Associations between food insecurity with gestational diabetes mellitus and maternal outcomes mediated by dietary diversity: A cross-sectional study

doi:10.4239/wjd.v16.i2.95463

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Feb 15, 2025 (publication date) through Jan 9, 2025

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World Journal of Diabetes

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World J Diabetes. Feb 15, 2025; 16(2): 95463
Published online Feb 15, 2025. doi: 10.4239/wjd.v16.i2.95463

Table 1 Baseline characteristics, and dietary intakes by food security status, n (%)

Variable	Food secure (n = 270)	Marginally secure (n = 226)	Food insecure (n = 104)	All participants (n = 600)	P value
Age (years)	32.16 ± 7.76	33.5 ± 7.17	33.76 ± 8.01	32.95 ± 7.3	0.056
Education
Less than 12^th grade	116 (43)	120 (53)	58 (56)	294 (49)	0.008^a
High school degree	80 (30)	60 (26.5)	34 (32)	174 (29)
More than high school	74 (27)	46 (21.5)	12 (12)	132 (22)
Income
Good	197 (73)	22 (10)	6 (6)	225 (37.5)	0.001^a
Average	50 (19)	76 (33)	20 (19)	146 (24.5)
Poor	22 (8)	128 (57)	78 (75)	228 (38)
Physical activity (total MET)	62.10 ± 2.67	62.09 ± 3.2	61.36 ± 2.8	61.97 ± 2.9	0.066
DDS	7.05 ± 1.5	6.34 ± 1.2	5.78 ± 1.9	6.56 ± 1.3	0.001^a
TG (mg/dL)	159.38 ± 40.67	175.8 ± 76.1	174.05 ± 50.74	168.1 ± 58.5	0.004^a
LDL (mg/dL)	122.23 ± 27.34	124.14 ± 25.7	125.88 ± 23.2	123.58 ± 26.04	0.442
TC (mg/dL)	170.82 ± 27.7	180.04 ± 29.5	175.88 ± 23.3	175.17 ± 27.98	0.001^a
HDL (mg/dL)	44.45 ± 7.7	45.47 ± 8.2	42.75 ± 7.58	44.54 ± 7.95	0.015^a
FBS (mg/dL)	86.89 ± 11.9	85.74 ± 12.28	89.13 ± 15.09	86.85 ± 12.71	0.08
SBP (mmHg)	115.33 ± 14.43	116.29 ± 16.20	117.96 ± 15.66	116.15 ± 15.3	0.326
DBP (mmHg)	73.88 ± 9.4	72.8 ± 9.4	74.3 ± 8.7	73.56 ± 9.31	0.291
Nutrient
Total energy (kcal/day)	2153.11 ± 319.9	2072.5 ± 311.2	2010.4 ± 376.1	2098.1 ± 331.1	0.001^a
Carbohydrate (gr/day)	272.18 ± 61.6	272.05 ± 68.4	279.95 ± 64.8	273.48 ± 64.8	0.535
Protein (gr/day)	89.14 ± 16.4	88.65 ± 16.6	81.11 ± 16.6	87.56 ± 16.7	0.001^a
Fat (gr/day)	73.08 ± 15.5	68.70 ± 16.2	69.04 ± 16.3	70.73 ± 16.07	0.005^a
Fiber (gr/day)	19.9 ± 2.82	18.3 ± 6.34	16.22 ± 8.06	18.3 ± 1.3	0.193

^aP < 0.05, denote significance.

P values were calculated using the one-way ANOVA test for comparisons of continuous variables AND Fisher's exact test P values for comparisons of categorical variables. BMI: Body mass index; NICU: Neonatal intensive care unit; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; GDM: Gestational diabetes mellitus; DDS: Dietary diversity score; TG: Triglycerides; FBS: Fasting blood sugar; SBP: Systolic blood pressure; DBP: Diastolic blood pressure.

Table 2 Maternal and neonatal outcomes by food security status, n (%)

Variable	Food secure (n = 270)	Marginally secure (n = 226)	Food insecure (n = 104)	All participants (n = 600)	P value
Maternal outcomes
GDM
No	262 (84)	202 (84)	60 (65.5)	524 (87)	0.001^a
Yes	8 (16)	24 (16)	44 (34.5)	76 (13)
Hypertension/preeclampsia
No	248 (92)	195 (85.5)	65 (62.5)	508 (84)	0.001^a
Yes	22 (8)	31 (4.5)	39 (6.5)	92 (16)
Gestational age	37.44 ± 2.1	37.47 ± 2.1	37.21 ± 2.2	37.44 ± 2.1	0.539
Weight before pregnancy	70.26 ± 9.3	71.24 ± 9.7	71.08 ± 10.1	70.77 ± 9.6	0.494
BMI before pregnancy	26.18 ± 3.1	26.61 ± 2.9	26.65 ± 4.1	26.24 ± 3.2	0.266
Weight gain (kg)	9.46 ± 2.5	9.03 ± 4.08	10.27 ± 2.85	9.44 ± 6.20	0.236
Neonatal outcomes
Neonatal RDS
No	268 (99.3)	228 (100)	92 (88.5)	586 (98)	0.001^a
Yes	2 (0.7)	0 (0)	12 (11.5)	14 (2)
NICU admission
No	254 (94)	195 (86)	51 (49)	500 (83)	0.001^a
Yes	16 (6)	31 (14)	53 (51)	100 (17)
ELBW
No	267 (99)	226 (100)	88 (84)	581 (96.5)	0.001^a
Yes	3 (1)	0 (0)	16 (16)	19 (3.5)
Birth weight (kg)	3.61 ± 0.25	3.63 ± 0.18	3.41 ± 0.61	3.58 ± 0.33	0.001^a

^aP < 0.05 denotes significance.

P values were calculated using the one-way ANOVA test for comparisons of continuous variables AND Fisher's exact test P values for comparisons of categorical variables. ELBW: Extremely low birth weight; BMI: Body mass index; RDS: Respiratory distress syndrome; NICU: Neonatal intensive care unit; GDM: Gestational diabetes mellitus.

Table 3 Baseline characteristics maternal and neonatal outcomes by dietary diversity score quartile categories, n (%)

Variable	Q1 (n = 108)	Q2 (n = 164)	Q3 (n = 196)	Q4 (n = 132)	P value
DDS	4.88 ± 0.36	5.87 ± 0.15	6.90 ± 0.2	8.30 ± 1.17	0.001^a
TG (mg/dL)	189.01 ± 88.23	170.78 ± 48.8	159.9 ± 47.4	159.9 ± 49.6	0.001^a
LDL (mg/dL)	124.68 ± 28.5	125.46 ± 26.3	123.43 ± 26.2	120.57 ± 23.6	0.422
TC (mg/dL)	179.59 ± 23.3	176.46 ± 28.6	174.80 ± 29.5	170.5 ± 27.8	0.08
HDL (mg/dL)	41.68 ± 8.2	44.76 ± 9.16	45.23 ± 7.1	45.57 ± 6.8	0.001^a
FBS (mg/dL)	92.91 ± 10.7	86.35 ± 13.9	85.81 ± 12.6	84.03 ± 11.1	0.001^a
SBP (mmHg)	117.7 ± 15.7	118.43 ± 17.2	114.88 ± 13.1	113.91 ± 15.1	0.030^a
DBP (mmHg)	74.46 ± 8.3	74.01 ± 10.4	73.39 ± 8.5	72.52 ± 9.5	0.376^a
Maternal outcomes
GDM
No	76 (70.5)	129 (78.5)	162 (82.5)	118 (89.5)	0.001^a
Yes	44 (57)	30 (40)	2 (3)	0 (0)
Hypertension/preeclampsia
No	87 (80)	130 (79.5)	175 (89.5)	116 (88)	0.024^a
Yes	21 (20)	34 (20.5)	21 (10.5)	16 (12)
Gestational age	37.67 ± 1.5	37.06 ± 2.2	37.33 ± 2.2	37.76 ± 1.9	0.016^a
Weight before pregnancy	72.11 ± 9.5	69.13 ± 10.09	71.33 ± 9.7	70.88 ± 8.7	0.056
BMI before pregnancy	26.18 ± 3.1	26.61 ± 2.9	26.65 ± 4.1	26.24 ± 3.2	0.266
Total gestational weight gain (kg)	11.12 ± 3.89	9.95 ± 2.50	7.89 ± 4.95	9.72 ± 1.83	0.001^a
Neonatal outcomes
Neonatal RDS
No	106 (98)	158 (96.3)	192 (96)	130 (98.5)	0.642
Yes	2 (2)	6 (3.7)	4 (2)	2 (1.5)
NICU admission
No	63 (59)	123 (75)	186 (95)	128 (97)	0.001^a
Yes	45 (41)	41 (25)	10 (5)	4 (3)
ELBW
No	106 (98)	156 (95)	191 (97.4)	128 (97)	0.526
Yes	2 (2)	8 (5)	5 (2.6)	4 (3)
Birth weight (kg)	3.62 ± 0.26	3.53 ± 0.38	3.58 ± 0.32	3.61 ± 0.33	0.102

^aP < 0.05 denotes significance.

P values were calculated using the one-way ANOVA test for comparisons of continuous variables AND Fisher's exact test P values for comparisons of categorical variables. NICU: Neonatal intensive care unit; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; GDM: Gestational diabetes mellitus; DDS: Dietary diversity score; TC: Total cholesterol; TG: Triglycerides; FBS: Fasting blood sugar; RDS: Respiratory distress syndrome; NICU: Neonatal intensive care unit; ELBW: Extremely low birth weight.

Table 4 Multivariate-adjusted odds ratio and 95%CI for gestational diabetes mellitus and gestational hypertension

	Food security status			P value
	Food secure	Marginally secure	Food insecure	P value
Gestational diabetes Mellitus
Model 1	Reference	2.35 (1.55-3.5)	4.52 (3.75-6.4)	0.001
P value		0.001	0.001
Model 2	Reference	1.25 (0.85-1.70)	3.64 (2.36-5.56)	0.001
P value		0.001	0.002
Gestational Hypertension
Model 1	Reference	2.77 (1.6-3.85)	1.25 (1.1-1.65)	0.001
P value		0.001	0.001
Model 2	Reference	2.53 (1.84-3.55)	1.10 (1.02-1.44)	0.001
P value		0.001	0.002

Model 1: Unadjusted; Model 2: Adjusted for age, body mass index, income, weight gain, education.

Citation: Hou HL, Sun GX. Associations between food insecurity with gestational diabetes mellitus and maternal outcomes mediated by dietary diversity: A cross-sectional study. World J Diabetes 2025; 16(2): 95463
URL: https://www.wjgnet.com/1948-9358/full/v16/i2/95463.htm
DOI: https://dx.doi.org/10.4239/wjd.v16.i2.95463