Postpartum Relapse in Diet Quality among Women Diagnosed with Gestational Diabetes

Abstract

Background: Women with gestational diabetes (GDM) often improve their dietary intake during pregnancy to control hyperglycemia. Maintaining improved diet quality after delivery could reduce women’s risk of type 2 diabetes (T2DM) later in life.

Methods: We compared the diet quality of English and Spanish-speaking women diagnosed with GDM during vs. after pregnancy in this prospective cohort study. Study participants were contacted by telephone to complete two 24-hour diet recalls during pregnancy and 2 recalls after delivery. The alternative healthy eating index (AHEI) score was calculated from recall data to assess diet quality; higher scores indicate better diet quality. We compared the mean pregnancy AHEI score to the mean postpartum AHEI score for the sample. We then calculated the difference in mean pregnancy and postpartum AHEI scores for each participant, reported the mean difference in AHEI scores for the sample, and tested for significant differences using paired t-tests.

Results: Of the 38 participants who completed at least 1 pregnancy recall, 27 also completed at least 1 postpartum recall. Mean age of participants was 32.76+/-4.42 and mean BMI was 32.17+/-8.55. Half of the participants spoke Spanish. Medicaid and/or CHIP provided insurance coverage for 73.7% of participants. Medication was necessary to control hyperglycemia in 42.1% of participants. The mean pregnancy AHEI score was higher than the mean postpartum AHEI score (66.8+/- 11.2 vs. 60.3+/-12.9, respectively) for the sample. The mean difference in AHEI scores from pregnancy to postpartum was -6.96 (p=0.013). In a sensitivity analysis of participants completing all 4 recalls, the mean difference in AHEI scores was -7.03; the difference remained statistically significant (p=0.05).

Conclusions: GDM-affected women report significantly better diet quality during vs. after pregnancy. Efforts to prevent this postpartum relapse in diet quality could reduce rates of T2DM in this high-risk population.