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Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study
Wei Bao1, Katherine Bowers1, Deirdre K Tobias1
1From the Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Rockville, MD (WB, MK, and CZ); the Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (KB); the Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (DKT and JC); the Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (SFO); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (JC); and the Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark (AV).
Background:
Low-carbohydrate diets (LCDs) have been vastly popular for weight loss. The association between a low-carbohydrate dietary pattern and risk of gestational diabetes mellitus (GDM) remains unknown.
Objective:
We aimed to prospectively examine the association of 3 prepregnancy low-carbohydrate dietary patterns with risk of GDM.
Design:
We included 21,411 singleton pregnancies in the Nurses' Health Study II. Prepregnancy LCD scores were calculated from validated food-frequency questionnaires, including an overall LCD score on the basis of intakes of carbohydrate, total protein, and total fat; an animal LCD score on the basis of intakes of carbohydrate, animal protein, and animal fat; and a vegetable LCD score on the basis of intakes of carbohydrate, vegetable protein, and vegetable fat. A higher score reflected a higher intake of fat and protein and a lower intake of carbohydrate, and it indicated closer adherence to a low-carbohydrate dietary pattern. RRs and 95% CIs were estimated by using generalized estimating equations with log-binomial models.
Results:
We documented 867 incident GDM pregnancies during 10 y follow-up. Multivariable-adjusted RRs (95% CIs) of GDM for comparisons of highest with lowest quartiles were 1.27 (1.06, 1.51) for the overall LCD score (P-trend = 0.03), 1.36 (1.13, 1.64) for the animal LCD score (P-trend = 0.003), and 0.84 (0.69, 1.03) for the vegetable LCD score (P-trend = 0.08). Associations between LCD scores and GDM risk were not significantly modified by age, parity, family history of diabetes, physical activity, or overweight status.
Conclusions:
A prepregnancy low-carbohydrate dietary pattern with high protein and fat from animal-food sources is positively associated with GDM risk, whereas a prepregnancy low-carbohydrate dietary pattern with high protein and fat from vegetable food sources is not associated with the risk. Women of reproductive age who follow a low-carbohydrate dietary pattern may consider consuming vegetable rather than animal sources of protein and fat to minimize their risk of GDM.
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