenticate our findings with objective data, we measured hemoglobin A1c (HbA1c) levels as a function of geospatial distribution of food environment in a matched subset (n=80). Results Residence in neighborhoods with a high prevalence of fast food restaurants (fourth quartile) was significantly associated with an increased risk of developing GDM (relative to first quartile, aOR: 1.63 [95% CI 1.21–2.19]). In multivariate analysis, this association held true after controlling for potential confounders (p=0.002). Measurement of HbA1c levels in a matched subset were significantly increased in association with residence in a zip code with a higher fast food/supermarket ratio (n=80, r=0.251 p<0.05). Conclusions As demonstrated by geospatial analysis, a relationship of food environment and risk for gestational diabetes was identified.

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Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study

Cited by 81 publications

References 36 publications

The Role of Energy, Nutrients, Foods, and Dietary Patterns in the Development of Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

The Role of Energy, Nutrients, Foods, and Dietary Patterns in the Development of Gestational Diabetes Mellitus: A Systematic Review of Observational Studies

A Review of the Relationship Between Socioeconomic Position and the Early-Life Predictors of Obesity

Geospatial analysis of food environment demonstrates associations with gestational diabetes

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