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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (3): 467-472. doi: 10.19723/j.issn.1671-167X.2021.03.005

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Relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus

GUO Hong-ping1,ZHAO Ai2,XUE Yong3,MA Liang-kun4,ZHANG Yu-mei1,Δ(),WANG Pei-yu5,Δ()   

  1. 1. Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing 100191, China
    2. Vanke School of Public Health, Tsinghua University, Beijing 100091, China
    3. College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
    4. Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    5. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
  • Received:2020-12-16 Online:2021-06-18 Published:2021-06-16
  • Contact: Yu-mei ZHANG,Pei-yu WANG E-mail:zhangyumei@bjmu.edu.cn;wpeiyu@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81573129)

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Abstract:

Objective: To explore the relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus (GDM). Methods: Pregnant women for 25-35 gestational weeks who underwent prenatal examination and completed GDM diagnostic test in two third-class hospitals in Beijing from October 2015 to October 2017 were recruited to participate in the cohort study, and were investigated at enrollment, 2 weeks after enrollment, and delivery. The cross-sectional survey data 2 weeks after enrollment was used for this study. Among them, dietary survey used the 24 h dietary records to collect the food intake of the subjects for the past day, and the intake of energy, macronutrients and micronutrients, was calculated according to the Chinese Food Composition Table. Using the data of fasting blood glucose (FBG) collected by clinical information system and referring to the Chinese Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes (2014), the GDM patients with FBG ≤5.3 mmol/L were divided into the well-control group, those with FBG >5.3 mmol/L were divided into poorly-control group, and pregnant women with normal glucose tolerance were consi-dered as the normal group. Binary Logistic regression was used to analyze the association between the nutrients intake and glycemic control effect in pregnant women with GDM. Results: A total of 227 pregnant women were enrolled, including 104 GDM patients and 123 normal pregnancy women. Among them, 76 subjects in the well-control group (73.1%, 76/104) and 28 subjects in the poorly-control group (26.9%, 28/104). Compared with the well-control group and the normal group, the protein intake and its energy ratio of the poorly-control group were significantly higher, while carbohydrate energy ratio was significantly lower. In terms of micronutrients, there was no significant difference between the well-control group and the poorly-control group. After adjusting for age, gestational age and physical activity level, with the well-control group as the control group, binary Logistic regression model showed that higher protein energy ratio was positively correlated with poorly glycemic control effect in pregnant women with GDM (OR=6.12, 95%CI: 1.44-25.98), while higher carbohydrate energy ratio was negatively correlated with poorly glycemic control (OR=0.54, 95%CI: 0.32-0.91). Conclusion: Reduced protein intake and increased carbohydrate intake were associated with better glycemic control in pregnant women with GDM. It is suggested that GDM patients should adjust their dietary pattern further to achieve good glycemic control effect.

Key words: Nutrients, Glycemic control, Gestational diabetes mellitus

CLC Number: 

  • R153.1

Table 1

Socio-demographic factors and health status among participants with different glycemic control effects"

Items Normal group (n=123) Well-control group (n=76) Poorly-control group (n=28) P
Age/years, $\bar{x} \pm s$ 32.4±3.3 33.0±4.1 35.7±3.7*# <0.001
Gestational age/weeks, M (P25, P75) 33.3 (30.4, 34.9) 31.1 (29.2, 33.1)* 33.6 (31.6, 35.0)# <0.001
Pregnancy BMI/(kg/m2), M (P25, P75) 21.5 (19.5, 23.4) 21.5 (20.2, 23.6) 21.8 (20.7, 25.4) 0.218
Nation, n (%) 0.051
Han 115 (93.5) 67 (88.2) 22 (78.6)
Other 8 (6.5) 9 (11.8) 6 (21.4)
Education level, n (%)a 0.766
Junior college or blow 4 (3.5) 10 (14.1) 2 (7.4)
University 62 (54.9) 33 (46.5) 16 (59.3)
Postgraduate or above 47 (41.6) 28 (39.4) 9 (33.3)
Occupation, n (%) 0.210
Home or unemployed 6 (4.9) 10 (13.2) 2 (7.1)
Work 100 (81.3) 54 (71.1) 20 (71.4)
Other 17 (13.8) 12 (15.8) 6 (21.4)
Family monthly income per person/Yuan, n (%)a 0.507
≤8 000 35 (29.2) 24 (32.9) 7 (25.0)
>8 000-14 000 40 (33.3) 29 (39.7) 13 (46.4)
>14 000 45 (37.5) 20 (27.4) 8 (28.6)
Subject’s average monthly income/Yuan, n (%)a 0.070
≤6 000 31 (25.8) 26 (37.1) 5 (18.5)
>6 000-10 000 53 (44.2) 23 (32.9) 8 (29.6)
>10 000 36 (30.0) 21 (30.0) 14 (32.7)
Physical activity, n (%) <0.001
High 20 (16.3) 34 (44.7)* 10 (35.7)
Medium 84 (68.3) 35 (46.1)* 16 (57.1)
Low 19 (15.4) 7 (9.2)* 2 (7.1)
Passive smoking, n (%) 0.225
Yes 28 (23.0) 8 (10.8) 4 (15.4)
No 88 (72.1) 60 (81.1) 20 (76.9)
Unclear 6 (4.9) 6 (8.1) 2 (7.7)
Family history of diabetes, n (%) 0.869
Yes 52 (42.3) 35 (46.1) 12 (42.9)
No 71 (57.7) 41 (53.9) 16 (57.1)
Parity, n (%) 0.105
0 100 (81.3) 53 (69.7) 19 (67.9)
≥1 23 (18.7) 23 (30.3) 9 (32.1)
Insulin usage, n (%) 0.721
Yes 4 (5.3) 1 (3.6)
No 72 (94.7) 27 (96.4)

Table 2

Macronutrients intake among participants with different glycemic control effects"

Nutrients Reference intakea Normal group (n=123) Well-control group (n=76) Poorly-control group (n=28) P
Energy/kcal, $\bar{x} \pm s$ 1 809.2±466.9 1 685.4±551.9 1 793.0±448.5 0.222
Carbohydrate/g, $\bar{x} \pm s$ 130b 275.2±81.3 262.5±94.6 248.2±72.5 0.258
Carbohydrate energy ratio/%, $\bar{x} \pm s$ 50-65c 61.0±8.9 61.9±10.3 55.4±8.6*# 0.006
Protein/g, M (P25, P75) 85d 73.7 (62.5, 87.4) 76.5 (57.2, 92.9) 85.9 (76.8, 104.2)*# 0.011
Protein energy ratio/%, M (P25, P75) 15-20c 17.0 (15.0, 19.0) 18.0 (16.0, 20.0)* 21.0 (18.0, 23.0)*# <0.001
Fat/g, M (P25, P75) 47.6 (34.4, 63.2) 39.9 (26.7, 53.5) 51.3 (38.4, 60.1) 0.021
Fat energy ratio/%, M (P25, P75) 20-30c 25.0 (20.0, 31.0) 22.0 (18.0, 29.0) 25.0 (22.0, 33.0) 0.074

Table 3

Micronutrients intake among participants with different glycemic control effects"

Nutrients Reference
intakea		 Normal group (n=123) Well-control group (n=76) Poorly-control group (n=28) P
Dietary fiber/g, M (P25, P75) 12 (8.6, 17.4) 13.8 (9.3, 18.4) 16.5 (9.5, 21.9) 0.263
Vitamin A/μgRE, M (P25, P75) 770 1 538.2 (584.9, 1 946.5) 1 824.5 (837.4, 2 977.8)* 1 801.2 (558.4, 2 607.9) 0.003
Carotene/μg, M (P25, P75) 1 377.3 (750.4, 3 099.1) 1 956.7 (1 176.1, 2 713.0) 1 843.8 (1 121.5, 3 488.6) 0.136
Retinol/μg, M (P25, P75) 1 342.5 (212.7, 1 495.1) 1 470.4 (319.2, 1 606.8)* 1 374.5 (160.9, 1511) 0.008
Vitamin B1/mg, M (P25, P75) 1.5 2.1 (1.0, 2.7) 2.2 (1.3, 2.9) 2.3 (1, 3.1) 0.274
Vitamin B2/mg, M (P25, P75) 1.5 2.5 (1.0, 3.0) 2.6 (1.5, 3.4) 2.9 (1.2, 3.7) 0.039
Niacin/mg, M (P25, P75) 12 27.4 (11.7, 32.6) 27.9 (16.0, 34.5) 29.2 (14.9, 38.2) 0.308
Vitamin C/mg, M (P25, P75) 115 153.5 (88.5, 229.6) 201.4 (134.5, 262.0)* 198.8 (110.9, 440.4) 0.005
Vitamin E/mg, M (P25, P75) 14b 30.7 (13.4, 39.6) 31.8 (20.5, 40.9) 33.4 (15.0, 44.3) 0.360
α-tocopherol/mg, M (P25, P75) 5.2 (3.6, 7.4) 4.8 (3.4, 6.0) 4.7 (3.4, 6.3) 0.359
Calcium/mg, M (P25, P75) 1 000 737.1 (530.1, 926.3) 879.8 (660.6, 1 096.7)* 906.1 (803.1, 1 137.2)* <0.001
Phosphorus/mg, M (P25, P75) 720 1 272.5 (993.6, 1 546.2) 1 423.4 (1 145.1, 1 833.4)* 1 588.6 (1 387.2, 1 965.2)* <0.001
Potassium/mg, M (P25, P75) 2 000b 1 763.2 (1 435.6, 2 245.8) 1 811.6 (1 458.9, 2 233.9) 1 893.0 (1 649.5, 2 344.3) 0.217
Sodium/mg, M (P25, P75) 1 500b 750.7 (385.2, 1 367.1) 496.7 (402.7, 786.4)* 574.2 (396.7, 1 166.7) 0.029
Magnesium/mg, M (P25, P75) 370 313 (235, 403.5) 350.0 (284.7, 474.7)* 418.2 (276.3, 552.5)* 0.002
Iron/mg, M (P25, P75) 29 77.9 (30.4, 106.7) 80.1 (41.8, 115.8) 104.5 (33, 139.7) 0.132
Zinc/mg, M (P25, P75) 9.5 15.6 (10.5, 18.8) 16.8 (12.4, 21.3) 19.5 (14.4, 27.3)* 0.002
Selenium/μg, M (P25, P75) 65 49.0 (35.1, 62.4) 45.2 (32.8, 58.4) 51.0 (39.4, 57.7) 0.500
Copper/mg, M (P25, P75) 0.9 2.5 (1.8, 3.1) 2.6 (2.0, 3.3) 2.8 (2.0, 3.6) 0.192
Manganese/mg, M (P25, P75) 4.9b 4.5 (3.3, 5.8) 5.7 (3.8, 7.9)* 6.0 (4.5, 7.9)* <0.001

Table 4

Binary Logistic regression analyze the relationship between nutrients intake and glycemic control effect in pregnant women with GDMa"

Nutrients Model 1b Model 2c
OR 95%CI P OR 95%CI P
Protein 1.25 1.05, 1.50 0.013 1.20 0.98, 1.46 0.075
Protein energy ratio 7.69 2.08, 28.36 0.002 6.12 1.44, 25.98 0.014
Carbohydrate energy ratio 0.51 0.31, 0.82 0.006 0.54 0.32, 0.91 0.022
Fat energy ratio 1.69 1.00, 2.86 0.050 1.76 0.97, 3.19 0.065
Phosphorus 1.01 1.00, 1.02 0.010 1.01 1.00, 1.02 0.060
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