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. 2014 Sep 30:349:g5450.
doi: 10.1136/bmj.g5450.

Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study

Cuilin Zhang  1 , Deirdre K Tobias  2 , Jorge E Chavarro  3 , Wei Bao  4 , Dong Wang  2 , Sylvia H Ley  2 , Frank B Hu  3
Affiliations

Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study

Cuilin Zhang et al. BMJ. .

Abstract

Objective: To quantify the association between a combination of healthy lifestyle factors before pregnancy (healthy body weight, healthy diet, regular exercise, and not smoking) and the risk of gestational diabetes.

Design: Prospective cohort study.

Setting: Nurses' Health Study II, United States.

Participants: 20,136 singleton live births in 14,437 women without chronic disease.

Main outcome measure: Self reported incident gestational diabetes diagnosed by a physician, validated by medical records in a previous study.

Results: Incident first time gestational diabetes was reported in 823 pregnancies. Each lifestyle factor measured was independently and significantly associated with risk of gestational diabetes. The combination of three low risk factors (non-smoker, ≥ 150 minutes a week of moderate to vigorous physical activity, and healthy eating (top two fifths of Alternate Healthy Eating Index-2010 adherence score)) was associated with a 41% lower risk of gestational diabetes compared with all other pregnancies (relative risk 0.59, 95% confidence interval 0.48 to 0.71). Addition of body mass index (BMI) <25 before pregnancy (giving a combination of four low risk factors) was associated with a 52% lower risk of gestational diabetes compared with all other pregnancies (relative risk 0.48, 0.38 to 0.61). Compared with pregnancies in women who did not meet any of the low risk lifestyle factors, those meeting all four criteria had an 83% lower risk of gestational diabetes (relative risk 0.17, 0.12 to 0.25). The population attributable risk percentage of the four risk factors in combination (smoking, inactivity, overweight, and poor diet) was 47.5% (95% confidence interval 35.6% to 56.6%). A similar population attributable risk percentage (49.2%) was observed when the distributions of the four low risk factors from the US National Health and Nutrition Examination Survey (2007-10) data were applied to the calculation.

Conclusions: Adherence to a low risk lifestyle before pregnancy is associated with a low risk of gestational diabetes and could be an effective strategy for the prevention of gestational diabetes.

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Conflict of interest statement

Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work

Figures

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Association between number of low risk lifestyle factors and risk of gestational diabetes. Low risk lifestyle factors include maintaining healthy body weight, consuming healthy diet, regular exercise, and not smoking. Relative risk adjusted for age, parity, family history of diabetes, history of infertility, race/ethnicity, questionnaire period, total energy intake, and alcohol consumption
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References

    1. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2004;27(suppl 1):S88-90. - PubMed
    1. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Aktary WM, et al. Screening and diagnosing gestational diabetes mellitus. (Evidence Reports/Technology Assessments No 210.) Agency for Healthcare Research and Quality, 2012. - PubMed
    1. Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM. An increase in the incidence of gestational diabetes mellitus: Northern California, 1991-2000. Obstet Gynecol 2004;103:526-33. - PubMed
    1. Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, McDuffie RS. Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care 2005;28:579-84. - PubMed
    1. Zhang F, Dong L, Zhang CP, Li B, Wen J, Gao W, et al. Increasing prevalence of gestational diabetes mellitus in Chinese women from 1999 to 2008. Diabet Med 2011;28:652-7. - PubMed

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