Effect of macronutrient intake during the second trimester on glucose metabolism later in pregnancy123

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Background: Dietary intake is known to influence glucose metabolism, but there is little consensus on the optimal distribution of macronutrient intakes during pregnancy to prevent gestational diabetes (GDM).Objective: We aimed to investigate whether macronutrient intake distribution during the second trimester of pregnancy was associated with glucose metabolism later in pregnancy.Design: Women with singleton pregnancies and without preexisting type 1 or type 2 diabetes were included. Participants underwent a 3-h oral-glucose-tolerance test at 30 wk (95% CI: 25, 33 wk) gestation and were asked to recall their second-trimester dietary intake by using a validated food-frequency questionnaire.Results: Of the 205 participants, 47 (22.9%) had a diagnosis of GDM. A higher intake of saturated fat (β ± SEE: 0.059 ± 0.021; P = 0.005) and trans fat (0.381 ± 0.145; P = 0.009) as a percentage of energy and of added sugar (0.017 ± 0.007; P = 0.02) and a lower intake of vegetable and fruit fiber (−0.026 ± 0.012; P = 0.03) were individually associated with increased fasting glucose after multiple adjustment. In participants with a family history of type 2 diabetes, a higher vegetable and fruit fiber intake was associated with reduced insulin resistance (−0.100 ± 0.029; P = 0.0008) and increased insulin sensitivity (0.029 ± 0.012; P = 0.01), after similar adjustment. An increased risk (OR per 1-SD change) of GDM was associated with lower carbohydrate (0.60; 95% CI: 0.40, 0.90) and higher total fat (1.61; 95% CI: 1.06, 2.44) intakes as a percentage of energy, after similar adjustment.Conclusions: Macronutrient intake during the second trimester of pregnancy was associated with a risk of abnormal glucose metabolism later in pregnancy. This finding supports the need for continued work to determine optimal prenatal nutritional strategies to prevent GDM. This trial is registered at clinicaltrials.gov as NCT01405547.

Abbreviations:

AUCglu
total AUC for glucose
FFQ
food-frequency questionnaire
GCT
glucose-challenge test
GDM
gestational diabetes
HOMA-IR
homeostasis model assessment of insulin resistance
ISogtt
Matsuda insulin sensitivity index
ISSI-2
insulin secretion sensitivity index-2
OGTT
oral-glucose-tolerance test

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1

From the Department of Nutritional Sciences (SHL, DLO, and AJH) and Division of Endocrinology (RR, BZ, and AJH), University of Toronto, Toronto, Canada; Physiology and Experimental Medicine, Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Canada (DLO); and Leadership Sinai Centre for Diabetes, (RR, BZ, and AJH), Obstetrics and Gynecology (MS), and Samuel Lunenfeld Research Institute (BZ), Mount Sinai Hospital, Toronto, Canada

2

Supported by grants from the Canadian Diabetes Association (CDA), Canadian Foundation for Dietetic Research, and Canadian Institutes of Health Research (CIHR); a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship (to SHL); a CIHR Clinical Research Initiative New Investigator Award, CDA Clinician-Scientist incentive funding, and a University of Toronto Banting and Best Diabetes Centre New Investigator Award (to RR); the Sam and Judy Pencer Family Chair in Diabetes Research at Mount Sinai Hospital and University of Toronto (to BZ); and the CIHR Canada Research Chair in the Epidemiology of Type 2 Diabetes and Ontario Ministry of Research and Innovation Early Researcher Award (to AJH).

3

Address reprint requests and correspondence to DL O’Connor, Department of Nutritional Sciences, University of Toronto, The Hospital for Sick Children, Room 8511C, 555 University Avenue, Toronto, ON, Canada M5G 1X8. E-mail: [email protected].

Copyright © 2014 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.