Radesky Jenny S, Oken Emily, Rifas-Shiman Sheryl L, Kleinman Ken P, Rich-Edwards Janet W, Gillman Matthew W
Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA.
Paediatr Perinat Epidemiol. 2008 Jan;22(1):47-59. doi: 10.1111/j.1365-3016.2007.00899.x.
Diet composition may be a modifiable predictor of risk for abnormal glucose tolerance during pregnancy. Prior studies suggest that diets high in total fat, saturated fat, red and processed meats, and with high glycaemic load increase the risk of developing gestational diabetes mellitus (GDM), while polyunsaturated fats, carbohydrates and fibre are protective. The aim of this study was to investigate associations of these and other nutrients and foods, including n-3 fatty acids, trans fats, whole grains and dietary patterns, with risk of GDM. We studied 1733 women with singleton pregnancies enrolled in Project Viva, a prospective pregnancy and birth cohort study in eastern MA. Using multinomial logistic regression, we examined associations of first trimester diet, assessed by validated food frequency questionnaire, with results of glucose tolerance testing at 26-28 weeks of gestation. A total of 91 women developed GDM and 206 women had impaired glucose tolerance (IGT). Pre-pregnancy body mass index (BMI) was a strong predictor for GDM risk (OR 3.44 [95% CI 1.88, 6.31] for pre-pregnancy BMI > or =30 vs. <25 kg/m(2)). After adjustment for confounders, the OR [95% CI] for risk of GDM for total dietary fat was 1.00 [0.96, 1.05], for saturated fat 0.98 [0.88, 1.08], for polyunsaturated fat 1.09 [0.94, 1.26], for trans fat 0.87 [0.51, 1.49], and for carbohydrates 1.00 [0.96, 1.03] per each 1% of total energy. The adjusted OR [95% CI] for risk of GDM for a one standard deviation increase in energy-adjusted glycaemic load (32 units, about two soft drinks) was 0.96 [0.76, 1.22] and for each daily serving of whole grains was 0.90 [0.73, 1.13]. Dietary patterns and intake of red and processed meats were not predictive of glucose tolerance outcome. Estimates for IGT were similar to those for GDM. Intake of n-3 fatty acids was associated with increased GDM risk (OR 1.11 [95% CI 1.02, 1.22] per each 300 mg/day), but not with IGT risk. Except for this finding, perhaps due to chance, these data do not show that nutrient or food intake in early pregnancy is linked to risk of GDM. Nutritional status entering pregnancy, as reflected by pre-pregnancy BMI, is probably more important than pregnancy diet in development of GDM.
饮食构成可能是孕期葡萄糖耐量异常风险的一个可改变的预测因素。先前的研究表明，总脂肪、饱和脂肪、红肉和加工肉类含量高以及血糖负荷高的饮食会增加患妊娠期糖尿病（GDM）的风险，而多不饱和脂肪、碳水化合物和纤维则具有保护作用。本研究的目的是调查这些及其他营养素和食物，包括n-3脂肪酸、反式脂肪、全谷物和饮食模式与GDM风险之间的关联。我们研究了参与“活力计划”的1733名单胎妊娠女性，该计划是马萨诸塞州东部一项前瞻性妊娠与出生队列研究。使用多项逻辑回归，我们通过经过验证的食物频率问卷评估孕早期饮食与妊娠26 - 28周时葡萄糖耐量测试结果之间的关联。共有91名女性患GDM，206名女性有糖耐量受损（IGT）。孕前体重指数（BMI）是GDM风险的一个强有力的预测因素（孕前BMI≥30与<25kg/m²相比，GDM风险的比值比[OR]为3.44[95%可信区间1.88, 6.31]）。在对混杂因素进行调整后，总膳食脂肪导致GDM风险的OR[95%可信区间]为1.00[0.96, 1.05]，饱和脂肪为0.98[0.88, 1.08]，多不饱和脂肪为1.09[0.94, 1.26]，反式脂肪为0.87[0.51, 1.49]，每增加总能量的1%，碳水化合物为1.00[0.96, 1.03]。能量调整后的血糖负荷每增加一个标准差（32个单位，约相当于两杯软饮料）导致GDM风险的调整后OR[95%可信区间]为0.96[0.76, 1.22]，每天每摄入一份全谷物为0.90[0.73, 1.13]。饮食模式以及红肉和加工肉类的摄入量并不能预测葡萄糖耐量结果。IGT的估计值与GDM的相似。n-3脂肪酸的摄入量与GDM风险增加相关（每天每摄入300mg，OR为1.11[95%可信区间1.02, 1.22]），但与IGT风险无关。除了这一可能因偶然因素导致的发现外，这些数据并未表明孕早期的营养素或食物摄入量与GDM风险有关。孕前BMI所反映的怀孕时的营养状况在GDM的发生发展中可能比孕期饮食更为重要。
