The Interplay of Persistent Organic Pollutants and Mediterranean Diet in Association With the Risk of Gestational Diabetes Mellitus

Abstract

Objective: Certain foods characterizing the alternate Mediterranean diet (aMED) are high in persistent organic pollutants (POPs), which are related to greater gestational diabetes mellitus (GDM) risk. We examined the associations of combined aMED and POP exposure with GDM.

Research design and methods: aMED score of 1,572 pregnant women was derived from food frequency questionnaires at early pregnancy within the U.S. Fetal Growth Study and plasma concentrations of 76 POPs, including organochlorine pesticides, polybrominated diphenyl ethers, polychlorinated biphenyls (PCBs), and per- and polyfluoroalkyl substances, were measured. Associations of combined aMED score and exposure to POPs with GDM risk were examined by multivariable logistic regression models.

Results: In 61 of 1,572 (3.88%) women with GDM, 25 of 53 included POPs had a detection rate >50%. Higher POP levels appeared to diminish potential beneficial associations of aMED score with GDM risk, with the lowest GDM risk observed among women with both high aMED score and low POP concentrations. Specifically, adjusted log-odds ratios of GDM risk comparing women with low PCB and high aMED score with those with low aMED score and high PCB concentrations was -0.74 (95% CI -1.41, -0.07). Inverse associations were also observed among women with low aMED score and high TransNo_chlor, PCB182_187, PCB196_203, PCB199, and PCB206. These associations were more pronounced among women with overweight or obesity.

Conclusions: Pregnant women who consumed a healthy Mediterranean diet but had a low exposure to POP concentrations had the lowest GDM risk. Future endeavors to promote a healthy diet to prevent GDM may consider concurrent POP exposure.

Graphical abstract

Figure 1

Associations of environmental chemicals (in classes) and aMED with GDM risk, Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Study–Singletons Cohort. All models were adjusted for maternal age, race and ethnicity, prepregnancy BMI, education level, maternal income, parity, physical activity, total energy intake, tobacco exposure, and family history of diabetes. Chemicals in model 1 were not corrected for total lipids but were corrected in model 2 (except for PFASs). All chemicals were natural log transformed and standardized to benefit the interpretation. H, high; L, low; Ref, reference.

Figure 2

Associations of individual chemicals of POPs and aMED with GDM risk, Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Study–Singletons cohort. The most unhealthy combination (low aMED score and high POP exposure) was used as the reference. All models were adjusted for maternal age, race and ethnicity, BMI, education level, maternal income, parity, physical activity, total energy intake, tobacco exposure, and family history of diabetes. All chemicals (except for PFASs) were corrected for total lipids, natural log transformed, and standardized. Orange and blue colors of error bars are used to differentiate POPs. BDE, brominated diphenyl ethers; DDD, dichlorodiphenyldichloroethane; DDE, dichlorodiphenyldichloroethylene; DDT, dichlorodiphenyltrichloroethane; H, high; HCB, hexachlorobenzene; HCH, hexachlorocyclohexane; L, low; NMeFOSAA, 2(N-methylperfluorooctanesulfonamido)acetic acid; PFDA, perfluorodecanoic acid; PFDoDA, perfluorododecanoic acid; PFHpA, perfluoroheptanoic acid; PFHxS, perfluorohexanesulfonic acid; PFNA, perfluorononanoic acid; PFOA, perfluorooctanoic acid; PFOS, perfluorooctanesulfonic acid; PFUnDA, perfluoroundecanoic acid; TransNo-chlor, trans-nonachlor.

Figure 3

Associations of POPs and aMED jointly with GDM risk by prepregnancy BMI, Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Study–Singletons Cohort. The most unhealthy combination (low aMED score and high POP exposure) was used as the reference, but only results of the most healthy group (high aMED score and low POP exposure) are presented. All models were adjusted for maternal age, education level, income, parity, physical activity, total energy intake, smoking status, family history of diabetes, and race and ethnicity. All chemicals were natural log transformed and standardized. Orange and blue colors of error bars are used to differentiate POPs. NMeFOSAA, 2(N-methylperfluorooctanesulfonamido)acetic acid; PFDA, perfluorodecanoic acid; PFDoDA, perfluorododecanoic acid; PFHpA, perfluoroheptanoic acid; PFHxS, perfluorohexanesulfonic acid; PFNA, perfluorononanoic acid; PFOA, perfluorooctanoic acid; PFOS, perfluorooctanesulfonic acid; PFUnDA, perfluoroundecanoic acid.