Evaluation On Dietary Characteristics And Its Relationship With Gestational Diabetes Mellitus Among Pregnant Women In Wuhan Based On The Adjusted Diet Balance Index During Pregnancy

Objective: To obtain the dietary characteristics of pregnant women in Wuhan and explore their association with gestational diabetes mellitus(GDM),so as to provide a scientific basis for reasonable guidance of dietary,and prevention and control of GDM during pregnancy.Methods: Strict screening was conducted before enrolling 1371 eligible gestational women from the Tongji-Central hospital Maternal and Child Health Cohort.Using Semiquantitative food frequency questionnaire(FFQ)to acquire the dietary intake of pregnant women at 11-16 w and 23-28 w of gestation,including 754 early pregnancy FFQs and 827 mid-pregnancy FFQs.Using the evaluation indexes and evaluation standards of 2007 Chinese Diet Balance Index(DBI)combined with 2016 Chinese pregnant women dietary guidelines and Reference intake of dietary nutrients for Chinese residents(DRIs,2013)to adjust and build a new DBI for Pregnancy(DBI-P),in order to evaluate the dietary nutrition characteristics and dietary patterns of pregnant women and their relationship with GDM.Univariate and multivariate linear regression models were used to analyze the influencing factors of dietary intake imbalance,and binary logistic regression model was used to explore the relationship between dietary patterns and GDM risk.SPSS 25.0 was used to analyze the data.Results:(1)Basic information: Total 1371 pregnant women were enrolled,and the people with the incidence of GDM was 15.1%.The average age of pregnant women was 28.8±3.5 years.Normal pre-pregnancy body mass index(BMI),thin,overweight,and obese pre-pregnancy weight groups was 68.7,17.9,10.2 and 2.8 percent,respectively.77.8% of pregnant women have a college degree or above.10.5% and 26.4% of pregnant women had a family history of diabetes and hypertension,respectively.Smoking and drinking alcohol before pregnancy accounted for 3.0% and 6.4%.Most pregnant women are primiparas.(2)Dietary characteristics: There were mainly low and moderate deficiencies of intake in the early and second trimesters,accompanied by excessive intake of fruit,oil and salt.The dietary quality was unbalanced at a moderate and low degree(Diet Quality Distance,DQD=38.2±9.1 in early trimester,DQD=33.3±8.2 in the second trimester).Dietary deficiencies and dietary imbalance were more likely to occur in the first trimester than in the second trimester,while the excessive dietary intake was more likely to occur in the second trimester(P<0.01).Pattern B was the main dietary pattern in our study,accounting for 60.5%,which was characterized by deficiency of animal blood or liver,soybean and its products,milk and aquatic products.General linear regression model showed that obese(BMI≥28kg/m2),lower education level,lower family per capita monthly income and no family history of diabetes were significantly correlated with higher DQD score(P<0.05).(3)The relationship between dietary quality and GDM: Water score was statistically different between the GDM group and the non-GDM group(P<0.05).The egg score of the GDM group in the second trimester was higher than that of non-GDM group,while the cereal score was lower than that of non-GDM group(P<0.05).There was no significant difference in dietary quality between the GDM group and the non-GDM group(P(29)0.05).Pattern B is the dominant dietary patterns in both groups.After adjusting for confounders,it was found that the risk of GDM in pregnant women who were in pattern D(characterized by excessive intake of fruit,oil,and salt)was 3.90 times than that in mode A in early pregnancy.(OR=3.90,95% CI: 1.11,13.66).Conclusions: The dietary characteristics of pregnant women in Wuhan are characterized by unbalanced overall dietary intake at low and moderate levels,and there is generally insufficient intake of food groups and nutrients,especially insufficient intake of animal blood or liver,soybean and its products,milk and aquatic products.However,problems with excessive intake of fruit,oil and salt are also common among pregnant women in Wuhan.Updated pregnancy DBI can quantify the extent of dietary problems and evaluate the dietary nutritional characteristics of pregnant women in Wuhan.However,further study is necessary to explore the correlation between dietary characteristics and GDM by different methods,in order to better control GDM and promote maternal and child health.