The association between dietary patterns before and in early pregnancy and the risk of gestational diabetes mellitus (GDM): Data from the Malaysian SECOST cohort

Heng Yaw Yong,Eline M Van Der Beek,Zulida Rejali,Geeta Appannah,Barakatun-Nisak Mohd Yusof,Jacques Bindels,Zalilah Mohd Shariff,Yvonne Yee Siang Tee

doi:10.1371/journal.pone.0227246

Abstract

Generally, dietary patterns (DP)s have been linked to the risk of diabetes mellitus, however, only few studies examined the associations between DPs in early pregnancy and the risk of gestational diabetes mellitus (GDM). This study aims to determine the association between DPs before and during pregnancy and risk of GDM in Malaysian pregnant women. DPs were derived using principal component analysis of consumed 126 food and beverage items assessed using a validated semi-quantitative food frequency questionnaire collecting data retrospectively for pre-pregnancy, but prospectively for the first and second trimester. Three different DPs were identified at each time point and labelled as DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), and DP 7-9 (second trimester). About 10.6% (n = 48) of pregnant women were diagnosed with GDM in our cohort. Women with high adherence (HA) to DP 2 (adjusted OR: 0.45, 95% CI: 0.20-0.91) and DP 5 (adjusted OR: 0.28, 95% CI: 0.11-0.68) showed a significantly reduced risk of GDM compared to women with low adherence (LA). Other DPs were not significantly associated with GDM risk. Compared to women with GDM, non-GDM women showed HA scores for all DPs throughout pregnancy. Overall, a relative low percentage of women with GDM was found in this cohort. The risk was lower in women with HA to a relatively unhealthy dietary pattern, i.e. DP 2 and DP 5. The lower body mass index (BMI) status and energy intake of women showing a HA to DP 2 in the first trimester may underlie the observed association with a lower GDM risk. Additionally, genetic variance might explain the less susceptibility to GDM despite HA to unhealthy DPs among non-GDM women.

Highlights

Gestational Diabetes Mellitus (GDM), an increasingly common type of hyperglycemia during pregnancy, follows the increasing trends of obesity and Type 2 Diabetes Mellitus (T2DM)
In 2017, the International Diabetes Federation (IDF) estimated that 20.9 million (16.2%) of live births were affected by hyperglycemia in pregnancy, and about 85.1% of these live births were due to GDM [1]
There are several approaches to identifying dietary patterns of pregnant women, the posterior-approach derived from principal component analysis (PCA) is the most commonly used for deriving dietary patterns during pregnancy [17,18,19,20]

Summary

Introduction

Gestational Diabetes Mellitus (GDM), an increasingly common type of hyperglycemia during pregnancy, follows the increasing trends of obesity and Type 2 Diabetes Mellitus (T2DM). Dietary intake during pregnancy is commonly assessed through the intakes of energy, macronutrients, micronutrients or food groups [12,13], which may be examined in relation to an imbalanced maternal diet and poor maternal nutritional status. Dietary pattern is a relatively new approach that describes a combination of commonly consumed foods [14] that allows for the diet to be described as a whole [15]. PCA is a technique to reduce a large of correlated variables into a smaller number of components [21,22], revealing the underlying structure within diets of the population. Numerous studies examining the role of PCA derived DPs in adverse pregnancy outcomes, such as GDM, pre-eclampsia, and preterm birth [23,24,25] have been published

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