Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study.
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.


METHODS
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.
From 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).
Wei
W
Bao
From 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).
Katherine
K
Bowers
From 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).
Deirdre K
DK
Tobias
From 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).
Sjurdur F
SF
Olsen
From 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).
Jorge
J
Chavarro
From 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).
Allan
A
Vaag
From 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).
Michele
M
Kiely
From 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).
Cuilin
C
Zhang
D000328:Adult; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D050528:Diet, Carbohydrate-Restricted / Q000009:adverse effects*; D059305:Diet, High-Fat / Q000009:adverse effects; D004038:Diet, Reducing / Q000009:adverse effects*; D004044:Dietary Proteins / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D039382:Maternal Nutritional Physiological Phenomena; D008460:Meat / Q000009:adverse effects; D009726:Nurses; D014674:Plant Proteins, Dietary / Q000008:administration & dosage / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D014481:United States / Q000453:epidemiology
D004044:Dietary Proteins; D014674:Plant Proteins, Dietary