Zhang Hehua, Xia Yang, Zhang Xiangsu, Chang Qing, Zhao Yuhong
Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Front Nutr. 2023 Jan 5;9:992472. doi: 10.3389/fnut.2022.992472. eCollection 2022.
Nutritional management is the cornerstone of gestational diabetes mellitus (GDM) prevention. High quality instead of low quantity of carbohydrate intake has been paying attention in controlling glycemia. Air pollution exposure can be interacted with dietary sourced nutrients, which may modify the associations with GDM. This study aims to explore the associations between overall quality of carbohydrate intake and GDM as well as the modifying effect of prenatal air pollution exposure.
Carbohydrate quality index (CQI) was calculated was calculated by summing scores of the four components; Land use regression prediction models were used to assess the air pollution exposure levels. GDM definition was based on 75 g glucose tolerance test results. Associations between pre-pregnancy CQI, pre-natal air pollution as well as the modifying effect on GDM were explored based on a birth cohort in China.
A total of 3,183 participants were included, of which 784 (24.63%) were diagnosed with GDM. Higher pre-pregnancy CQI was associated with a lower incidence of GDM [odds ratio (OR) = 0.75, 95% confidence interval (CI): 0.56-0.99, = 0.04], especially for higher fasting blood glucose related GDM (OR = 0.66, 95% CI: 0.47, 0.91). Higher air pollution exposure before and during pregnancy was associated with a greater risk of GDM. Higher exposure to particulate matter with an aerodynamic diameter of < 2.5 μm ( < 0.01), particulate matter with an aerodynamic diameter of < 10 μm ( < 0.01), and sulfur dioxide ( = 0.02) during pregnancy decreased the beneficial effect of high pre-pregnancy CQI on GDM.
CQI related dietary interventions pre-pregnancy to prevent GDM incidence should be considered. Women who are planning to be pregnant should avoid high exposure to air pollution during pregnancy.
营养管理是妊娠期糖尿病（GDM）预防的基石。在控制血糖方面，碳水化合物摄入的高质量而非低数量受到关注。空气污染暴露可与饮食来源的营养素相互作用，这可能改变与GDM的关联。本研究旨在探讨碳水化合物摄入的总体质量与GDM之间的关联以及产前空气污染暴露的调节作用。
通过对四个组成部分的得分求和来计算碳水化合物质量指数（CQI）；使用土地利用回归预测模型评估空气污染暴露水平。GDM的定义基于75克葡萄糖耐量试验结果。基于中国的一个出生队列，探讨孕前CQI、产前空气污染之间的关联以及对GDM的调节作用。
共纳入3183名参与者，其中784名（24.63%）被诊断为GDM。较高的孕前CQI与较低的GDM发病率相关[比值比（OR）=0.75，95%置信区间（CI）：（0.56 - 0.99），P = 0.04]，尤其是对于空腹血糖较高相关的GDM（OR = 0.66，95% CI：0.47，0.91）。孕期前后较高的空气污染暴露与GDM的更大风险相关。孕期暴露于空气动力学直径<2.5μm的颗粒物（P<0.01）、空气动力学直径<10μm的颗粒物（P<0.01）和二氧化硫（P = 0.02）会降低孕前高CQI对GDM的有益作用。
应考虑孕前与CQI相关的饮食干预以预防GDM的发生。计划怀孕的女性在孕期应避免高暴露于空气污染。
