Healthful Dietary Patterns and the Risk of Hypertension Among Women With a History of Gestational Diabetes Mellitus: A Prospective Cohort Study.
Women who developed gestational diabetes mellitus represent a high-risk population for hypertension later in life. The role of diet in the progression of hypertension among this susceptible population is unknown. We conducted a prospective cohort study of 3818 women with a history of gestational diabetes mellitus in the Nurses' Health Study II as part of the ongoing Diabetes & Women's Health Study. These women were followed-up from 1989 to 2011. Incident hypertension was identified through self-administered questionnaires that were validated previously by medical record review. Adherence scores for the alternative Healthy Eating Index 2010, the alternative Mediterranean diet, and the Dietary Approaches to Stop Hypertension were computed for each participant. Cox proportional hazard models were used to evaluate the associations between dietary scores and hypertension while adjusting for major risk factors for hypertension. We documented 1069 incident hypertension cases during a median of 18.5 years of follow-up. After adjustment for major risk factors for hypertension, including body mass index, alternative Healthy Eating Index 2010, alternative Mediterranean diet, and Dietary Approaches to Stop Hypertension scores were significantly inversely associated with the risk of hypertension; hazard ratio and 95% confidence interval comparing the extreme quartiles (highest versus lowest) were 0.76 (0.61-0.94; P for linear trend =0.03) for AHEI score, 0.72 (0.58-0.90; P for trend =0.01) for Dietary Approach to Stop Hypertension score, and 0.70 (0.56-0.88; P for trend =0.002) for alternative Mediterranean diet score. Adherence to a healthful dietary pattern was related to a lower subsequent risk of developing hypertension among women with a history of gestational diabetes mellitus.
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Shanshan
S
Li
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Yeyi
Y
Zhu
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Jorge E
JE
Chavarro
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Wei
W
Bao
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Deirdre K
DK
Tobias
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Sylvia H
SH
Ley
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
John P
JP
Forman
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Aiyi
A
Liu
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
James
J
Mills
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Katherine
K
Bowers
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Marin
M
Strøm
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Susanne
S
Hansen
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.).
Frank B
FB
Hu
From the Epidemiology Branch (S.L., Y.Z., W.B., J.M., C.Z.), and Biostatistics Branch (A.L.), Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD; Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.E.C.); Department of Nutrition, Harvard T.H. Chan School of Public Health, and Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.K.T.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (S.H.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.P.F.); Department of Pediatrics, Cincinnati Children's Hospital, OH (K.B.); Centre for Fetal Programming, Department of Epidemiology Research, National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark (M.S., S.H.); Department of Epidemiology, Department of Nutrition, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (F.B.H.). zhangcu@mail.nih.gov.
Cuilin
C
Zhang
D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D015897:Comorbidity; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology*; D000072001:Diet, Healthy; D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology*; D015994:Incidence; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
dietary pattern; gestational diabetes mellitus; hypertension; nutrition; women