title: Diet, physical activity and mental health status are associated with dysglycaemia in pregnancy: the Healthy Start Study.
abstract: OBJECTIVE
  To examine the association between dysglycaemia and multiple modifiable factors measured during pregnancy.
  
  
  METHODS
  The Healthy Start Study collected self-reported data on modifiable factors in early and mid-pregnancy (median 17 and 27 weeks gestation, respectively) from 832 women. Women received one point for each modifiable factor for which they had optimum scores: diet quality (Healthy Eating Index score ≥64), physical activity level (estimated energy expenditure ≥170 metabolic equivalent task-h/week), and mental health status (Perceived Stress Scale score <6 and Edinburgh Postnatal Depression Scale score <13). Dysglycaemia during pregnancy was defined as an abnormal glucose challenge result, ≥1 abnormal results on an oral glucose tolerance test, or a clinical diagnosis of gestational diabetes. Logistic regression models estimated odds ratios for dysglycaemia as a function of each factor and the total score, adjusted for age, race/ethnicity, pre-pregnancy BMI, history of gestational diabetes, and family history of Type 2 diabetes.
  
  
  RESULTS
  In individual analyses, only physical activity was significantly associated with a reduced risk of dysglycaemia (adjusted odds ratio 0.67, 95% CI 0.44-1.00). We observed a significant, dose-response association between increasing numbers of optimal factors and odds of dysglycaemia (adjusted P=0.01). Compared with having no optimal modifiable factors, having all three was associated with a 73% reduced risk of dysglycaemia (adjusted odds ratio 0.27, 95% CI 0.08-0.95).
  
  
  CONCLUSIONS
  An increasing number of positive modifiable factors in pregnancy was associated with a dose-response reduction in risk of dysglycaemia. Our results support the hypothesis that modifiable factors in pregnancy are associated with the risk of prenatal dysglycaemia.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: K A
authors.initials: KA
authors.lastname: Sauder
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO.
authors.forename: A P
authors.initials: AP
authors.lastname: Starling
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO.
authors.forename: A L
authors.initials: AL
authors.lastname: Shapiro
authors.affiliation: Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: J L
authors.initials: JL
authors.lastname: Kaar
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO.
authors.forename: B M
authors.initials: BM
authors.lastname: Ringham
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO.
authors.forename: D H
authors.initials: DH
authors.lastname: Glueck
authors.affiliation: Department of Community & Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO.
authors.forename: J A
authors.initials: JA
authors.lastname: Leiferman
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Siega-Riz
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO.
authors.forename: D
authors.initials: D
authors.lastname: Dabelea
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D000072001:Diet, Healthy; D015444:Exercise; D005260:Female; D044882:Glucose Metabolism Disorders / Q000453:epidemiology / Q000517:prevention & control*; D000070497:Healthy Lifestyle; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D008603:Mental Health; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D057566:Self Report; D055815:Young Adult