Pre-pregnancy inflammatory and insulinemic dietary patterns and risk of gestational diabetes mellitus: a prospective cohort study of 14,674 women
Author(s)
Type
Journal Article
Abstract
Backgroud
Gestational diabetes mellitus (GDM) is associated with various short-term and long-term adverse health outcomes for both mothers and offspring. It is critical to identify modifiable factors that may inform the prevention of GDM. We, therefore, examined whether pre-pregnancy pro-inflammatory and hyperinsulinemic dietary patterns are associated with increased risk of GDM.
Methods
We included 14,674 women in the Nurses’ Health Study II who reported at least one singleton pregnancy between 1991 and 2001. We derived pre-pregnancy dietary pattern scores for empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) from validated food frequency questionnaires collected before pregnancy. Incident first-time GDM was ascertained from self-report of a physician diagnosis with high validity. We used log-binomial models with generalized estimating equations to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for the associations of pre-pregnancy EDIP and EDIH scores with GDM risk, adjusting for pre-pregnancy body mass index and other potential confounders.
Results
Participants reported 20,337 pregnancies over 10 years of follow-up, with 831 complicated by GDM. Women with higher pre-pregnancy EDIP and EDIH scores had a greater risk of GDM: adjusted RRs (95% CIs) for EDIP increasing quintiles were 1.00 (reference), 1.22 (0.97, 1.53), 1.19 (0.94, 1.49), 1.40 (1.13, 1.75), and 1.41 (1.13, 1.75); for EDIH were 1.00, 1.19 (0.94, 1.52), 1.21 (0.95, 1.54), 1.29 (1.02, 1.64), and 1.58 (1.26, 1.98) (both P-trend: <0.001). The observed associations were generally consistent across stratum of major risk factors of GDM such as pre-pregnancy overweight or obesity status, family history of diabetes, and genetic susceptibility of GDM.
Conclusions
In a large US cohort of predominantly White women, higher intake of pro-inflammatory and hyperinsulinemic diets was associated with increased risk of GDM. Further studies are warranted to confirm our findings, to provide evidence promoting anti-inflammatory and anti-hyperinsulinemic diets as a preventive measure for gestational diabetes in women planning pregnancy.
Gestational diabetes mellitus (GDM) is associated with various short-term and long-term adverse health outcomes for both mothers and offspring. It is critical to identify modifiable factors that may inform the prevention of GDM. We, therefore, examined whether pre-pregnancy pro-inflammatory and hyperinsulinemic dietary patterns are associated with increased risk of GDM.
Methods
We included 14,674 women in the Nurses’ Health Study II who reported at least one singleton pregnancy between 1991 and 2001. We derived pre-pregnancy dietary pattern scores for empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) from validated food frequency questionnaires collected before pregnancy. Incident first-time GDM was ascertained from self-report of a physician diagnosis with high validity. We used log-binomial models with generalized estimating equations to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for the associations of pre-pregnancy EDIP and EDIH scores with GDM risk, adjusting for pre-pregnancy body mass index and other potential confounders.
Results
Participants reported 20,337 pregnancies over 10 years of follow-up, with 831 complicated by GDM. Women with higher pre-pregnancy EDIP and EDIH scores had a greater risk of GDM: adjusted RRs (95% CIs) for EDIP increasing quintiles were 1.00 (reference), 1.22 (0.97, 1.53), 1.19 (0.94, 1.49), 1.40 (1.13, 1.75), and 1.41 (1.13, 1.75); for EDIH were 1.00, 1.19 (0.94, 1.52), 1.21 (0.95, 1.54), 1.29 (1.02, 1.64), and 1.58 (1.26, 1.98) (both P-trend: <0.001). The observed associations were generally consistent across stratum of major risk factors of GDM such as pre-pregnancy overweight or obesity status, family history of diabetes, and genetic susceptibility of GDM.
Conclusions
In a large US cohort of predominantly White women, higher intake of pro-inflammatory and hyperinsulinemic diets was associated with increased risk of GDM. Further studies are warranted to confirm our findings, to provide evidence promoting anti-inflammatory and anti-hyperinsulinemic diets as a preventive measure for gestational diabetes in women planning pregnancy.
Date Issued
2025-12-01
Date Acceptance
2025-06-03
Citation
BMC Medicine, 2025, 23 (1)
ISSN
1741-7015
Publisher
BMC
Start Page
383
Journal / Book Title
BMC Medicine
Volume
23
Issue
1
Copyright Statement
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40597404
PII: 10.1186/s12916-025-04188-7
Subjects
Dietary patterns
Gestational diabetes mellitus
Inflammatory diet
Insulinemic diet
Humans
Female
Diabetes, Gestational
Pregnancy
Adult
Prospective Studies
Diet
Risk Factors
Inflammation
Hyperinsulinism
Publication Status
Published
Coverage Spatial
England
Article Number
383
Date Publish Online
2025-07-01