The Relationship Between Gestational Diabetes Mellitus And Pre-Pregnancy And Mid-Pregnancy Dietary Flavonoid Intake In Pregnant Women In Shenyang

Objectives:To find out the prevalence of gestational diabetes mellitus(GDM)among pregnant women in Shenyang,Liaoning Province,and their pre-pregnancy and midpregnancy dietary flavonoid intake;to investigate the correlation between dietary flavonoid intake and GDM,and to provide a reference for whether dietary flavonoidcontaining foods should be recommended to pregnant women.Methods: The study was a cross-sectional study with 2,190 individuals from the “Maternal-Fetal Cohort”,a sub-cohort of the Northeast Regional Natural Population Cohort Study,who met the inclusion and exclusion criteria after screening the initial population.Information for the study was collected through questionnaires,physical examination and blood biochemistry,including baseline information and blood biochemistry information.The target population was identified using the appropriate diagnostic criteria.Information on dietary intake was collected through a semi-quantitative Food Frequency Questionnaire(FFQ),which included 19 food items containing dietary flavonoids in the pre-pregnancy and pregnancy phases.Total dietary flavonoid intake was quadratically and tristatically classified by quartiles and tertile,respectively(with the first quartile as the reference group);quercetin,myricetin,luteolin and kaem-pferol intake were quadratically classified by quartiles(with the first quartile as the reference group);apigenin was dichotomously classified by mean(with the less-than-mean group as the reference group).The association between dietary intake of flavonoids and GDM was analysed using a multifactorial logistic regression model;age and pre-pregnancy body mass index(BMI)were used as stratification factors to analyse the association between dietary intake of flavonoids and GDM.The association between dietary flavonoid intake and GDM was analysed in subgroups using age and pre-pregnancy BMI as stratification factors.All statistical analyses in this study were performed using SAS 9.4 statistical software.Results: The study identified 2190 as the final respondents,463 of whom had GDM,a prevalence of 21.14%.There was a statistically significant difference between the GDM group and the non-GDM group in terms of fertility history and family history of diabetes(P< 0.05).In mid-pregnancy,the differences in carbohydrate and fruit intake levels between the two groups were statistically significant(P<0.05);with the exception of quercetin,the differences between the GDM and non-GDM groups were statistically significant in the intake levels of myricetin,luteolin,kaem-pferol,apigenin and total dietary flavonoids.In the logistic regression analysis,there was a statistical association between prepregnancy quercetin intake as a protective factor and GDM.Statistical associations between quercetin,myricetin,luteolin,kaem-pferol and total dietary flavonoid intake as protective factors and GDM in mid-pregnancy.The results of the subgroup analysis showed a protective effect of mid-pregnancy dietary flavonoid intake on the risk of GDM in the low(<35 years)and high pre-pregnancy BMI groups(≥24 kg/m2)at mid-pregnancy(OR=0.61,95% CI: 0.43,0.87;OR=0.55,95% CI: 0.32,0.94).Conclusions:This study found a statistical association between pre-and mid-pregnancy dietary flavonoid intake and GDM.Quercetin,myricetin,luteolin,kaem-pferol and total dietary flavonoids were all protective against GDM.It is recommended to increase the intake of dietary flavonoid-containing foods during pregnancy preparation and during pregnancy,especially for women during pregnancy,to help prevent GDM.