Dietary patterns during pregnancy and maternal and birth outcomes in women with type 1 diabetes: the Environmental Determinants of Islet Autoimmunity (ENDIA) study

Rebecca L Thomson¹, James D Brown², Helena Oakey², Kirsten Palmer^{3

4}, Pat Ashwood², Megan A S Penno², Kelly J McGorm², Rachel Battersby⁵, Peter G Colman⁶, Maria E Craig^{7

8}, Elizabeth A Davis^{9

10}, Tony Huynh^{11

12}, Leonard C Harrison^{13

14}, Aveni Haynes⁹, Richard O Sinnott¹⁵, Peter J Vuillermin^{16

17}, John M Wentworth^{6

13}, Georgia Soldatos^{18

19

20}, Jennifer J Couper^{2

21}; ENDIA Study Group

Affiliations

¹ Adelaide Medical School, Faculty of Health and Medical Sciences and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia. r.thomson@adelaide.edu.au.
² Adelaide Medical School, Faculty of Health and Medical Sciences and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.
³ Monash Women's, Monash Health, Clayton, VIC, Australia.
⁴ Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
⁵ Department of Nutrition & Food Services, Women's and Children's Hospital, North Adelaide, SA, Australia.
⁶ Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia.
⁷ School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
⁸ Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia.
⁹ Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Nedlands, WA, Australia.
¹⁰ Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia.
¹¹ Department of Endocrinology and Diabetes, Queensland Children's Hospital, South Brisbane, QLD, Australia.
¹² Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.
¹³ Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
¹⁴ Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.
¹⁵ Melbourne eResearch Group, School of Computing and Information Services, University of Melbourne, Melbourne, VIC, Australia.
¹⁶ Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia.
¹⁷ Child Health Research Unit, Barwon Health, Geelong, VIC, Australia.
¹⁸ School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
¹⁹ School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
²⁰ Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, Australia.
²¹ Endocrinology and Diabetes Department, Women's and Children's Hospital, North Adelaide, SA, Australia.

PMID: 39222156
PMCID: PMC11519125
DOI: 10.1007/s00125-024-06259-5

Multicenter Study

Dietary patterns during pregnancy and maternal and birth outcomes in women with type 1 diabetes: the Environmental Determinants of Islet Autoimmunity (ENDIA) study

Rebecca L Thomson et al. Diabetologia. 2024 Nov.

. 2024 Nov;67(11):2420-2432.

doi: 10.1007/s00125-024-06259-5. Epub 2024 Sep 2.

Authors

Affiliations

¹ Adelaide Medical School, Faculty of Health and Medical Sciences and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia. r.thomson@adelaide.edu.au.
² Adelaide Medical School, Faculty of Health and Medical Sciences and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.
³ Monash Women's, Monash Health, Clayton, VIC, Australia.
⁴ Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
⁵ Department of Nutrition & Food Services, Women's and Children's Hospital, North Adelaide, SA, Australia.
⁶ Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia.
⁷ School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
⁸ Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia.
⁹ Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Nedlands, WA, Australia.
¹⁰ Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia.
¹¹ Department of Endocrinology and Diabetes, Queensland Children's Hospital, South Brisbane, QLD, Australia.
¹² Children's Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.
¹³ Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
¹⁴ Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.
¹⁵ Melbourne eResearch Group, School of Computing and Information Services, University of Melbourne, Melbourne, VIC, Australia.
¹⁶ Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia.
¹⁷ Child Health Research Unit, Barwon Health, Geelong, VIC, Australia.
¹⁸ School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
¹⁹ School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
²⁰ Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, Australia.
²¹ Endocrinology and Diabetes Department, Women's and Children's Hospital, North Adelaide, SA, Australia.

PMID: 39222156
PMCID: PMC11519125
DOI: 10.1007/s00125-024-06259-5

Abstract

Aims/hypothesis: Dietary patterns characterised by high intakes of vegetables may lower the risk of pre-eclampsia and premature birth in the general population. The effect of dietary patterns in women with type 1 diabetes, who have an increased risk of complications in pregnancy, is not known. The aim of this study was to investigate the relationship between dietary patterns and physical activity during pregnancy and maternal complications and birth outcomes in women with type 1 diabetes. We also compared dietary patterns in women with and without type 1 diabetes.

Methods: Diet was assessed in the third trimester using a validated food frequency questionnaire in participants followed prospectively in the multi-centre Environmental Determinants of Islet Autoimmunity (ENDIA) study. Dietary patterns were characterised by principal component analysis. The Pregnancy Physical Activity Questionnaire was completed in each trimester. Data for maternal and birth outcomes were collected prospectively.

Results: Questionnaires were completed by 973 participants during 1124 pregnancies. Women with type 1 diabetes (n=615 pregnancies with dietary data) were more likely to have a 'fresh food' dietary pattern than women without type 1 diabetes (OR 1.19, 95% CI 1.07, 1.31; p=0.001). In women with type 1 diabetes, an increase equivalent to a change from quartile 1 to 3 in 'fresh food' dietary pattern score was associated with a lower risk of pre-eclampsia (OR 0.37, 95% CI 0.17, 0.78; p=0.01) and premature birth (OR 0.35, 95% CI 0.20, 0.62, p<0.001). These associations were mediated in part by BMI and HbA_1c. The 'processed food' dietary pattern was associated with an increased birthweight (β coefficient 56.8 g, 95% CI 2.8, 110.8; p=0.04). Physical activity did not relate to outcomes.

Conclusions/interpretation: A dietary pattern higher in fresh foods during pregnancy was associated with sizeable reductions in risk of pre-eclampsia and premature birth in women with type 1 diabetes.

Keywords: Birth outcomes; Dietary patterns; Pre-eclampsia; Pregestational diabetes; Pregnancy complications; Type 1 diabetes.

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Figures

**Fig. 1**
STROBE (Strengthening the reporting of observational studies in epidemiology) diagram of participants included in the analysis

**Fig. 2**
Association between dietary patterns (‘processed food’ dietary pattern or ‘fresh food’ dietary pattern) and maternal complications and birth outcomes in women with type 1 diabetes (n=615). Values are presented as ORs with 95% CIs for an increase of one IQR in dietary pattern principal components score. Models were adjusted for age, parity and socioeconomic status

See this image and copyright information in PMC

References

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Dietary patterns during pregnancy and maternal and birth outcomes in women with type 1 diabetes: the Environmental Determinants of Islet Autoimmunity (ENDIA) study

Affiliations

Dietary patterns during pregnancy and maternal and birth outcomes in women with type 1 diabetes: the Environmental Determinants of Islet Autoimmunity (ENDIA) study

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous