The Association Between Pre-pregnancy Prime Diet Quality Score And Gestational Diabetes Mellitus

Objective:The aim of this study is to evaluate the pre-pregnancy dietary quality of pregnant women in Northeast China by using China prime diet quality score(CPDQS),a simple and effective index to and to examine its association with the risk of gestational diabetes mellitus(GDM).Methods:This study was conducted using data from the maternal-fetal cohort,a sub-cohort of the Northeast Natural Population Cohort.Participants were recruited from Shengjing Hospital affiliated to China Medical University.From the end of 2018,pregnant women who underwent 75 g Oral glucose tolerance test(OGTT)at 24-28 weeks of gestation in our hospital and completed a baseline questionnaire were enrolled.The information collected by the baseline questionnaire included social demographic characteristics,life styles,and reproductive history.Pre-pregnancy dietary intake was collected by means of a validated semi-quantitative food frequency questionnaire.The scores of CPDQS were calculated to assess dietary quality.GDM was diagnosed according to IADPSG criteria.The subjects were divided into three groups by CPDQS tertiles,which was the lowest tertile(T1),the middle tertile(T2)and the highest tertile(T3).Baseline characteristics of the study population were evaluated by comparing tertiles of CPDQS and subjects with and without GDM,using the rank sum test,Chi-square test or analysis of variance.Multivariate logistic regression was used to analyze the association between CPDQS and GDM(T1 serving as the reference).The models were initially adjusted for age and ethnicity(model 1),and then further adjusted(model 2)for history of gestation,smoking status,physical activity,family annual income,education,family history of diabetes,multivitamin use,and total caloric intake before pregnancy.Finally,all models were also adjusted for pre-pregnancy body mass index(model 3).In addition,subgroup analyses and multiplicative interaction were performed by stratifying by age(<35 vs.≥35years),pre-pregnancy BMI(<18.5 kg/m~2,18.5-23.9 kg/m~2vs.≥24 kg/m~2),pregnancy history(yes vs.no),physical activity(high-level vs.low-level),sitting activity(high-level vs.low-level),and assisted reproductive technology(yes vs.no).Results:In this study,a total of 2359 people were included as the subjects,502 of whom had GDM,with a prevalence rate of 21.28%.There were statistical differences in age,pre-pregnancy BMI,pregnancy history,miscarriage history,family history of diabetes,and whether they had received assisted reproductive technology between the GDM group and the non-GDM group(P<0.05).The median score of pre-pregnancy CPDQS was 57.Univariate analysis found statistical differences among the CPDQS tertiles in terms of age,ethnicity,education,annual household income,smoking status,physical activity and total energy intake(P<0.05).No statistical correlation between pre-pregnancy CPDQS and GDM risk was observed in the multivariate adjusted logistic regression models.Subgroup analysis showed that no significant association was found between CPDQS and the risk of GDM.An analysis of multiple food groups found that in adjusted models 1,2 and 3,compared with the lowest T1 group,the odds ratio(OR)and 95%confidence interval(CI)of grains/legumes intake T3 group were 0.70(0.55,0.89),0.75(0.60,0.90)and 0.69(0.53,0.89),respectively.Conclusions:No statistical correlation between pre-pregnancy CPDQS of pregnant women in Northeast China and the risk of GDM has been observed.The increased grains/legumes intake before pregnancy may be associated with the decreased risk of GDM.