Reduced Risk Of Gestational Diabetes Mellitus Research Articles

Dietary interventions in pregnancy for the prevention of gestational diabetes: a literature review.

The aim of this review is to provide an overview of dietary interventions delivered during pregnancy for the prevention of gestational diabetes mellitus (GDM). GDM increases the risk of adverse pregnancy and neonatal outcomes, and also increases future cardiometabolic risks for both the mother and the offspring. Carrying or gaining excessive weight during pregnancy increases the risk of developing GDM, and several clinical trials in women with overweight or obesity have tested whether interventions aimed at limiting gestational weight gain (GWG) could help prevent GDM. Most dietary interventions have provided general healthy eating guidelines, while some had a specific focus, such as low glycaemic index, increased fibre intake, reducing saturated fat or a Mediterranean-style diet. Although trials have generally been successful in attenuating GWG, the majority have been unable to reduce GDM risk, which suggests that limiting GWG may not be sufficient in itself to prevent GDM. The trials which have shown effectiveness in GDM prevention have included intensive face-to-face dietetic support, and/or provision of key foods to participants, but it is unclear whether these strategies could be delivered in routine practice. The mechanism behind the effectiveness of some interventions over others remains unclear. Dietary modifications from early stages of pregnancy seem to be key, but the optimum dietary composition is unknown. Future research should focus on designing acceptable and scalable dietary interventions to be tested early in pregnancy in women at risk of GDM.

Dietary protein in early pregnancy and gestational diabetes mellitus: a prospective cohort study.

The relationship between dietary protein intake and the risk of gestational diabetes mellitus (GDM) remains inconsistent and unclear. Here, we examined the correlation between the various sources of protein intake among Chinese pregnant women and GDM. This prospective cohort study included 1060 pregnant women at 6-13+6 weeks of gestation from Guangdong Provincial Hospital for Women and Children, South China. The participants' intake of dietary protein was assessed using a validated quantitative food frequency questionnaire during the early trimester. GDM was diagnosed via an oral glucose tolerance test performed at 24-28 gestational weeks. Logistic regression analysis was used to evaluate the association between dietary protein intake during pregnancy and GDM. Furthermore, we applied restricted cubic splines to determine their linear relationship. About 26.3% (n = 279) of pregnant women were diagnosed with GDM. Animal protein intake was revealed to have a positive correlation with GDM risk (Q4 vs. Q1: OR, 2.78; 95% CI, 1.46-5.34; P = 0.015), whereas high intake levels of dietary plant protein were linked to reduced GDM risk (Q4 vs. Q1: OR, 0.43; 95% CI, 0.25-0.73). In stratified analysis, the relationship between protein and GDM was stronger during early pregnancy in women with obesity. However, total protein intake did not show a significant association with GDM. Our study findings suggest that a plant protein-based diet was associated with reduced GDM risk, whereas the dietary intake of animal protein was positively associated with GDM risk among Chinese women during early pregnancy.

Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study

BackgroundAmerican Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented.MethodsWe conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews.ResultsFour key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals.ConclusionFindings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.

Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females.

American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities.

612-P: The Effectiveness of Lifestyle, Metformin, or Dietary Supplements for the Prevention of Gestational Diabetes Mellitus (GDM) by Participant Characteristics—A Systematic Review and Meta-analysis

The GDM prevalence has been rising, affecting 7-28% of pregnancies worldwide. Prior systematic reviews examining the success of interventions for GDM prevention have presented results where some interventions have modest effect and others, no effect. The impact of individual characteristics on the efficacy of interventions has not been thoroughly investigated. To address this knowledge gap, we performed a systematic review of controlled trials of lifestyle (diet and exercise), metformin and dietary supplement interventions initiated in the preconception, prenatal or postpartum period to assess whether participant characteristics impact the interventions’ effectiveness in GDM prevention. Overall, 116 studies met inclusion criteria (lifestyle n=92, metformin n=13 and dietary supplements n=12). Lifestyle, metformin and dietary supplements reduced GDM risk by 24% (RR 0.76, 95% CI 0.69-0.83), 34% (RR 0.66, 95% CI 0.47-0.93), and 45% (RR 0.55, 95% CI 0.36-0.83). With lifestyle, lower risks of GDM was seen in individuals with overweight or obesity (n=33, RR 0.70, 95% CI 0.59-0.83), without PCOS (n=3, RR 0.62, 95% CI 0.47-0.82) and without a history of GDM (n=13, RR 0.63, 95% CI 0.53-0.70) (p<0.05). With metformin, lower GDM risks were achieved when commenced prior to conception (n=3, RR 0.22, 95% CI 0.11-0.45)(p<0.01). Dietary supplements resulted in lower GDM risks among individuals with normal weight (n=1, RR 0.42, 95% CI 0.24-0.72), with prediabetes (n=1, RR 0.08, 95% CI 0.02-0.31), and when initiated before 20 weeks’ gestation (n=10, RR 0.46, 95% CI 0.30-0.71) (p<0.05). Given the potentially greater effectiveness of these interventions in certain groups of individuals, future research on tailored recommendations in precision GDM prevention, replacing the current ‘one-size-fits-all’ approach, is needed. Disclosure S.Lim: None. R.Taylor: None. M.Pathirana: None. K.Liu: None. G.G.Ukke: None. M.P.Bonham: None. M.Chen: None. A.J.Fawcett: None. S.C.Chivers: None. J.L.Josefson: None. W.W.Takele: None. L.M.Redman: Research Support; Dexcom, Inc., Abbott Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; ABGIL, Teladoc Health. K.Vesco: Research Support; Pfizer Inc. J.A.Grieger: None. N.Habibi: None. A.Quinteros: None. G.Leung: None. S.J.Zhou: None.

Metabolic biomarkers linking urinary arsenic species to gestational diabetes mellitus: A cross-sectional study in Chinese pregnant women

Environmental arsenic (As) exposure has been associated with gestational diabetes mellitus (GDM) risk. Our recent study found that GDM was positively associated with urinary As3+ level while negatively correlated to As5+. However, the mechanisms underlying the association between arsenic species and GDM remain largely unknown. In the present study, through the measurement of urinary arsenic species and metabolome analysis in 399 pregnant women, we aimed to identify the metabolic biomarkers that may link arsenic exposure to GDM based on a novel systems epidemiology strategy termed meet-in-metabolite-analysis (MIMA). The metabolomics analysis revealed that 20 and 16 urinary metabolites were relevant to arsenic exposure and GDM, respectively. Among them, 12 metabolites were identified to be both arsenic- and GDM-related, which are mainly involved in purine metabolism, one‑carbon metabolism (OCM) and glycometabolism. Moreover, it was further showed that the regulation of thiosulfate (AOR: 2.52; 95 % CI: 1.33, 4.77) and phosphoroselenoic acid (AOR: 2.35; 95 % CI: 1.31, 4.22) could significantly contribute to the negative association between As5+ and GDM. Considering the biological functions of these metabolites, it is suggested that As5+ may reduce GDM risk by disturbing OCM in the pregnant women. These data will provide novel insights into the mechanism of action of environmental arsenic exposure on GDM incidence from the aspect of metabolism disorder.

Effect of folic acid supplementation in the association between short sleep duration and gestational diabetes mellitus.

To examine whether or notfolic acid (FA) supplementation may modify the relationships between duration or quality of sleep and gestational diabetes mellitus (GDM) risk. In a case-control study of patients with GDM and controls, mothers were interviewed face-to-face at enrollment. The Pittsburgh Sleep Quality Scale was used to assess duration and quality of sleep during early pregnancy, and information on FA supplementation and covariates was obtained using a semiquantitative questionnaire. Among 396 patients with GDM and 904 controls, GDM risk increased by 328% and 148% among women with short (< 7h) and long (≥ 9h) sleep durations, respectively, compared to those averaging 7-8.9h sleep.Mothers with poor sleep quality increased their GDM risk by an average of 75% (all p < 0.05). The effect of short sleep duration on GDM risk was much weaker among women with adequate FA supplementation (taking supplements containing ≥ 0.4mg FA daily for each day of the first three months of pregnancy) than that among women with inadequate FA supplementation, with a p-value for interaction = 0.003. There wereno significant effects of FA on links among long duration and poor quality of sleep with GDM risk. Sleep duration and quality in early gestation were related to increased GDM risks. FA supplementation may reduce GDM risk associated with short sleep duration.

Association between Prepregnancy Weight Change and Risk of Gestational Diabetes Mellitus in Chinese Pregnant Women

BackgroundEvidence regarding prepregnancy weight change and gestational diabetes mellitus (GDM) is lacking among East Asian women. ObjectivesOur study aimed to investigate the association between weight change from age 18 y to pregnancy and GDM in Chinese pregnant women. MethodsOur analyses included 6972 pregnant women from the Tongji-Shuangliu Birth Cohort. Body weights were recalled for age 18 y and the time point immediately before pregnancy, whereas height was measured during early pregnancy. Prepregnancy weight change was calculated as the difference between weight immediately before pregnancy and weight at age 18 y. GDM outcomes were ascertained by 75-g oral-glucose-tolerance test. Multivariable logistic regression models were used to examine the association between prepregnancy weight change and risk of GDM. ResultsIn total, 501 (7.2%) developed GDM in the cohort. After multivariable adjustments, prepregnancy weight change was linearly associated with a higher risk of GDM (P < 0.001). Compared with participants with stable weight (weight change within 5.0 kg) before pregnancy, multivariable-adjusted odds ratios and 95% confidence intervals were 1.55 (1.22, 1.98) and 2.24 (1.78, 2.83) for participants with moderate (5–9.9 kg) and high (≥10 kg) weight gain, respectively. In addition, overweight/obesity immediately before pregnancy mediated 17.6% and 31.7% of the associations of moderate and high-weight gain with GDM risk, whereas weekly weight gain during pregnancy mediated 21.1% and 22.7% of the associations. ConclusionsWeight gain from age 18 y to pregnancy was significantly associated with a higher risk of GDM. Maintaining weight stability, especially prevention of excessive weight gain from early adulthood to pregnancy, could be a potential strategy to reduce GDM risk.

The Association Between Acculturation and Diet and Physical Activity Among Pregnant Hispanic Women with Abnormal Glucose Tolerance.

Background: Hispanic women are disproportionately affected by gestational diabetes mellitus (GDM), yet few studies have assessed the impact of acculturation on health behaviors that may reduce GDM risk. Materials and Methods: We assessed relationships between acculturation and meeting American Diabetes Association guidelines for macronutrient intake and American College of Obstetricians and Gynecologists guidelines for physical activity (PA) using baseline data from Estudio Project Aiming to Reduce Type twO diabetes, a randomized trial conducted in Massachusetts (2013-2017) among 255 Hispanic pregnant women with hyperglycemia. Acculturation was assessed via the Psychological Acculturation Scale, duration of time and generation in the continental United States, and language preference; diet with 24-hours dietary recalls; and PA with the Pregnancy Physical Activity Questionnaire (PPAQ). Results: The majority of participants who reported low psychological acculturation (74.9%), preferred English (78.4%), were continental U.S. born (58.0%), and lived in the continental United States ≥5 years (91.4%). A total of 44.8%, 81.8%, 22.9%, and 4.6% of women met guidelines for carbohydrate, protein, fat, and fiber intakes, respectively; 31.9% met guidelines for PA. Women with higher acculturation were less likely to meet carbohydrate guidelines (English preference: adjusted risk ratios [aRR] 0.45, 95% confidence intervals [CI] 0.23-0.75; U.S. born: aRR 0.60, 95% CI 0.36-0.91; duration of time in United States: aRR 0.96, 95% CI 0.92-0.99). Women with higher acculturation were more likely to meet PA guidelines (U.S. born: aRR 1.95, 95% CI 1.11-3.44). Conclusions: In summary, higher acculturation was associated with lower likelihood of meeting dietary guidelines but greater likelihood of meeting PA guidelines during pregnancy. Interventions aimed at reducing GDM in Hispanics should be culturally informed and incorporate acculturation. Clinical Trial Registration: clinicaltrials.gov NCT01679210.

Association between ambient air pollution exposure during pregnancy and gestational diabetes mellitus: a meta-analysis of cohort studies.

Numerous studies have evaluated the association between air pollution and gestational diabetes mellitus (GDM), but the findings were inconsistent. This meta-analysis aimed to provide higher grade evidence on the association of air pollution with GDM based on previous studies. PubMed, Web of science, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform (Wanfang) were searched comprehensively up to September 2021. Totally, 20 eligible cohort studies were finally included, for which the pooled RR and 95% CIs were estimated. Stratified analyses by study regions and units of pollutant increase were conducted for further investigation. Sensitivity analyses were also performed to assess the robustness. The finding showed that PM2.5, PM10, NO2, and SO2 exposure increased the risk of GDM, while O3 exposure reduced GDM risk. Specifically, PM2.5 exposure in the first and second trimesters, NO2 and SO2 exposure in the first trimester significantly increased the risk of GDM, with the RR ranging from 1.015 to 1.032. In addition, the elevation of GDM risk induced by PM2.5, PM10, and O3 exposure was more pronounced in Asian subjects than in American subjects. The meta-analysis provides high-quality evidence on the effect of maternal air pollution exposure on GDM in each exposure period.

Associations of Maternal rs1801131 Genotype in MTHFR and Serum Folate and Vitamin B12 with Gestational Diabetes Mellitus in Chinese Pregnant Women.

Circumstantial evidence links one-carbon metabolism (OCM) related nutrients, such as folate and vitamin B12, with gestational diabetes mellitus (GDM). However, few studies have evaluated the combined effects of these nutrients with OCM related gene polymorphisms on GDM. This study investigated whether OCM related genetic variants modified the associations of folate and B12 with GDM. Logistic regression was used to estimate odds ratios (ORs) for OCM related nutrients and single nucleotide polymorphisms (SNPs) in genes encoding main OCM related enzymes (MTHFR, MTR, and MTRR) on GDM. Higher folate concentrations were associated with increased GDM risk (OR: 1.59; 95% CI: 1.22, 2.13). However, higher B12 concentrations were associated with reduced GDM risk (OR: 0.76; 95% CI: 0.65, 0.92). Pregnancies with MTHFR rs1801131 G alleles had a significantly lower risk of GDM than pregnancies with T alleles (OR: 0.65; 95% CI: 0.47, 0.91) under the dominant model. The genotype-stratified analysis revealed the association between folate and GDM (OR: 1.66, 95% CI: 1.20, 2.30) or B12 and GDM (OR: 0.80, 95% CI: 0.65, 0.98) was more evident in pregnancies with TT genotype. Higher folate and lower B12 are associated with GDM. Pregnancies with MTHFR rs1801131 TT genotype are more susceptible to OCM nutrient-related GDM.

Does Exercise Prevent Gestational Diabetes Mellitus in Pregnant Women? A Clin-IQ.

Excessive weight gain during pregnancy has been on the rise globally, leading to increased prevalence of gestational diabetes mellitus (GDM). A diagnosis of GDM often leads to pregnancy and infant-related complications. Regular exercise may have the potential to prevent GDM. However, evidence surrounding the utility of exercise during pregnancy as an effective risk reduction intervention has been mixed. This clinical inquiry examined the role of regular exercise during pregnancy in preventing GDM in both obese and normal-weight women and analyzed specific aspects of exercise that make it an effective preventive measure. The review of evidence included 3 meta-analyses, 3 systematic reviews, and 1 umbrella review. Findings identified several components of an exercise program that can reduce GDM risk. Specifically, an exercise intervention of 40- to 60-minute sessions 3 times per week beginning as early as possible during pregnancy and continuing with good adherence over the course of pregnancy yielded clinically significant results. Adhering to a similar exercise routine before pregnancy also was shown to be protective against GDM for all women, but especially so for women who are overweight or obese.

Novel association between a transient receptor potential cation channel subfamily M member 5 expression quantitative trait locus rs35197079 and decreased susceptibility of gestational diabetes mellitus in a Chinese population.

Aims/IntroductionEmerging evidence suggests that expression quantitative trait loci (eQTLs) are more likely to associate with complex diseases. Transient receptor potential cation channel subfamily M member 5 (TRPM5) is a ubiquitously expressed voltage‐gated cation channel that acts indispensably to trigger insulin secretion in pancreatic β‐cells. The present study evaluated the association between TRPM5 eQTL single‐nucleotide polymorphisms and the risk of gestational diabetes mellitus (GDM) in a Chinese population.Materials and MethodsA total of 380 unrelated Chinese pregnant women including 241 GDM patients and 139 controls were included in this study. The eQTL single‐nucleotide polymorphisms of TRPM5 were obtained from the GTEx eQTL Browser, and were subsequently genotyped using the Agena MassARRAY iPLEX platform.ResultsLogistic regression analysis and linear regression analysis showed that rs35197079 and rs74848824 were significantly associated with reduced GDM risk and lower fasting plasma glucose levels after adjusting confounder factors in dominant genetic models. Stratification analysis based on pre‐pregnancy body mass index validated a strong association between rs35197079 and GDM susceptibility in underweight and normal weight individuals. Luciferase and electrophoretic mobility shift assays carried out in rat pancreatic β‐cells showed that rs35197079 was functional.ConclusionsThe TRPM5 eQTL single‐nucleotide polymorphism rs35197079 was associated with decreased GDM susceptibility in a Chinese population, especially in underweight and normal weight pregnant women, and it was functional in modulating gene transcription.

Association of pre- and early-pregnancy factors with the risk for gestational diabetes mellitus in a large Chinese population

Gestational diabetes mellitus (GDM) has aroused wide public concern, as it affects approximately 1.8–25.1% of pregnancies worldwide. This study aimed to examine the association of pre-pregnancy demographic parameters and early-pregnancy laboratory biomarkers with later GDM risk, and further to establish a nomogram prediction model. This study is based on the big obstetric data from 10 “AAA” hospitals in Xiamen. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. Data are analyzed using Stata (v14.1) and R (v3.5.2). Total 187,432 gestational women free of pre-pregnancy diabetes mellitus were eligible for analysis, including 49,611 women with GDM and 137,821 women without GDM. Irrespective of confounding adjustment, eight independent factors were consistently and significantly associated with GDM, including pre-pregnancy body mass index (BMI), pre-pregnancy intake of folic acid, white cell count, platelet count, alanine transaminase, albumin, direct bilirubin, and creatinine (p < 0.001). Notably, per 3 kg/m2 increment in pre-pregnancy BMI was associated with 22% increased risk [adjusted odds ratio (OR) 1.22, 95% confidence interval (CI) 1.21–1.24, p < 0.001], and pre-pregnancy intake of folic acid can reduce GDM risk by 27% (adjusted OR 0.73, 95% CI 0.69–0.79, p < 0.001). The eight significant factors exhibited decent prediction performance as reflected by calibration and discrimination statistics and decision curve analysis. To enhance clinical application, a nomogram model was established by incorporating age and above eight factors, and importantly this model had a prediction accuracy of 87%. Taken together, eight independent pre-/early-pregnancy predictors were identified in significant association with later GDM risk, and importantly a nomogram modeling these predictors has over 85% accuracy in early detecting pregnant women who will progress to GDM later.

Association of CPT1A gene polymorphism with the risk of gestational diabetes mellitus: a case-control study.

Gestational diabetes mellitus (GDM) is a growing public health problem worldwide and its etiology remains unclear. The pathophysiology of GDM is similar to that of type 2 diabetes (T2DM) and insulin resistance (IR) is the main reason for the development of GDM. Carnitine palmitoyltransferase 1A (CPT1A) is a candidate gene for metabolic disorders; however, the association of the CPT1A gene and GDM has not yet been studied. We aimed to explore whether single-nucleotide polymorphisms (SNPs) of the CPT1A gene could influence the risk of GDM. We examined 18 single-nucleotide polymorphisms (SNPs) in the CPT1A gene and the risk of GDM in a nested case-control study of 334 GDM patients and 334 controls. The controls who had no GDM were randomly selected through matching to cases by age and residence. After adjusting the family history of diabetes, pre-pregnancy body mass index, and multiple comparison correction, the CPT1A rs2846194 and rs2602814 were associated with reduced GDM risk while rs59506005 was associated with elevated GDM risk. Moreover, the GGAC haplotype in the CPT1A gene (rs17399246 rs1016873 rs11228450 rs10896396) was associated with a reduced risk of GDM. Our study provides evidence for an association between genetic polymorphisms in the CPT1A and the risk of GDM.

Higher Parity, Pre-Pregnancy BMI and Rate of Gestational Weight Gain Are Associated with Gestational Diabetes Mellitus in Food Insecure Women.

Food insecurity may exacerbate adverse maternal health outcomes during pregnancy, however, this association has not been well established, particularly in the context of developing countries. This study aimed to identify the associations between household food insecurity and gestational diabetes mellitus (GDM) risk among urban pregnant women. Household food insecurity was assessed using the translated 10-item Radimer/Cornell hunger scale. Logistic regression models were used to estimate the associations between food insecurity status and GDM risk. About 35.6% of women experienced food insecurity, with 25.2% reported household food insecurity, 8.0% individual food insecurity, and 2.4% child hunger. Food insecure women were at significantly higher risk of developing GDM compared to food secure women (AOR = 16.65, 95% CI = 6.17–24.98). The significant association between food insecurity and GDM risk was influenced by pre-pregnancy BMI, parity and rate of GWG at second trimester. Food insecure women with parity ≥ 2 (AOR = 4.21, 95% CI = 1.98–8.92), overweight/obese BMI prior to pregnancy (AOR = 12.11, 95% CI = 6.09–24.10) and excessive rate of GWG in the second trimester (AOR = 9.66, 95% CI = 4.27–21.83) were significantly more likely to develop GDM compared to food secure women. Food insecurity showed strong association with GDM risk in that the association was influenced by maternal biological and physical characteristics. Multipronged interventions may be necessary for food insecure pregnant women who are not only at risk of overweight/obesity prior to pregnancy but also may have excessive gestational weight gain, in order to effectively reduce GDM risk.

The overall plant-based diet index during pregnancy and risk of gestational diabetes mellitus: a prospective cohort study in China.

The high overall plant-based diet index (PDI) is considered to protect against type 2 diabetes in the general population. However, whether the PDI affects gestational diabetes mellitus (GDM) risk among pregnant women is still unclear. We evaluated the association between PDI and GDM risk based on a Chinese large prospective cohort - the Tongji Maternal and Child Health Cohort. Dietary data were collected at 13-28 weeks of pregnancy by a validated semi-quantitative FFQ. The PDI was obtained by assigning plant food groups positive scores while assigning animal food groups reverse scores. GDM was diagnosed by a 75g 2-h oral glucose tolerance test at 24-28 weeks of gestation. Logistic regression models were fitted to estimate OR of GDM, with associated 95 % CI, comparing women in different PDI quartiles. Among the total 2099 participants, 169 (8·1 %) were diagnosed with GDM. The PDI ranged from 21·0 to 52·0 with a median of 36·0 (interquartile range (IQR) 33·0-39·0). After adjusting for social-demographic characteristics and lifestyle factors etc., the participants with the highest quartile of PDI were associated with 57 % reduced odds of GDM compared with women in the lowest quartile of PDI (adjusted OR 0·43; 95 % CI 0·24, 0·77; Pfor trend = 0·005). An IQR increment in PDI was associated with 29 % decreased odds of GDM (adjusted OR 0·71; 95 % CI 0·56, 0·90). Findings suggest that adopting a plant-based diet during pregnancy could reduce GDM risk among Chinese women, which may be valuable for dietary counselling during pregnancy.

Cost-effectiveness analysis of polycystic ovary syndrome management and the risk of gestational diabetes in pregnant women: a decision-tree model

ABSTRACT Background This study estimated the cost-effectiveness of metformin to reduce the risk of gestational diabetes mellitus (GDM) in pregnant women with polycystic ovary syndrome (PCOS) from the US health-care payer perspective. Methods A decision tree was developed to simulate the progression of PCOS in a hypothetical cohort of 10,000 pregnant women diagnosed with PCOS and two scenarios were tested. Normal glucose regulation without developing GDM, average cost-effectiveness ratios (ACER), and the incremental cost-effectiveness ratios (ICERs) were the outcome measures assessed through pregnancy. Evidence from randomized clinical trials and other published literature were used to assess disease progression and its associated health-care costs. Sensitivity analyses that varied key model parameters were conducted. Results Management of PCOS with metformin was associated with lowest ACER ($669.78 per normal glucose regulation without GDM) as compared to ‘no intervention’ strategy. Metformin use is the most cost-effective strategy to manage PCOS during pregnancy with average cost savings of $7,593,372.97 and an average effect gain of 2271 of normal glucose regulation without GDM among pregnant women with PCOS. Sensitivity analyses determined that the results are robust. Conclusions Management of PCOS during pregnancy may be a cost-effective strategy to reduce GDM risk and its associated complications.

The Overall Plant-based Diet Index During Pregnancy and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study

Abstract Objectives The overall plant-based diet index (PDI) has been demonstrated to be protective against type 2 diabetes (T2D) in the general population. Whether the PDI was linked to gestational diabetes mellitus (GDM) is unclear. We aimed to assess the association of the PDI with GDM incidence in Chinese pregnant women. Methods A total of 2099 pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) were included in the present study. Dietary data were collected at 13–28 wks of pregnancy by using a validated semi-quantitative food frequency questionnaire (FFQ). Food groups including cereals, fruits, vegetables, nuts, beans, vegetable oil, dairy, eggs, meat, and fish, were ranked into quintiles and given positive (1–5 for plant food groups) or reverse (5–1 for animal food groups) scores. The PDI was obtained by summing the 10 food group scores, with a theoretical range of 10 to 50. GDM was diagnosed by the 75-g 2-h oral glucose tolerance test at 24–28 wks. Cubic-restricted spline function and logistic regression analyses were used to examine the association between the PDI during pregnancy and GDM. Results GDM was reported by 8.1% of the 2099 pregnancies. The PDI score ranged from 17 to 43 (theoretical range: 10–50), the mean (SD) was 30.2 (4.4). After adjusting for maternal age, ethnicity, education, income, parity, gravidity, family history of diabetes, total energy intake per day, and other pre-pregnancy information such as body mass index (BMI), smoking status, drinking status, exercise, and sleep quality, a linear association between the PDI and GDM risk was demonstrated by the restricted cubic splines (P for overall association = 0.024, P for nonlinearity = 0.370). Compared to the lowest quartile 1 of PDI, ORs (95% CI) were 0.91 (0.59, 1.42) for quartile 2, 0.91 (0.58, 1.41) for quartile 3, and 0.52 (0.30, 0.89) for quartiles 4 (P for trend = 0.040) in the adjusted model. Conclusions Our study suggests that higher PDI is associated with a substantially lower risk of developing GDM, which indicates that adopt plant-based diets during pregnancy could be an easy avenue to reduce GDM risk. Funding Sources Funding was received from the National Program on Basic Research Project of China (NO.2013FY114200) and the Fundamental Research Funds for the Central Universities (HUST2016YXZD040) for Nianhong Yang.

PDB81 A COST-EFFECTIVENESS ANALYSIS OF POLYCYSTIC OVARY SYNDROME (PCOS) MANAGEMENT USING METFORMIN TO REDUCE THE RISK OF GESTATIONAL DIABETES MELLITUS (GDM) IN PREGNANT WOMEN

This study estimated the cost-effectiveness of metformin use to reduce the risk of gestational diabetes mellitus (GDM) in pregnant women with polycystic ovary syndrome (PCOS) from the US health care payer perspective. Decision tree model was developed from the US health care payer perspective to simulate the progression of PCOS in a hypothetical cohort of 10,000 pregnant women who already diagnosed with PCOS. For average age group ±30 years old, two strategies were compared: using metformin or a no medications strategy to manage PCOS during pregnancy. Normal pregnancies without developing GDM, costs, average cost-effectiveness ratios (ACER), and the incremental cost-effectiveness ratios (ICERs) were the outcome measures assessed over the three trimesters of pregnancy. Evidence from randomized clinical trials, epidemiological studies, and other published literature were used to assess disease progression and its associated healthcare costs. Sensitivity analyses that varied key model parameters were conducted. Management of PCOS with metformin was less costly with lowest ACER ($US 669.78 per normal pregnancy without GDM) while “no intervention” strategy was associated with highest ACER ($US 1,990.86 per normal pregnancy without GDM). Metformin use is the most cost-effective strategy to manage PCOS during pregnancy with average cost savings of $US 7,593,372.97 and an average effect gain of 2271 of normal pregnancies without GDM among 10,000 pregnant women with PCOS. Sensitivity analyses determined that the results are robust. Using metformin to manage PCOS is a dominant strategy as compared with no medications strategy to reduce GDM risk and its associated complications and costs for pregnant women with PCOS if they do not have contraindications.