Association of diet in pregnancy with maternal and birth outcomes in women with type 1 diabetes in the Environmental Determinants of Islet Autoimmunity study — ASN Events
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Association of diet in pregnancy with maternal and birth outcomes in women with type 1 diabetes in the Environmental Determinants of Islet Autoimmunity study (#65)

Rebecca L Thomson 1 , James D Brown 1 , Helena Oakey 1 , Georgia Soldatos 2 3 , Kirsten Palmer 4 5 , Megan Penno 1 , Pat Ashwood 1 , Rachel Battersby 6 , Peter Colman 7 , Maria Craig 8 9 , Elizabeth Davis 10 , Tony Huynh 11 12 , Leonard Harrison 13 , Aveni Haynes 10 , Richard Sinnott 14 , Peter Vuillermin 15 16 , John Wentworth 7 13 , Jennifer Couper 1 17
  1. Adelaide Medical School, Faculty of Health and Medical Sciences and Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
  2. Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
  3. Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, Australia
  4. Monash Women’s, Monash Health, Clayton, VIC, Australia
  5. Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
  6. Department of Nutrition & Food Services, Women’s and Children’s Hospital, North Adelaide, SA, Australia
  7. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia
  8. School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
  9. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
  10. Telethon Institute for Child Health Research, The University of Western Australia, 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. Melbourne eResearch Group, School of Computing and Information Services, University of Melbourne, Melbourne, VIC, Australia
  15. Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia
  16. Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
  17. Endocrinology and Diabetes Department, Women’s and Children’s Hospital, North Adelaide, SA, Australia

Aims: Pregnant women with type 1 diabetes (T1D) have an increased risk of adverse perinatal and maternal outcomes, including pre-eclampsia, preterm deliveries and infants born large for gestational age. Dietary patterns characterised by a high intake of vegetables, plant foods and vegetable oils may result in a lower risk of developing hypertensive disorders of pregnancy (HDP) in the general population. This study aimed to investigate the relationship between diet during pregnancy and maternal and birth outcomes in women with T1D.

Methods: Diet was assessed during the third trimester using a validated food frequency questionnaire in women from the Environmental Determinants of Islet Autoimmunity (ENDIA) study. Dietary patterns were analysed using logistic regression with principal component scores. Maternal and birth outcomes were collected from case notes.

Results: 994 women completed the dietary questionnaire (T1D = 622, non-T1D = 372; 68% of ENDIA cohort). Women with T1D were more likely to have a diet lower in carbohydrates and glycaemic load and higher in cholesterol and fatty acids (odds ratio [OR] = 0.88, P = 0.001). Women with T1D were more likely to have a healthy dietary pattern (nuts, vegetables, fruit, fish, eggs and whole grains; OR = 1.22, P < 0.001) and less likely to have an unhealthy dietary pattern (takeaway foods, meat, refined grains and fruit juice; OR = 0.87, P = 0.001). 216 women had HDP (gestational hypertension or pre-eclampsia; T1D = 182, 29%; non-T1D = 34, 9%). 429 women had premature deliveries (<37 weeks; T1D = 382, 42%; non-T1D = 47, 8%). Mixed logistic regression models, adjusted for confounders, maternal age, parity and socioeconomic status, showed a diet more aligned with the healthy dietary pattern in women with T1D was associated with a lower risk of HDP (OR = 0.71, P = 0.008), and premature birth (OR = 0.63, P < 0.001). Linear regression models, which adjusted for confounders, maternal age, parity and socioeconomic status, showed a diet more aligned with the unhealthy dietary pattern was associated with higher HbA1c (β coefficient = 0.04, P = 0.02), whilst a diet more aligned with the healthy dietary pattern was associated with lower HbA1c (β coefficient = -0.13, P < 0.001).

Conclusions: A modest and independent protective association was observed between a healthy dietary pattern during pregnancy and both HDP and premature birth risk in women with T1D.

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