title: Pre-pregnancy dietary patterns and risk of gestational diabetes mellitus: results from an Australian population-based prospective cohort study.
abstract: OBJECTIVE
  We examined the associations between pre-pregnancy dietary patterns and the incidence of gestational diabetes mellitus (GDM) in a population-based cohort study of women of reproductive age.
  
  
  METHODS
  The Australian Longitudinal Study on Women's Health included 3,853 women without pre-existing diabetes who were followed-up between 2003 and 2012. Pre-pregnancy dietary patterns were derived using factor analysis based on 101 food items from a validated food frequency questionnaire. GDM was self-reported and validated in a subsample. Multivariable regression models with generalised estimating equations were used to estimate RR and 95% CI.
  
  
  RESULTS
  During 9 years follow-up, 292 GDM cases (4.4%) were documented in 6,626 pregnancies. No associations were found for the 'Fruit and low-fat dairy' and 'Cooked vegetables' patterns. The 'Meats, snacks and sweets' pattern was associated with higher GDM risk after adjustment for socioeconomic, reproductive and lifestyle factors (RR [95% CI] per SD increase in score: 1.38 [1.02, 1.86]). Further adjustment for BMI attenuated the results (1.35 [0.98, 1.81]). In stratified analysis, the 'Meats, snacks and sweets' pattern was associated with significantly higher GDM risk in parous and obese women, and in women with lower educational qualifications. The 'Mediterranean-style' pattern was associated with lower GDM risk in the fully adjusted model (0.85 [0.76, 0.98]).
  
  
  CONCLUSIONS
  These findings support general dietary recommendations for women of reproductive age to consume a diet rich in vegetables, whole grains, nuts and fish, and low in red and processed meats and snacks. Further prospective studies are needed to confirm these findings.
authors.affiliation: School of Public Health, University of Queensland, Herston Road, Herston, QLD, 4006, Australia. d.schoenaker@uq.edu.au.
authors.forename: Danielle A J M
authors.initials: DA
authors.lastname: Schoenaker
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors.forename: Sabita S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.affiliation: School of Medicine, University of Queensland, Brisbane, QLD, Australia.|Departments of Obstetric and Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: Leonie K
authors.initials: LK
authors.lastname: Callaway
authors.affiliation: School of Public Health, University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
authors.forename: Gita D
authors.initials: GD
authors.lastname: Mishra
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology*; D004032:Diet; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D011153:Population; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors
keywords: Dietary patterns; Gestational diabetes mellitus; Nutrition; Pregnancy