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The Impact of Gestational Weight Gain and Diet on Abnormal Glucose Tolerance During Pregnancy in Hispanic Women

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An Erratum to this article was published on 05 May 2009

Abstract

Objective To examine the association of gestational weight gain and dietary factors with abnormal glucose tolerance (AGT). Methods We conducted a prospective cohort study among 813 Hispanic prenatal care patients in Massachusetts. Gestational weight gain and oral glucose tolerance test results were abstracted from medical records. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Target weight gain was based on BMI-specific weekly weight gain rates established by the Institute of Medicine (IOM). Results We observed a statistically significant interaction between prepregnancy BMI and weight gain in relation to AGT (P < 0.01). Class II/III (BMI ≥ 35 kg/m2) obese women who had a high rate of weight gain (>0.30 kg/week) or who exceeded target weight were 3–4 times as likely to develop AGT compared to women who gained within IOM ranges (OR = 4.2, 95% CI 1.1–16.0, OR = 3.2 95% CI 1.0–10.5, respectively). Increasing levels of saturated fat and fiber and decreasing levels of energy-dense snack foods and polyunsaturated fat:saturated fat ratio were significantly associated with increased risk of AGT, independent of gestational weight gain. Conclusions Weight gain among class II/III obese women and certain dietary components may represent modifiable risk factors for AGT.

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References

  1. Kim, C., Berger, D. K., & Chamany, S. (2007). Recurrence of gestational diabetes mellitus: A systematic review. Diabetes Care, 30, 1314–1319. doi:10.2337/dc06-2517.

    Article  PubMed  Google Scholar 

  2. Gonzalez-Quintero, V. H., Istwan, N. B., Rhea, D. J., Rodriguez, L. I., Cotter, A., Carter, J., et al. (2007). The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes. Diabetes Care, 30, 467–470. doi:10.2337/dc06-1875.

    Article  PubMed  CAS  Google Scholar 

  3. Kwik, M., Seeho, S. K., Smith, C., McElduff, A., & Morris, J. M. (2007). Outcomes of pregnancies affected by impaired glucose tolerance. Diabetes Research and Clinical Practice, 77, 263–268. doi:10.1016/j.diabres.2006.12.004.

    Article  PubMed  CAS  Google Scholar 

  4. Petitt, D. J., Bennett, P. H., Knowler, W. C., Baird, H. R., & Aleck, K. A. (1985). Gestational diabetes mellitus and impaired glucose tolerance during pregnancy. Long-term effects on obesity and glucose tolerance in the offspring. Diabetes, 34(Suppl 2), 119–122.

    PubMed  Google Scholar 

  5. Gillman, M. W., Rifas-Shiman, S., Berkey, C. S., Field, A. E., & Colditz, G. A. (2003). Maternal gestational diabetes, birth weight, and adolescent obesity. Pediatrics, 111, e221–e226. doi:10.1542/peds.111.3.e221.

    Article  PubMed  Google Scholar 

  6. Schmidt, M. I., Duncan, B. B., Reichelt, A. J., Branchtein, L., Matos, M. C., Costa e Forti, A., et al. (2001). Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care, 24, 1151–1155. doi:10.2337/diacare.24.7.1151.

    Article  PubMed  CAS  Google Scholar 

  7. Dodd, J. M., Crowther, C. A., Antoniou, G., Baghurst, P., & Robinson, J. S. (2007). Screening for gestational diabetes: The effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomes. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47, 307–312. doi:10.1111/j.1479-828X.2007.00743.x.

    Article  PubMed  Google Scholar 

  8. Linne, Y., Barkeling, B., & Rossner, S. (2002). Natural course of gestational diabetes mellitus: Long term follow up of women in the SPAWN study. An International Journal of Obstetrics and Gynaecology, 109, 1227–1231.

    Google Scholar 

  9. Carr, D. B., Newton, K. M., Utzschneider, K. M., Tong, J., Gerchman, F., Kahn, S. E., et al. (2008). Modestly elevated glucose levels during pregnancy are associated with a higher risk of future diabetes among women without gestational diabetes mellitus. Diabetes Care, 31, 1037–1039. doi:10.2337/dc07-1957.

    Article  PubMed  CAS  Google Scholar 

  10. Di Cianni, G., Seghieri, G., Lencioni, C., Cuccuru, I., Anichini, R., De Bellis, A., et al. (2007). Normal glucose tolerance and gestational diabetes mellitus: What is in between? Diabetes Care, 30, 1783–1788. doi:10.2337/dc07-0119.

    Article  PubMed  Google Scholar 

  11. Hillier, T. A., Pedula, K. L., Schmidt, M. M., Mullen, J. A., Charles, M. A., & Pettitt, D. J. (2007). Childhood obesity and metabolic imprinting: The ongoing effects of maternal hyperglycemia. Diabetes Care, 30, 2287–2292. doi:10.2337/dc06-2361.

    Article  PubMed  Google Scholar 

  12. Hampton, T. (2007). Study finds newborn outcomes affected by blood glucose levels during pregnancy. Journal of the American Medical Association, 298, 613–614. doi:10.1001/jama.298.6.613.

    Article  PubMed  CAS  Google Scholar 

  13. Mello, G., Parretti, E., Mecacci, F., Lucchetti, R., Lagazio, C., Pratesi, M., et al. (1997). Risk factors for fetal macrosomia: The importance of a positive oral glucose challenge test. European Journal of Endocrinology, 137, 27–33. doi:10.1530/eje.0.1370027.

    Article  PubMed  CAS  Google Scholar 

  14. Lapolla, A., Dalfra, M. G., Bonomo, M., Castiglioni, M. T., Di Cianni, G., Masin, M., et al. (2007). Can plasma glucose and HbA1c predict fetal growth in mothers with different glucose tolerance levels? Diabetes Research and Clinical Practice, 77, 465–470. doi:10.1016/j.diabres.2007.01.022.

    Article  PubMed  CAS  Google Scholar 

  15. Group T.H.S.C.R. (2008). Hyperglycemia and adverse pregnancy outcomes. The New England Journal of Medicine, 358, 1991. doi:10.1056/NEJMoa0707943.

    Article  Google Scholar 

  16. Hedley, A. A., Ogden, C. L., Johnson, C. L., Carroll, M. D., Curtin, L. R., & Flegal, K. M. (2004). Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. Journal of the American Medical Association, 291, 2847–2850. doi:10.1001/jama.291.23.2847.

    Article  PubMed  CAS  Google Scholar 

  17. Schieve, L. A., Cogswell, M. E., & Scanlon, K. S. (1998). Trends in pregnancy weight gain within and outside ranges recommended by the Institute of Medicine in a WIC population. Maternal and Child Health Journal, 2, 111–116. doi:10.1023/A:1022992823185.

    Article  PubMed  CAS  Google Scholar 

  18. Helms, E., Coulson, C. C., & Galvin, S. L. (2006). Trends in weight gain during pregnancy: A population study across 16 years in North Carolina. American Journal of Obstetrics and Gynecology, 194, e32–e34. doi:10.1016/j.ajog.2006.01.025.

    Article  PubMed  Google Scholar 

  19. Olson, C. M., & Strawderman, M. S. (2003). Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. Journal of the American Dietetic Association, 103, 48–54. doi:10.1053/jada.2003.50001.

    Article  PubMed  Google Scholar 

  20. Kim, S. Y., Dietz, P. M., England, L., Morrow, B., & Callaghan, W. M. (2007). Trends in pre-pregnancy obesity in nine states, 1993–2003. Obesity (Silver Spring, Md.), 15, 986–993.

    Article  Google Scholar 

  21. Jensen, D. M., Sorensen, B., Feilberg-Jorgensen, N., Westergaard, J. G., & Beck-Nielsen, H. (2000). Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk profile. Diabetic Medicine, 17, 281–286. doi:10.1046/j.1464-5491.2000.00268.x.

    Article  PubMed  CAS  Google Scholar 

  22. Virally, M., Laloi-Michelin, M., Meas, T., Ciraru, N., Ouled, N., Medeau, V., et al. (2007). Occurrence of gestational diabetes mellitus, maternal and fetal outcomes beyond the 28th week of gestation in women at high risk of gestational diabetes. A prospective study. Diabetes & Metabolism, 33, 290–295. doi:10.1016/j.diabet.2007.03.003.

    Article  CAS  Google Scholar 

  23. Saldana, T. M., Siega-Riz, A. M., & Adair, L. S. (2004). Effect of macronutrient intake on the development of glucose intolerance during pregnancy. The American Journal of Clinical Nutrition, 79, 479–486.

    PubMed  CAS  Google Scholar 

  24. Moses, R. G., Shand, J. L., & Tapsell, L. C. (1997). The recurrence of gestational diabetes: Could dietary differences in fat intake be an explanation? Diabetes Care, 20, 1647–1650. doi:10.2337/diacare.20.11.1647.

    Article  PubMed  CAS  Google Scholar 

  25. Radesky, J. S., Oken, E., Rifas-Shiman, S. L., Kleinman, K. P., Rich-Edwards, J. W., & Gillman, M. W. (2008). Diet during early pregnancy and development of gestational diabetes. Paediatric and Perinatal Epidemiology, 22, 47–59.

    PubMed  Google Scholar 

  26. Marshall, J. A., Bessesen, D. H., & Hamman, R. F. (1997). High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: The San Luis Valley Diabetes Study. Diabetologia, 40, 430–438. doi:10.1007/s001250050697.

    Article  PubMed  CAS  Google Scholar 

  27. Mendoza, J. A., Drewnowski, A., & Christakis, D. A. (2007). Dietary energy density is associated with obesity and the metabolic syndrome in U.S. adults. Diabetes Care, 30, 974–979. doi:10.2337/dc06-2188.

    Google Scholar 

  28. Storlien, L. H., Baur, L. A., Kriketos, A. D., Pan, D. A., Cooney, G. J., Jenkins, A. B., et al. (1996). Dietary fats and insulin action. Diabetologia, 39, 621–631. doi:10.1007/BF00418533.

    Article  PubMed  CAS  Google Scholar 

  29. Meyer, K. A., Kushi, L. H., Jacobs, D. R., Jr., & Folsom, A. R. (2001). Dietary fat and incidence of type 2 diabetes in older Iowa women. Diabetes Care, 24, 1528–1535. doi:10.2337/diacare.24.9.1528.

    Article  PubMed  CAS  Google Scholar 

  30. Simpson, C. (1998). Reaffirming our commitment to improving health services for Hispanics. Closing the gap: A newsletter of the Office of Minority Health V. 3, Editor. U.S. Department of Health and Human Services.

  31. Pawson, I. G., Martorell, R., & Mendoza, F. E. (1991). Prevalence of overweight and obesity in US Hispanic populations. The American Journal of Clinical Nutrition, 53, 1522S–1528S.

    PubMed  CAS  Google Scholar 

  32. Kieffer, E. C., Carman, W. J., Gillespie, B. W., Nolan, G. H., Worley, S. E., & Guzman, J. R. (2001). Obesity and gestational diabetes among African-American women and Latinas in Detroit: Implications for disparities in women’s health. Journal of the American Medical Women’s Association, 56, 181–187, 196.

    Google Scholar 

  33. Chasan-Taber, L., Schmidt, M. D., Pekow, P., Sternfeld, B., Manson, J., & Markenson, G. (2007). Correlates of physical activity in pregnancy among Latina women. Maternal and Child Health Journal, 11, 353–363.

    Article  PubMed  Google Scholar 

  34. Detjen, M. G., Nieto, F. J., Trentham-Dietz, A., Fleming, M., & Chasan-Taber, L. (2007). Acculturation and cigarette smoking among pregnant Hispanic women residing in the United States. American Journal of Public Health, 97, 2040–2047.

    Article  PubMed  Google Scholar 

  35. Institute of Medicine, National Academy of Sciences. (1990). Nutrition during pregnancy. Washington, DC: National Academy Press.

  36. Siega-Riz, A. M., Adair, L. S., & Hobel, C. J. (1994). Institute of Medicine maternal weight gain recommendations and pregnancy outcome in a predominantly Hispanic population. Obstetrics and Gynecology, 84, 565–573.

    PubMed  CAS  Google Scholar 

  37. Saldana, T. M., Siega-Riz, A. M., Adair, L. S., & Suchindran, C. (2006). The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina. American Journal of Obstetrics and Gynecology, 195, 1629–1635. doi:10.1016/j.ajog.2006.05.017.

    Article  PubMed  CAS  Google Scholar 

  38. Tucker, K. L., Bianchi, L. A., Maras, J., & Bermudez, O. I. (1998). Adaptation of a food frequency questionnaire to assess diets of Puerto Rican and non-Hispanic adults. American Journal of Epidemiology, 148, 507–518.

    PubMed  CAS  Google Scholar 

  39. Bermudez, O. I., Velez-Carrasco, W., Schaefer, E. J., & Tucker, K. L. (2002). Dietary and plasma lipid, lipoprotein, and apolipoprotein profiles among elderly Hispanics and non-Hispanics and their association with diabetes. The American Journal of Clinical Nutrition, 76, 1214–1221.

    PubMed  CAS  Google Scholar 

  40. Willett, W. C. (1998). Nutritional epidemiology (2nd ed.). New York, NY: Oxford University Press.

  41. Foster-Powell, K., Holt, S. H., & Brand-Miller, J. C. (2002). International table of glycemic index and glycemic load values: 2002. The American Journal of Clinical Nutrition, 76, 5–56.

    PubMed  CAS  Google Scholar 

  42. Phillips, S. M., Bandini, L. G., Naumova, E. N., Cyr, H., Colclough, S., Dietz, W. H., et al. (2004). Energy-dense snack food intake in adolescence: Longitudinal relationship to weight and fatness. Obesity Research, 12, 461–472. doi:10.1038/oby.2004.52.

    Article  PubMed  Google Scholar 

  43. Schmidt, M. D., Pekow, P., Freedson, P. S., Markenson, G., & Chasan-Taber, L. (2006). Physical activity patterns during pregnancy in a diverse population of women. Journal of Women’s Health, 15, 909–918. doi:10.1089/jwh.2006.15.909.

    Google Scholar 

  44. National Heart, Lung and Blood Institute. (1998). Obesity education initiative, expert panel on the identification, evaluation, and treatment of overweight and obesity in adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. NIH publication No 98-4083. National Institute of Health, Bethesda, MD.

  45. World Health Organization. (1997). Obesity: Preventing and managing the global epidemic. Report of the WHO consultation of obesity. Geneva: World Health Organization.

  46. Institute of Medicine. (2007). Influence of pregnancy weight on maternal and child health: A workshop report (pp. 1–93). Washington, DC: National Research Council.

  47. Rudra, C. B., Sorensen, T. K., Leisenring, W. M., Dashow, E., & Williams, M. A. (2007). Weight characteristics and height in relation to risk of gestational diabetes mellitus. American Journal of Epidemiology, 165, 302–308. doi:10.1093/aje/kwk007.

    Article  PubMed  Google Scholar 

  48. Dudhbhai, M., Lim, L., Bombard, A., Juliard, K., Meenakshi, B., Trachelenberg, Y., et al. (2006). Characteristics of patients with abnormal glucose challenge test and normal oral glucose tolerance test results: Comparison with normal and gestational diabetic patients. American Journal of Obstetrics and Gynecology, 194, e42–e45. doi:10.1016/j.ajog.2005.11.031.

    Article  PubMed  Google Scholar 

  49. Solomon, C. G., Willett, W. C., Carey, V. J., Rich-Edwards, J., Hunter, D. J., Colditz, G. A., et al. (1997). A prospective study of pregravid determinants of gestational diabetes mellitus. Journal of the American Medical Association, 278, 1078–1083. doi:10.1001/jama.278.13.1078.

    Article  PubMed  CAS  Google Scholar 

  50. Brennand, E. A., Dannenbaum, D., & Willows, N. D. (2005). Pregnancy outcomes of First Nations women in relation to pregravid weight and pregnancy weight gain. Journal of Obstetrics and Gynaecology Canada, 27, 936–944.

    PubMed  Google Scholar 

  51. Wang, Y., Storlien, L. H., Jenkins, A. B., Tapsell, L. C., Jin, Y., Pan, J. F., et al. (2000). Dietary variables and glucose tolerance in pregnancy. Diabetes Care, 23, 460–464. doi:10.2337/diacare.23.4.460.

    Article  PubMed  CAS  Google Scholar 

  52. Feskens, E. J., Virtanen, S. M., Rasanen, L., Tuomilehto, J., Stengard, J., & Pekkanen, J. (1995). Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study. Diabetes Care, 18, 1104–1112. doi:10.2337/diacare.18.8.1104.

    Article  PubMed  CAS  Google Scholar 

  53. Bermudez, O. I., Falcon, L. M., & Tucker, K. L. (2000). Intake and food sources of macronutrients among older Hispanic adults: Association with ethnicity, acculturation, and length of residence in the United States. Journal of the American Dietetic Association, 100, 665–673. doi:10.1016/S0002-8223(00)00195-4.

    Article  PubMed  CAS  Google Scholar 

  54. Moses, R. G., Luebcke, M., Davis, W. S., Coleman, K. J., Tapsell, L. C., Petocz, P., et al. (2006). Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. The American Journal of Clinical Nutrition, 84, 807–812.

    PubMed  CAS  Google Scholar 

  55. Kalkwarf, H. J., Bell, R. C., Khoury, J. C., Gouge, A. L., & Miodovnik, M. (2001). Dietary fiber intakes and insulin requirements in pregnant women with type 1 diabetes. Journal of the American Dietetic Association, 101, 305–310. doi:10.1016/S0002-8223(01)00080-3.

    Article  PubMed  CAS  Google Scholar 

  56. Olafsdottir, A. S., Skuladottir, G. V., Thorsdottir, I., Hauksson, A., & Steingrimsdottir, L. (2006). Maternal diet in early and late pregnancy in relation to weight gain. International Journal of Obesity (London), 30, 492–499. doi:10.1038/sj.ijo.0803184.

    Article  CAS  Google Scholar 

  57. Oken, E., Taveras, E. M., Kleinman, K. P., Rich-Edwards, J. W., & Gillman, M. W. (2007). Gestational weight gain and child adiposity at age 3 years. American Journal of Obstetrics and Gynecology, 196, 322.e1-8.

    Google Scholar 

  58. Clapp, J. F., 3rd, Seaward, B. L., Sleamaker, R. H., & Hiser, J. (1988). Maternal physiologic adaptations to early human pregnancy. American Journal of Obstetrics and Gynecology, 159, 1456–1460.

    PubMed  Google Scholar 

  59. Forsum, E., Sadurskis, A., & Wager, J. (1988). Resting metabolic rate and body composition of healthy Swedish women during pregnancy. The American Journal of Clinical Nutrition, 47, 942–947.

    PubMed  CAS  Google Scholar 

  60. Forsum, E., Sadurskis, A., & Wager, J. (1989). Estimation of body fat in healthy Swedish women during pregnancy and lactation. The American Journal of Clinical Nutrition, 50, 465–473.

    PubMed  CAS  Google Scholar 

  61. Van Loan, M. D., Kopp, L. E., King, J. C., Wong, W. W., & Mayclin, P. L. (1995). Fluid changes during pregnancy: Use of bioimpedance spectroscopy. Journal of Applied Physiology, 78, 1037–1042.

    PubMed  Google Scholar 

  62. Clapp, J. F., 3rd, & Little, K. D. (1995). Effect of recreational exercise on pregnancy weight gain and subcutaneous fat deposition. Medicine and Science in Sports and Exercise, 27, 170–177. doi:10.1249/00005768-199502000-00004.

    PubMed  Google Scholar 

  63. Bodnar, L. M., & Siega-Riz, A. M. (2002). A Diet Quality Index for Pregnancy detects variation in diet and differences by sociodemographic factors. Public Health Nutrition, 5, 801–809. doi:10.1079/PHN2002348.

    Article  PubMed  Google Scholar 

  64. Margetts, B. M., Thompson, R. L., Speller, V., & McVey, D. (1998). Factors which influence ‘healthy’ eating patterns: Results from the 1993 Health Education Authority health and lifestyle survey in England. Public Health Nutrition, 1, 193–198.

    PubMed  CAS  Google Scholar 

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Acknowledgements

The first author received support from T32 DK062032-14S1 and from a diversity supplement to DK064902. The work was also supported by an American Diabetes Association Career Development Award 7-00-CD-02. The principal investigator had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 136 Harrison Avenue, Boston, MA, 02111, USA

    Alison Tovar & Aviva Must

  2. Department of Public Health and Family Medicine, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Boston, MA, USA

    Aviva Must, Odilia I. Bermudez & Raymond R. Hyatt

  3. Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, The University of Massachusetts, Amherst, MA, USA

    Lisa Chasan-Taber

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  1. Alison Tovar
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Correspondence to Alison Tovar.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s10995-009-0468-z

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Tovar, A., Must, A., Bermudez, O.I. et al. The Impact of Gestational Weight Gain and Diet on Abnormal Glucose Tolerance During Pregnancy in Hispanic Women. Matern Child Health J 13, 520–530 (2009). https://doi.org/10.1007/s10995-008-0381-x

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