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Effect of macronutrient intake on the development of glucose intolerance during pregnancy^1,2,3

¹ From the Departments of Nutrition (TMS, AMS-R, and LSA) and Maternal and Child Health (AMS-R), School of Public Health, and the Carolina Population Center (AMS-R and LSA), University of North Carolina Chapel Hill.

Background: Dietary intake influences glucose tolerance status, yet the relation between macronutrient intake and the development of glucose intolerance during pregnancy has not been adequately examined.

Objective: We examined the relation between macronutrient intake early in pregnancy and the development of glucose intolerance.

Design: Data are from 1698 women in the Pregnancy, Infection, and Nutrition Study. Dietary intake during the second trimester was assessed with a food-frequency questionnaire. Women were classified into 1 of 3 glucose categories: gestational diabetes mellitus (GDM), impaired glucose tolerance (IGT), and normal glucose tolerance. Multivariate logistic regression was used to calculate the relative risk of IGT and GDM, with adjustment for potential confounders. A series of models were specified to test alternate hypotheses about the relation of diet to risk of IGT or GDM.

Results: The overall prevalences of IGT and GDM in the cohort were 2.6% and 5.2%, respectively. The addition model showed that adding 100 kcal from carbohydrates to the diet was associated with a 12% decrease in risk of IGT and a 9% decrease in risk of GDM. The substitution model showed that substituting fat for carbohydrates (per each 1% of total calories) resulted in a significant increase in risk of both IGT and GDM [relative risk = 1.1 (95% CI: 1.02, 1.12) and 1.1 (1.02, 1.10), respectively]. Predicted probabilities of IGT and GDM were reduced by one-half with a 10% decrease in dietary fat and a 10% increase in carbohydrate.

Conclusions: This study found an association between increased fat intake and the development of glucose abnormalities in pregnancy.

Key Words: Macronutrient intake • gestational diabetes • impaired glucose tolerance • fat • carbohydrates