Associations Of Dietary Habits, Physical Activity, And Cognitive Views And Gestational Diabetes Mellitus Among Cantonese Women

Background and objective:Gestational diabetes mellitus (GDM) is glucose intolerance at any degree appearing for the first time during pregnancy. It is the most common complication during pregnancy, affecting approximately2-12%of pregnant women. Worldwide, one in ten pregnancies is associated with diabetes, of which90%are diagnosed as GDM. It has been reported that some behavioral factors, such as dietary intake, physical activity, weight gain, and substance use are associated with the risk of GDM among pregnancy women. However, most of the studies in this respect were carried out on Caucasian women and only a few studies were about Asian populations, with those about Chinese people even sparser. In addition, in Asia there are very diverse life styles between different countries or regions; particularly in China, traditional cognitive views on pregnancy health are quite unique. Studies to understand the association of cognitive view on pregnancy health with the incidence of GDM are extremely lacking. The aim of this study was to evaluate the relationship between dietary habits, physical activity, and cognitive views and the risk of GDM in Chinese women.Methods:1. This was a cross-sectional study involving571pregnant women who underwent a75-g oral glucose challenge test at their24th to28th gestational week. Pregnant women were consecutively admitted to the Department of Gynecology and Obstetrics and the Department of Endocrinology at Nanfang Hospital. The relationships between the potential risk factors and GMD were evaluated using three questionnaires, respectively.2. Food frequency questionnaire (FFQ) was used by three dieticians to evaluate all the subjects’dietary habits. Locally featured special foods such as Cantonese Dim Sum and tropical fruits were included in the food frequency questionnaire. The physical activity of all the subjects was evaluated with a International Physical Activity Questionnaire (IPAQ). Using a structured questionnaire, face-to-face interviews were conducted by trained interviewers to obtain information on maternal socio-demographic characteristics (age, residence, marital status, occupation, and education). Of the571eligible cases, a total of539(94%) cases were fully interviewed and thus evaluated in the present study.3. Statistical analysis:All data entry SPSS15.0unified package, One-way analysis of variance (ANOVA) was performed to assess the univariate differences among continuous variables. The χ2test was used to compare the observed frequencies between various groups. Binary logistic regression was performed to model the relation between the daily intake of high-GI fruit and energy-dense foods, physical activity, cognitive view on pregnancy health, maternal anthropometric parameters, and incident GDM. Measurement data were presented as mean±standard deviation. P<0.05as significant difference, P<0.01as very significant.Results:1. Sixty-nine women (13%) were identified as with GDM (GDM+). Increased intake of high-GI fruit and energy-dense snack foods in GDM+subjects was observed than in GDM-group (P=0.010, P=0.002, respectively), while physical activity in GDM+group was lower than GDM-group (P=0.020). Furthermore, subjects who regarded that nausea and vomiting-caused insufficient food intake as relevant to fetal abnormalities had an increased risk for GDM (P=0.018), and those with unlimited dietary intake as soon as morning sickness got recovered were also at higher risk for GDM (P=0.038).2. After multiple logistic regression analysis, increased pre-pregnancy BMI, greater weight gain during pregnancy, positive family history, and the cognitive views for unlimited food intake subsequent to morning sickness remain independent predictors of GDM (OR=1.151, P=0.009; OR=1.096, P=0.041;OR=2.101, P=0.038; OR=1.911, P=0.032, respectively). Moreover, increased consumption of energy-dense snack foods and high-GI fruits were strongly associated with the risk of GDM (OR=1.050, P=0.001; OR=1.002, P=0.017, respectively).Conclusion:The intensive health education that guides for a reasonable dietary behavior and adequate physical activities is highly in demand for the control of GDM, and further work is needed to better understand the relationship between diet, physical activity, health education and glucose disturbances during pregnancy.