Association of dietary glycemic index and glycemic load with the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis

Figures & data

Figure 1. Flow chart of study selection.

Table 1. Baseline characteristics of the included studies.

Author	Year	Country	Study design	N	GDM case	Age (years)	Gestational week	BMI (kg/m^2)	Dietary assessment	GDM assessment	Maximum adjusted covariates
Fernández-González	2022	Spain	Prospective cohort	3827	202	34.6 ± 4.3	–	21.4 ± 2.6	136-item FFQ	100 g OGTT with the cutoffs of Carpenter and Coustan or the cutoffs from the National Diabetes Data Group after a positive 50 g OGTT	Age at the first pregnancy, BMI, baseline parity, family history of DM, leisure-time physical activity, television viewing, smoking habit, total energy intake, adherence to Mediterranean diet, fast-food consumption, snacking between meals, following special diet at baseline, alcohol intake, CVD, hypertension prevalence, fiber intake, solid carbohydrates/total, carbohydrates from whole grains/total
He	2021	China	Historical cohort	260	57	28.8 ± 3.3	12.3 ± 1.7	28.5 ± 3.0	24-h dietary recall	2 h 75g OGTT, one or more abnormal values from a: fasting≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L, 2 h≥ 8.5 mmol/L	Pregnancy alcohol drinking, baseline BMI, gestational week, maternal age, total energy intake, dietary counseling, hospital, baseline fasting glucose and triglyceride levels, parity, family history of diabetes or hypertension, folic acid and vitamin supplement, gestational hypertension, gestational weight gain
Wahab	2021	The Netherlands	Prospective birth cohort	3471	31	31.4 ± 4.4	13.4 (10.6, 21.2)*	–	293-item FFQ	Medical records	None
Xu	2021	China	Nested case-control	486	162	30.37 ± 3.01	12-18	22.08 ± 3.40	24-h dietary recall	2 h 75g OGTT, one or more abnormal values from a: fasting≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L, 2 h≥ 8.5 mmol/L	Education level, cigarette smoking status, passive smoking status, alcohol intake, gravidity, parity, energy, protein intake, fat intake, weight change before 13GW, other fiber types (cereal, fruit, vegetable, and legume)
Zhang	2021	China	Prospective cohort	9317	1751	26.1 ± 3.3	9-11	21.1 ± 2.6	24-h dietary recall, FFQ	2 h 75g OGTT, one or more abnormal values from a: fasting≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L, 2 h≥ 8.5 mmol/L.	Maternal age, parity, pregravid BMI, gestational weight gain, maternal occupation, family income, energy intake, dietary GI or GL adjusted residuals of sugar-sweetened beverage, energy adjusted residuals of animal protein, energy adjusted residuals of fiber pre-pregnancy
Aminianfar	2020	Iran	Prospective cohort	812	231	29.3 ± 4.9	8-16	25.1 ± 4.0	117-item FFQ	1 h 50g OGTT, fasting plasma glucose concentration of >5.3 mmol/L and/or 1-h post-challenge levels of ≥7.8 mmol/L	Age, energy, physical activity, educational level, occupation status, family number, history of stillbirth, history of preterm delivery, history of cesarean, history of abortion, pregnancy number, dietary intake of fiber, maternal weight gain
Dong	2020	China	Prospective cohort	1462	524	28.53 ± 4.03	8-14	21.0 ± 2.70	3-day 24-h dietary recall	2 h 75g OGTT, one or more abnormal values from a: fasting≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L, 2 h≥ 8.5 mmol/L.	Age, pre-pregnancy BMI, gravida, parity, employment in early pregnancy, family history of diabetes, physical activity, fat energy supply ratio, protein energy supply ratio, dietary fiber intake
Hasbullah	2020	Malaysia	Prospective cohort	294	45	30.1 ± 4.6	≤10	23.9 ± 5.0	137-item FFQ	2 h 75g OGTT, fasting≥ 5.1 mmol/L or 2 h≥ 7.8 mmol/L	None
Looman	2018	Australia	Prospective cohort	3607	285	27.5 ± 1.5	–	23.8 ± 4.6	101-item FFQ	Self-reported physician diagnosis	Age at pregnancy, country of birth, educational level, total energy intake, physical activity, smoking, polycystic ovarian syndrome, hypertension during pregnancy, parity, inter-pregnancy interval, fat and protein intake, BMI
Liang	2010	China	Case-control	259	128	30 ± 5	–	21.5 ± 3.1	FFQ	–	–
Radesky	2008	USA	Prospective cohort	1733	91	32.2 ± 4.9	<22	24.6 ± 5.3	Over 140-item FFQ	3 h 100 g OGTT, two or more abnormal values from: a blood glucose <95 mg/dL at baseline, <180 mg/dL at 1 h, <155 mg/dL at 2 h and <140 mg/dL at 3 h	Maternal age, pre-pregnancy BMI, race/ethnicity, previous GDM, history of diabetes in participant’s mother, smoking during pregnancy
Zhang	2006	USA	Prospective cohort	13110	758	–	–	–	133-item FFQ	Self-reported	Age, parity, BMI, race/ethnicity, cigarette smoking status, family history of diabetes in a first-degree relative, alcohol intake, physical activity, total energy, dietary cereal fiber, fruit and vegetable fiber, intakes of protein
Scholl	2004	USA	Prospective cohort	1082	–	<18 177, 18-25 639, 25-29 153, ≥29 113	–	<19.8 165, 19.8-26 513, 26-29 169, ≥29 235	24-h dietary recall	–	–

* Median (95%).

GDM: gestational diabetes mellitus; BMI: body mass index; FFQ: food frequency questionnaire; GI: glycemic index; GL: glycemic load; OGTT: oral glucose tolerance test.

Table 2. Newcastle-Ottawa Quality assessment scale for cohort studies.

Study	Selection				Comparability	Outcome
	Representativeness of exposed cohort	Selection of non-exposed cohort	Ascertainment of exposure	Demonstration that outcome of interest was not present at start of study	Comparability of cohorts on the basis of the design or analysis	Assessment of outcome	Follow-up long enough	Adequacy of follow up of cohorts
Fernández-González [31]	*	*	*	*	–	*	*	–
He [25]	*	*	*	*	*	*	–	*
Wahab [27]	*	*	*	*	–	*	*	*
Zhang [14]	*	*	*	*	–	*	*	–
Aminianfar [15]	*	*	*	*	*	*	*	–
Dong [30]	*	*	*	*	–	*	*	–
Hasbullah [16]	*	*	*	*	–	*	*	–
Looman [26]	*	*	*	*	–	–	*	–
Radesky [33]	*	*	*	*	–	*	*	–
Zhang [29]	*	*	*	*	–	–	*	*
Scholl [34]	*	*	*	*	–	*	*	–

Table 3. Newcastle-Ottawa Quality assessment scale for case-control studies.

Study	Selection				Comparability	Exposure
	Case definition adequate	Representativeness of the cases	Selection of controls	Definition of controls	Comparability of cases and controls on the basis of the design or analysis	Ascertainment of exposure	Same method of ascertainment for cases and controls	Non-response rate
Xu [28]	*	*	*	*	**	*	*	–
Liang [32]	–	*	*	–	*	–	–	–

Figure 2. Dose-response association between GI and the risk of GDM GI, glycemic index.

Figure 3. Dose-response association between GI and the risk of GDM after covariate adjustment GI, glycemic index.

Figure 4. Dose-response association between GL and the risk of GDM GL, glycemic load.

Figure 5. Dose-response association between GL and the risk of GDM after covariate adjustment GL, glycemic load.

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Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.