1. Macronutrient Intake and Gestational Diabetes in Obese Women
L. Mullaney1, A.O’Higgins2, S.Cawley1, A. Doolan3, D. McCartney1 and M.J. Turner2
1School of Biological Sciences, Dublin Institute of Technology, Dublin 2UCD Centre for
Human Reproduction, CWIUH, Dublin 3 Department of Pediatrics, Trinity College, Dublin
Introduction
Results
Obesity has been shown to be a risk factor for the development of Gestational Diabetes (GDM).1 Under-reporting of energy Intake (EI) is more likely to occur in obese women.2
Increased fat and decreased carbohydrate intake during pregnancy has been associated with the development of GDM.3 Other studies have suggested that carbohydrate intake or carbohydrate quality during pregnancy are not associated with the risk of developing GDM.1 Further studies have also shown that low glycaemic index diets may lower the risk of developing GDM.4
Excessive fructose intake has been associated with adverse metabolic effects,5 however there is a lack of research investigating this issue in an obstetric cohort.
The aim of this study was to investigate the association between maternal macronutrient intake among obese women in early pregnancy and development of GDM.
The mean age was 29.7 ± 5.9 years, mean weight was 94.3 ± 14.2 kg and mean BMI was 35.0 ± 4.9 kg/m2 (n=71). 31 women (40%) developed GDM. Underreporting of EI occurred in 34 women (47.9%).
Nutrient intake differences between GDM and non-GDM women are shown in Table 1. Women who developed GDM had a lower intake of % energy from protein (p=0.02) and a higher intake of % energy from carbohydrate (p=0.02) than women who did not develop GDM. Plausible reporters who developed GDM had a higher intake of % energy from carbohydrate (p=0.02) than women who did not develop GDM.
Methods
Women were recruited after sonographic confirmation of a singleton pregnancy in the first trimester.
Dietary information was collected using the validated Willett Food Frequency Questionnaire. Self-assessed habitual physical activity levels (PAL) were also collected using a self-administered questionnaire. 6
Basal metabolic rate (BMR) was calculated using standard equations based on gender, weight, and age.7 EI was calculated using WFFQ data and WISP v 4.0 software. Lowest plausible thresholds for PAL were calculated according to respondents’ individual self-reported PAL.8
Those whose EI/BMR < the calculated plausible threshold for their physical activity were classed dietary under-reporters.9
Maternal height and weight were measured. BMI was calculated and women were classified as obese based on a BMI > 30 kg/m2.10
GDM was diagnosed using a 75g two hour glucose tolerance test between 24 and 28 weeks gestation (IADPSG criteria).11
Conclusions
Obese women who developed GDM had a greater % of energy from carbohydrate in early pregnancy. Surprisingly there was no difference in GI and % energy from NMES or fructose in women who developed GDM versus those who didn’t. Whether changes in dietary intake can prevent the development of GDM requires a randomised control trial.
The increased incidence of EI under-reporting in obese women may result in erroneous conclusions regarding the nutritional status and risk profile of these women. Particular emphasis on specialist dietary assessment to accurately capture intakes in obese women maybe required.
References
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2Mullaney L, O’Higgins AC, Cawley S, et al. (2014) J Public Health
3Saldana TM, Siega-Riz AM, Adair LS. (2004) Am J Clin Nutr
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6 Food and Agricultural Organisation/World Health Organisation/
United Nations University. (2001)
7Henry CJ. (2005) Public Health Nutr
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10WHO (2000) WHO Technical Report Series 894: 1-253
11Metzger BE, Gabbe SG, Persson B, et al. (2010) Diabetes Care