Association between Chinese Dietary Guidelines Compliance Index for Pregnant Women and Risks of Pregnancy Complications in the Tongji Maternal and Child Health Cohort

Higher sweet beverage consumption was associated with increased gestational weight gain and birth weight: A Chinese cohort study

Diet during pregnancy is crucial to maternal metabolism and fetal development, so exploring the most potent food risk factor could improve maternal and child health. In this study, we investigated the diet and lifestyle of 833 healthy pregnant women in the second trimester from November 2020 to August 2021. Based on the Tianjin Antenatal Care System in China, we followed up with these women and recorded their gestational weight gain (GWG) and newborn birth weight. We conducted a dietary survey through FFQ based on the food groups recommended by the Chinese Dietary Guidelines and included common ultra-processed foods. We collected 219 semi-quantitative FFQs and 614 self-reported FFQs for analysis. According to the consumption frequency of 12 food groups, 4 dietary patterns were extracted by principal component analysis. We analyzed the associations of food energy, consumption frequency, and dietary patterns with GWG and birth weight, especially GWG in the first and second trimesters (f-GWG). The results showed that f-GWG was positively correlated with food energy. Beverage consumption was associated with f-GWG (r = 0.288, P = .026) in obese pregnant women. A dietary pattern that favors high consumption of ultra-processed foods (fried foods, baked desserts, and sweet beverages) was associated with increased GWGs. Non-obesity women with high consumption of baked desserts and sweet beverages had higher GWGs (P < .05). After adjusting for confounding factors (including total energy, physical activity, and sleep quality), only sweet beverage consumption was associated with f-GWG (β 0.498, 95%CI 0.153-0.843) and birth weight (β 0.124, 95%CI 0.009-0.240). Sweet beverage consumption is a key adjustable risk factor for prenatal care.

Pre-Pregnancy Provegetarian Food Pattern and the Risk of Developing Gestational Diabetes Mellitus: The Seguimiento Universidad de Navarra (SUN) Cohort Study

Background and Objectives: Gestational diabetes mellitus (GDM) is one of the most common medical conditions in pregnancy, with adverse effects on maternal and neonatal outcomes. Evidence suggests a beneficial effect of plant-based dietary patterns, rich in foods derived from plant sources and low in animal foods, on type 2 diabetes; however, their effects on GDM remain unclear. We aimed to investigate the association between pre-pregnancy provegetarian food patterns and the incidence of GDM in a Spanish cohort. Materials and Methods: This subsample of the Seguimiento Universidad de Navarra (SUN) cohort analyzed 3589 Spanish university graduate pregnant women with a mean (standard deviation) age of 28 (±4.3) who were initially free of pre-existing diabetes at baseline. Dietary food consumption was evaluated through a validated, 136-item semi-quantitative food frequency questionnaire. The pre-pregnancy provegetarian food pattern was obtained by assigning positive scores to plant-based food groups and reverse scores to animal food groups. Energy-adjusted quintiles were applied to allocate points to construct the provegetarian food pattern, ranging from 12 to 60 points. Logistic regression models were performed to estimate the odds ratios (OR) of GDM across quintiles of a pre-pregnancy provegetarian food pattern, using the lowest quintile as the reference category. Results: We identified 178 incidence cases of GDM. Women in the highest quintile (Q5) of provegetarian food pattern before pregnancy exhibited a 42% relative reduction in the odds of GDM [adjusted OR (95% CI) Q5 vs. Q1: 0.58 (0.35, 0.97); p-trend = 0.109]. Higher consumption of meat and dairy before pregnancy was associated with a significantly increased risk of GDM [adjusted OR (95% CI) Q5 vs. Q1: 1.94 (1.19, 3.16); p-trend = 0.005] and [adjusted OR (95% CI) Q5 vs. Q1: 1.77 (1.07, 2.94); p-trend = 0.082], respectively. Conclusions: Higher pre-pregnancy consumption of a provegetarian food pattern was associated with a lower risk of developing GDM in Spanish women. Further studies are needed to confirm these findings.

Digital therapeutics-based lifestyle intervention for gestational diabetes mellitus prevention of high-risk pregnant women: a study protocol for a non-randomised controlled trial

INTRODUCTION

Digital therapeutics have been approved as a treatment aid for various medical conditions and are increasingly prevalent. Despite numerous studies on the potential of digital therapeutic interventions in preventing gestational diabetes mellitus (GDM), there is a critical need for more high-quality, large-scale studies to validate their effectiveness. This need arises from the inconsistencies in results and variations in the quality of previous research.

METHODS AND ANALYSIS

We propose a non-randomised controlled trial involving 800 high-risk pregnant women in 6 maternity and child health hospitals in Fujian, China. This study aims to investigate the role and effectiveness of digital therapeutics-based lifestyle intervention in managing the health of pregnant women at high risk for GDM. The study will compare the differences in GDM prevalence, pregnancy weight management and other pregnancy-related health outcomes between pregnant women who received digital therapeutics-based lifestyle intervention and those in the control group. The intervention includes dietary guidance, a personalised physical activity programme and lifestyle improvement strategies delivered through a smartphone app. Primary outcomes include the incidence of GDM at 24-28 weeks gestation and gestational weight gain (GWG). Secondary outcomes comprise improvements in individual lifestyle and risk factors, nutritional issues, implementation outcomes and other pregnancy-related outcomes.

ETHICS AND DISSEMINATION SECTION

The trial was approved by the Ethics Committee of Fujian Maternity and Child Health Hospital (approval number: 2023KY046), Jianyang Maternity and Child Health Hospital (approval number: A202401), Fuqing Maternity and Child Health Hospital (approval number: FY2024003), Changting Maternity and Child Health Hospital (approval number: 202401), Datian Maternity and Child Health Hospital (approval number: dtfy202401) and Quanzhou Maternity and Child Health Hospital (approval number: 2024(50)). We will disseminate our findings by publishing articles in leading peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ChiCTR2300071496.

Adhere to the Chinese dietary guidelines associated with better subjective well-being: evidence from a cross-sectional survey and a daily diary investigation

BACKGROUND

Subjective well-being (SWB) plays an essential role in general health. Although beneficial effects of selected micronutrients and foods on SWB have been reported, they do not reflect the impact of the habitual diet on SWB. Therefore, the purpose of this study is to investigate the association between adherence to the Chinese Dietary Guidelines (CDG) with SWB.

METHODS

This study combined a cross-sectional survey and a daily diary investigation. The cross-sectional survey was conducted on 1,433 students from 8 universities in southern China between October and November 2020. The daily diary investigation was conducted in November 2022, collecting 10-day daily data from 115 students at two universities in southern China over ten consecutive days, resulting in 1,020 valid matched daily responses. Adherence to the CDG was assessed by the China Prime Diet Quality Score (CPDQS), SWB was measured by the Index of Well-being (IWB) and the Affect Valuation Index (AVI). Correlation analysis, multiple regression analyses, and hierarchical regression were conducted to examine the associations of adherence to the CDG with its components, and SWB.

RESULTS

The cross-sectional survey revealed significant predictors of SWB, including adherence to the CDG (β = 0.24, p<0.001) and its components: cereals and tubers (β = 0.07, p = 0.024), vegetables and fruits (β = 0.11, p<0.001), dairy/soy/nuts (β = 0.11, p = 0.002), and condiments and alcoholic beverages (β = 0.08, p = 0.002). The daily diary investigation showed positive associations between adherence to the CDG (β = 0.19, p<0.001), and its components: vegetables and fruits (β = 0.11, p = 0.001), dairy/soy/nuts (β = 0.06, p = 0.009), animal source food (β = 0.06, p = 0.026), and condiments and alcoholic beverages (β = 0.07, p = 0.026), with higher levels of daily SWB.

CONCLUSIONS

Adherence to healthy dietary patterns such as the CDG, rather than focusing on individual components in isolation, is associated with better SWB. Furthermore, the consumption of CDG components had an impact on SWB, although the specific effects varied between the two studies. This study offers modest evidence supporting the role of the CDG in promoting positive mental health.

Eating behavior during pregnancy mediates the association between depression and diet quality--a new strategy for intervention in pregnancy

Background

Depression can result in changes in eating behavior and decrease the quality of eating. It has been shown that maternal depression during pregnancy can result in malnutrition, which can have adverse effects on the pregnancy and the offspring. There is currently no clear association between depression and diet.

Methods

Five hundred and forty-nine pregnant women recruited from Danyang Maternal and Child Health Hospital in Jiangsu Province participated in this study and were administered the Intuitive Eating Scale-2 (IES-2), Edinburgh Post-natal Depression Scale (EPDS), Pregnancy Stress Scale (PPS), Self-rating Anxiety Scale (SAS), and Dietary Guidelines Adherence Index for Pregnant Women during Pregnancy (CDGCI-PW). The nutritional software collected dietary records for three consecutive days in mid-pregnancy to calculate dietary intake and nutrients that support energy production. The mediation analyses were conducted using SPSS 24.0 macro PROCESS.

Results

The relationship between depressive symptoms during pregnancy and diet quality was moderated primarily by two aspects of eating behavior, "Reliance on Hunger and Satiety Cues" (RHS) and "Body-Food Choice Congruence" (BFC). Depressive symptoms (EPDS scores) showed a negative correlation with RHS, BFC, and RHS, and BFC showed a positive correlation with diet quality, yielding a significant specific indirect effect. The multiple mediation model explained 14.7% of the variance in the diet quality.

Conclusion

This study highlights the important role of eating behaviors during pregnancy in the relationship between depressive symptoms (EPDS scores) and diet quality, and provides preliminary evidence for feasible ways pregnant women with depressive symptoms can improve diet quality, promote maternal and child health, and reduce depression.

Effects of a Comprehensive Dietary Intervention Program, Promoting Nutrition Literacy, Eating Behavior, Dietary Quality, and Gestational Weight Gain in Chinese Urban Women with Normal Body Mass Index during Pregnancy

In urban Chinese women with normal body weight during pregnancy, we implemented a comprehensive dietary intervention program aimed at enhancing nutrition literacy, dietary quality, and gestational weight gain. The methods included both online and offline health education on prenatal nutrition, weekly weight monitoring, family back education practices, and real-time dietary guidance. The intervention was delivered to randomly assigned control and intervention group participants from gestational week 12 to week 24. The intervention group (n = 44; 100% complete data) showed significant differences (mean (SD)) compared to the control group (n = 42; 95.5% complete data) in nutrition literacy (53.39 ± 6.60 vs. 43.55 ± 9.58, p < 0.001), restrained eating (31.61 ± 7.28 vs. 28.79 ± 7.96, p < 0.001), Diet Quality Distance (29.11 ± 8.52 vs. 40.71 ± 7.39, p < 0.001), and weight gain within the first 12 weeks of intervention (4.97 ± 1.33 vs. 5.98 ± 2.78, p = 0.029). However, there was no significant difference in the incidence of gestational diabetes (2 (4.5%) vs. 4 (9.5%), p = 0.629). Participants in the intervention group reported an overall satisfaction score of 4.70 ± 0.46 for the intervention strategy. These results emphasize the positive role of comprehensive dietary intervention in promoting a healthy diet during pregnancy.

Effects of dynamic zero COVID-19 policy on anxiety status and lifestyle changes of pregnant women in rural South China: a survey-based analysis by propensity score matching method

Introduction

The coronavirus disease 2019 (COVID-19) pandemic triggered a global public health crisis and has brought an unprecedented impact on pregnant women. The problems faced by pregnant women in the rural areas of China during the epidemic are different from those in urban areas. Although the epidemic situation in China has gradually improved, studying the impact of the previous dynamic zero COVID-19 policy on the anxiety status and lifestyle of pregnant women in rural areas of China, is still necessary.

Methods

A cross-sectional survey of pregnant women in rural South China was conducted from September 2021 to June 2022.Using questionnaires, sociodemographic characteristics, anxiety status, physical activity, sleep quality, and dietary status of the population were collected. Using the propensity score matching method, the effect of the dynamic zero COVID-19 strategy on the anxiety status and lifestyle of pregnant women was analyzed.

Results

Among the pregnant women in the policy group (n = 136) and the control group (n = 680), 25.7 and 22.4% had anxiety disorders, 83.1 and 84.7% had low or medium levels of physical activity, and 28.7 and 29.1% had sleep disorders, respectively. However, no significant difference (p > 0.05) was observed between the two groups. Compared with control group, the intake of fruit in the policy group increased significantly (p = 0.019), whereas that of aquatic products and eggs decreased significantly (p = 0.027). Both groups exhibited an unreasonable dietary structure and poor compliance with the Chinese dietary guidelines for pregnant women (p > 0.05). The proportion of pregnant women in the policy group, whose intake of stable food (p = 0.002), soybean, and nuts (p = 0.004) was less than the recommended amount, was significantly higher than that in the control group.

Discussion

The dynamic zero COVID-19 strategy had little impact on the anxiety status, physical activity, and sleep disorders of pregnant women in the rural areas of South China. However, it affected their intake of certain food groups. Improving corresponding food supply and organized nutritional support should be addressed as a strategic approach to improve the health of pregnant women in rural South China during the pandemic.

Differences in Awareness of Chinese Dietary Guidelines Among Urban and Rural Residents: A Cross-Sectional Survey in Southwest China

Objectives: This study aimed to compare the awareness of Chinese dietary guidelines (CDGs, 2016) between rural and urban areas in Southwest China and identify the factors that affect CDGs (2016) awareness. Methods: This cross-sectional survey included 8,320 individuals aged 18-75 years from Chongqing, Sichuan, Guizhou, and Yunnan, China. Convenience sampling method was adopted to select the survey subjects and face-to-face surveys in each region were conducted to collect data. Descriptive statistics and generalized linear model were used to evaluate differences in awareness of CDGs among urban and rural residents and its influencing factors. Results: Overall CDGs awareness was low in urban and rural areas, although the awareness rate was higher in the former than in the latter (29.1% vs. 19.9%, respectively). Region, education level, Body Mass Index (BMI), gender, income, and age are the influencing factors of CDGs awareness. Urban participants were likely to acquire relevant knowledge from social media, books/magazines, family/friends, and experts. However, rural participants were likely to acquire relevant knowledge from food sales staff (p < 0.05). Conclusion: Rural residents are less aware of CDGs than their urban counterparts in Southwest China. Future dietary education should adopt different strategies for different populations, with considerable focus on rural residents.

The effect of diet quality on the risk of developing gestational diabetes mellitus: A systematic review and meta-analysis

Objective

To examine the effect of diet quality on the risk of gestational diabetes mellitus.

Methods

This review included cohort and case-control studies reporting an association between diet quality and gestational diabetes mellitus. We searched PubMed, Cochrane Library, Web of Science, Embase, PsycINFO, CINAHL Complete, Chinese Periodical Full-text Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and China Wanfang Database for studies published from inception to November 18, 2022. The Newcastle-Ottawa Scale was used for quality assessment, and the overall quality of evidence was assessed using the GRADEpro GDT.

Results

A total of 19 studies (15 cohort, four case-control) with 108,084 participants were included. We found that better higher diet quality before or during pregnancy reduced the risk of developing gestational diabetes mellitus, including a higher Mediterranean diet (OR: 0.51; 95% CI: 0.30-0.86), dietary approaches to stop hypertension (OR: 0.66; 95% CI: 0.44-0.97), Alternate Healthy Eating Index (OR: 0.61; 95% CI: 0.44-0.83), overall plant-based diet index (OR: 0.57; 95% CI: 0.41-0.78), and adherence to national dietary guidelines (OR: 0.39; 95% CI:0.31-0.48). However, poorer diet quality increased the risk of gestational diabetes mellitus, including a higher dietary inflammatory index (OR: 1.37; 95% CI: 1.21-1.57) and overall low-carbohydrate diets (OR: 1.41; 95% CI: 1.22-1.64). After meta-regression, subgroup, and sensitivity analyses, the results remained statistically significant.

Conclusions

Before and during pregnancy, higher diet quality reduced the risk of developing gestational diabetes mellitus, whereas poorer diet quality increased this risk.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022372488.

Awareness of nutrition and health knowledge and its influencing factors among Wuhan residents

Background

Nutrition and health knowledge play a crucial role in promoting healthy dietary behaviors, and have been found to be related to sociodemographic characteristics. However, the existing evidence is limited and inconsistent. We aimed to evaluate the awareness level of nutrition and health knowledge and its influencing factors among Wuhan residents, and to provide scientific basis for carrying out targeted nutrition education programmes.

Methods

By stratified random sampling, residents aged 18-64 in Wuhan were selected for self-administered questionnaire survey. We adopted the structured questionnaire to investigate respondents' sociodemographic characteristics, nutrition and health knowledge, and the way to acquire knowledge. Among them, nutrition and health knowledge includes the following four parts: dietary guidelines recommendations, food and nutrients, nutrition and disease prevention, and nutrition skills. Chi-square tests were used to analyze the associations between total awareness rate and sociodemographic characteristics. Multiple linear regression models were used to analyze the influencing factors of nutrition and health awareness.

Results

A total of 33,436 valid questionnaires were obtained, with a response rate of 97.8%. The total awareness rate was 20.4%, with the highest in nutrition and disease prevention (72.7%) and the lowest in nutrition skills (46.3%). Responders aged 35-44 (23.3%), females (22.8%), educational workers (24.8%), obtaining a master's degree or above (34.1%), living in downtown area (23.1%), and without a history of chronic disease (24.6%) were more likely to have higher awareness rates (all p < 0.001). The multiple linear regression models showed that age, gender, education level, occupation, residential address, and the history of chronic disease were the potential factors affecting individual nutrition awareness.

Conclusion

The total awareness rate of nutrition and health knowledge among Wuhan residents was not optimistic. Besides, our findings suggested that sociodemographic characteristics are closely related to nutrition awareness, which may provide important clues for carried out nutrition education campaigns.

Healthier diet associated with reduced risk of excessive gestational weight gain: A Chinese prospective cohort study

Limited studies have examined the associations between diet quality and gestational weight gain (GWG) among Chinese pregnant women, adopting Chinese GWG guidelines. We prospectively investigate the associations of diet quality, using the Chinese Healthy Diet Index for Pregnancy (CHDI-P), which assessed diet quality from 'Diversity', 'Adequacy' and 'Limitation' dimensions with overall 100 points, with GWG among participants enroled in Southwest China. Food consumption was collected by 24 h dietary recalls for three consecutive days and CHDI-P scores were divided into tertiles. GWG was calculated according to the weight measured before delivery and classified into adequate weight gain (AWG), insufficient weight gain (IWG) and excessive weight gain(EWG) following Chinese GWG guidelines. Multinomial regression analyses and stratified analyses by pre-pregnancy body mass index were performed to estimate the association between CHDI-P and GWG. A total of 1416 participants were recruited in early pregnancy, and 971 and 997 participants were respectively followed up in middle and late pregnancy. The mean CHDI-P score was 56.44 ± 6.74, 57.07 ± 7.44 and 57.38 ± 7.94 points in early, middle and late pregnancy, respectively. Women in the lowest CHDI-P scores group had an increased risk of EWG in middle (OR = 1.53, 95% confidence interval [CI] = 1.08-2.17) and late pregnancy (OR = 1.71, 95% CI = 1.21-2.41) than women in the highest group, while overweight/obese women had a greater risk of EWG in late pregnancy (OR = 4.25, 95% CI = 1.30-13.90). No association was found between the CHDI-P scores and IWG. Poor diet quality in middle and late pregnancy was associated with a higher risk of EWG.

Adherence to Dietary Guidelines among Women with and without Gestational Diabetes: Evidence from the Growing up in New Zealand Study

Diet is thought to play a role in the development and management of gestational diabetes mellitus (GDM). Dietary guidelines provide practical recommendations for achieving nutrient requirements and mitigating the risk of chronic disease. The aim of this study was to describe the adherence to dietary guidelines by women with and without GDM and determine whether adherence is associated with the development of GDM. Adherence to Ministry of Health food group recommendations was assessed in 5391 pregnant women participating in the Growing Up in New Zealand study. A food frequency questionnaire (FFQ) administered during pregnancy provided dietary data. The presence of GDM was determined using diagnostic coding in clinical data and blood glucose results. A quarter of women did not meet any food group recommendations. There were no significant differences in the number of food group targets met by women with or those without GDM. Meeting food group recommendations was not associated with odds of having GDM in adjusted analyses. This study found adherence to dietary recommendations is poor in both women with and without GDM and no association between adherence to food group recommendations and the development of GDM. Greater support is required to assist women to achieve food and nutrition recommendations.