Association of Polyphenols Consumption with Risk for Gestational Diabetes Mellitus and Preeclampsia: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Search Strategy and Information Sources
2.2. Eligibility Criteria and Study Selection
- (i)
- original studies from 1980 without language restrictions that assessed the polyphenol intake in pregnant women between the ages of 18–40 years and the risk of GDM or PE;
- (ii)
- studies of polyphenol-rich foods consumption by food frequency questionnaires or direct dietary intervention of polyphenols, curcumin, resveratrol, flavonoids, quercetin, tannins, catechins, phenolic acid, hydroxybenzoic acid, hydroxycinnamic acid, anthocyanins, or polyphenol-rich foods (tea, berries, chocolate, coffee);
- (iii)
- randomized controlled trials (RCTs), observational studies (prospective cohort studies);
- (iv)
- studies providing odds ratios (ORs), relative risks (RRs), or hazard ratios (HRs) along with 95% confidence intervals (CIs) or sufficient data to calculate the effect size (ES). When the article provided more than one estimator, the most adjusted one was selected.
2.3. Quality Assessment
2.4. Data Extraction
2.5. Data Synthesis and Statistical Analysis
3. Results
3.1. Selected Studies
3.2. Gestational Diabetes Mellitus Risk Assessment
3.3. Preeclampsia Risk Assessment
4. Discussion
4.1. Our Findings
4.2. Why Is It Expected That Polyphenol-Rich Food Intake Protects against GDM?
4.3. Why Is It Expected That Polyphenol-Rich Food Intake Protects against PE?
4.4. Why Is It Important to Find New Strategies to Manage GDM and PE?
4.5. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author, Year, Country | Data Collection, Food Questionnaire | Study Design, Enrolment Period | Study Setting | Average Follow-Up (Weeks or Months) | PE */GDM Diagnosis (Cases) | Risk Estimate | Covariates Adjusted for ** |
---|---|---|---|---|---|---|---|
PE studies | |||||||
[20] Triche et al., 2008, United States | In-person interview with a questionnaire designed for the study | Prospective, September 1996–January 2000 | Multi-center, clinics and hospitals based | From 14 gestational weeks until delivery | Hypertension at least 6 h apart with proteinuria | Under 1 serving of chocolate vs. women 5 or more servings of chocolate per week during 1st trimester aOR = 0.81 (0.37, 1.79) | 1st trimester smoking, clinic/private prenatal care provider, parity, race, education |
[21] Wei et al., 2009, Canada | In-person interview with a questionnaire designed for the study | Retrospective, January 2003–March 2006 | Multi-center, hospital based. | During pregnancy (not specified) | Hypertension at least 4 h apart with proteinuria | No tea drinker vs. tea persistent drinker during whole pregnancy aOR = 1.39 (0.81, 2.41) No coffee drinker vs. persistent drinker during whole pregnancy aOR = 175 (0.86, 9.16) | History of abortion, education, smoking |
[22] Saftlas et al., 2010, United States | In-person interview with a questionnaire designed for the study | Prospective, April 1988–December 1991 | Multi-center, care practices based | During pregnancy (not specified) | Hypertension at least 6 h apart with proteinuria | No regular chocolate consumption vs. 4 or more servings per week in 1st and 3rd trimester aOR = 0.41 (0.21, 0.77) | Parity, abortion history, maternal education, smoking during pregnancy, race, caffeine intake during pregnancy, fetal gender, GDM during pregnancy |
[23] Kawanishi et al., 2021, Japan | Self-administered FFQ | Prospective, January 2011–March 2014 | Nationwide birth cohort study | During pregnancy (not specified) | Hypertension with proteinuria | No coffee (Q1) vs. high coffee consumption (Q4 or ≥2 cups/day) aOR = 0.79 (0.62, 0.99) No tea (Q1) vs. high tea consumption (Q4 or ≥2 cups/day) aOR = 1.11 (0.95, 1.29) | Parity, pre-pregnancy smoking, alcohol consumption, folic acid supplementation, education, coffee and tea intake |
GDM studies | |||||||
[24] Adeney et al., 2007, United States | Self-administered FFQ | Prospective, December 1996–September 2002 | Multi center, hospital based | Gestational age 13 weeks at enrolment until delivery | 1 h 50 g and 3 h 100 g oral glucose tolerance tests | None caffeinated coffee vs. high caffeinated coffee consumption (>7 cups per week) before pregnancy RR = 0.76 (0.40, 1.46) | Race, parity, smoking, alcohol, physical activity, employment during pregnancy, consumption of soft drinks, tea, decaffeinated coffee, caloric and fat intake, percentage of calories from fat, frequency of cream and sugar usage |
[25] Hinkle et al., 2015, Denmark | In-person and telephone interviews with a designed for the study questionnaire | Prospective, March 1996–November 2002 | National birth cohort study | From gestational ages of 12 and 30 weeks at enrolment until the child was 18 months of age | National Hospital Discharge Register and Post-delivery Interview | No tea intake vs. ≥8 teacups per day consumption RR = 0.77 (0.55, 1.08) No coffee intake vs. ≥8 coffee cups per day consumption RR = 0.89 (0.64, 1.25) | Parity, self-reported smoking status at the first interview, cola intake, socio-occupational status |
[26] Tryggvadottir et al., 2016, Iceland | Self-performed 4-day weighed food record | Prospective, April 2012–October 2013 | Single center, hospital based | From gestational age 19 to 38 weeks | 75-g oral glucose tolerance test | Low vs. high tertile fruit and berries consumption aOR = 1.09 (0.99, 1.01) Low vs. high tertile coffee, tea and cocoa powder consumption aOR= 1.00 (0.99, 1.01) | Parity, energy intake, weekly weight gain, total metabolic equivalent of task |
[27] Huang et al., 2017, China | In-person and telephone interviews for 3-day dietary record | Prospective. April 2013–August 2014 | Single center, hospital based | From gestational age of 6 weeks at enrolment to mid/late pregnancy (≥28 weeks) | 75-g oral glucose tolerance test | Low (Q1) vs. high (Q4) total polyphenols consumption (100 g/d of increment) aOR = 4.82 (2.39, 9.78) Low (Q1) vs. high (Q4) berries consumers (100 g/d of increment) aOR = 1.69 (0.80, 3.56) | Education, occupation, income, gestational weight gain, family history of diabetes, smoking and alcohol, consumption of grains, vegetables, meat and fish, glycemic index value of other fruit, consumption of other subtype of fruit |
[28] Dong et al., 2019, Japan | Self-administered FFQ | Prospective, January 2011–March 2014 | National birth, cohort study | Gestational age of 12 weeks at enrolment to 1 month after giving birth | 75-g oral glucose tolerance test | Less than 1 servings of chocolate per month (Q1) vs. ≥7 times of chocolate per day (Q4) OR = 0.78 (0.67, 0.90) | Smoking, drinking education, occupation, depression, history of macrosomia babies, parity, physical activity, intake of total meat, red meat, coffee, green tea, milk, soya isoflavone, Mg, dietary fiber, dietary fat, saturated fat, snacks (potato chips or other crackers), total energy intake |
[29] Dong et al., 2021, Japan | Self-administered FFQ | Prospective, January 2011–March 2014 | National birth cohort study | From a median gestational age of 12 weeks at enrolment to mid/late pregnancy | 75-g oral glucose tolerance test | Less than 1 servings of isoflavone product per month (Q1) vs. ≥7 times of isoflavone product per day (Q4) RR = 0.82 (0.70, 0.95) | Socio-demographic factors, disease history, medication, lifestyle factors, education level, history of depression, history of macrosomia babies, marital status, parity, smoking, drinking, physical activity, Western dietary pattern score |
[30] Gao et al., 2021, China | In-person interview with FFQ | Prospective. January 2013–May 2016 | Multi center, hospital based | Gestational age from 8 to 16 weeks at enrolment until delivery | 75-g oral glucose tolerance test | Low (Q1) vs. high (Q4) total polyphenol consumers (100 g/d of increment) OR = 0.57 (0.30, 0.99) Low (Q1) vs. high (Q4) total anthocyanidin consumers (100 g/d of increment) OR = 0.62 (0.38, 1.00) Low (Q1) vs. high (Q4) total flavonoid consumers (100 g/d of increment) OR = 0.57 (0.32, 0.99) | 1st and 2nd trimester weight gain, gravidity, parity, family history of diabetes, smoking and drinking status before pregnancy, physical activity, poor sleep quality, supplement use, dietary intake of vitamin C, vitamin E, fiber, cholesterol, selenium, zinc, and iron (all adjusted for energy intake), polyphenols from fruits and vegetables further adjusted nut polyphenols intake |
[31] Sun et al., 2021, China | In-person and telephone interviews with a designed for the study questionnaire | Prospective, during 2017 | Single center, hospital-based | 40 weeks of pregnancy (information gathered each trimester) | 75-g oral glucose tolerance test | Non consumers (Q1) vs. high consumers (Q4) of total fruits RR = 1.03 (0.83, 1.27) Non consumers (Q1) vs. high consumers (Q4) of total anthocyanin RR = 0.73 (0.56, 0.93) | Educational, family income, family history of diabetes, parity, smoking, alcohol, physical activity, energy, vegetables, whole grains, red meat, beverages, dietary fiber intake |
Author, Year | Inclusion | Exclusion | Total Number of Patients | Number of Cases and Controls | Age, Years, Median or Mean | Pre-Gestational BMI | Multiparous, Primiparous | Ethnicity |
---|---|---|---|---|---|---|---|---|
PE studies | ||||||||
[20] Triche et al., 2008 | Pregnant who visited 56 obstetric practices and 15 clinics associated with 6 hospitals in Connecticut and Massachusetts. | Pregnant with more than 24 weeks’ gestational age at enrollment, with insulin-dependent diabetes mellitus, women that did not speak English or Spanish, or intended to terminate their pregnancy | 1681 | PE: 63 Controls:1618 | #PE cases:29.0 ± 5.3 Control: 29.2 ± 5.0 | #PE cases: 25.3 ± 3.4 Control: 23.7 ± 2.8 | Both | Yes |
[21] Wei et al., 2009 | Nulliparous preeclamptic 48 hrs before delivery, at least 18 years of age, who spoke either French or English | Multiparous, had chronic hypertension or hypertension before 20 weeks of pregnancy, gestational hypertension without proteinuria, pregestational diabetes, heart disorders or HIV positive serology | 337 | PE: 92 Controls: 245 | PE cases: 29.0 ± 5.2 Controls: 29.1 ± 5.3 | PE cases: 23.9 ± 6.1 Control: 22.6 ± 4.2 | Nulliparous | No |
[22] Saftlas et al., 2010 | Singleton pregnancy, women interviewed before 16 weeks of gestation, English speakers | Diabetes mellitus, non-English speaking, ≥16 weeks’ gestation or previous study participation | 2540 | PE: 58 GH: 158 Normal: 2324 | #PE cases:30.7 ± 4.5 Control: 31.4 ± 4.5 | Not clearly specified | Both | No |
[23] Kawanishi et al., 2021 | Singleton pregnancy | Multiple pregnancies, women with a medical history of hypertension, renal disease, history of HDP in previous pregnancies, and cases of DM and GDM | 85,533 | PE: 2222 Control:83,311 | Lower quintile of caffeine intake: 31.1 ± 4.9 Higher quintile of caffeine intake 31.3 ± 5.1 | Lower quintile of caffeine intake: 20.9 ± 3.0 Higher quintile of caffeine intake: 21.2 ± 3.3 | Both | No |
GDM studies | ||||||||
[24] Adeney et al., 2007 | NA | Patients were excluded when experienced a spontaneous or induced abortion, fetal demise prior to 28 weeks of gestation, those with prior insulin dependent or T2DM, interview data was missing or incomplete | 1632 | GDM: 75 Control: 1557 | No coffee consumption: 31.7 ± 0.2 High coffee consumption: 33.5 ± 0.2 | No coffee consumption: <20: 20% 20–24.9: 55% >25: 25% High coffee consumption <20: 19% 20–24.9: 54% >25: 27% | Both | Yes |
[25] Hinkle et al., 2015 | 1st singleton pregnancy recorded in the register, women who completed the 1st two interviews | Pre-existing diabetes and deliveries if any relevant covariates were missing | 71,239 | GDM: 912 Control: 70,327 | By exposure: Coffee: 0 cups/d: 29.2 ± 4.4 ≥ 8 cups/d: 31.7 ± 5.0 Tea: 0 cups/d: 29.5 ± 4.7 ≥8 cups/d: 31.3 ± 4.8 | #By exposure: Coffee: 0 cups/d: 23.8 ± 4.1 8 cups/d: 23.7 ± 4.0 Tea: 0 cups/d: 24.0 ± 4.2 ≥8 cups/d: 23.6 ± 3.9 | Nulliparous | No |
[26] Tryggvadottir et al., 2016 | Women living in Reykjavik, 18 and 40 years old, non-smokers with or without family history of diabetes or GDM, BMI above of 18.5 | Parity >3 | 168 | GDM:17 Control: 151 | Normal weight: 29.0 ± 4.8 Overweight: 30.0 ± 4.3 Obese: 30.0 ± 4.6 | Normal weight: 21.6 ± 1.6 Overweight: 27.2 ± 1.2 Obese: 33.2 ± 2.7 | Multiparous | No |
[27] Huang et al., 2017 | Primiparous women, 20 to 35 years old at 6–12 weeks of gestational age, measurement of blood glucose during 24 to 28 gestation weeks | Multiparous, no information of blood glucose or lost to follow-up, abortion, multiple pregnancy, type 1 or 2 diabetes, hypertension, renal insufficiency, kidney stones, thyroid-gland dysfunction, chronic obstructive pulmonary disease or asthma, HIV infection or active tuberculosis virus, mental disorders or anemia | 772 | GDM: 169 Control: 603 | Overall (general fruit consumption) Q1: 25.73 ± 3.11 Q4: 26.73 ± 3.3 | Overall (General fruits consumption) Q1: < 18.5: 40.2% 18.5–24: 55.2% 24 or more: 4.6% Q4: = <18.5: 29.5% 18.5–24: 64.2% 24 or more: 6.2% | Primiparous | No |
[28] Dong et al., 2019 | Singleton pregnancy | Extreme BMI, history of stroke, heart disease, cancer, type 1 and/or 2 diabetes, GDM at study enrolment | 84,948 | GDM: 1904 Control: 83,044 | Lowest chocolate consumption (Q1): 30.9 ± 5.1 Highest chocolate consumption (Q4): 30.5 ± 4.9 | Lowest chocolate consumption (Q1): 21.3 ± 3.3 Highest chocolate consumption (Q4): 21.0 ± 3.0 | Multiparous and nulliparous | No |
[29] Dong et al., 2021 | Singleton pregnancy, free of GDM, stroke, heart disease, Kawasaki disease, cancer, type 1 and/or 2 diabetes | Extreme BMI before pregnancy, extreme total energy intake (higher or lower) | 84,948 | GDM: 1904 Control: 83,044 | Q1: 29.8 (5.3) Q5: 31.3 (4.9) | Q1: 21.4 (3.3) Q5: 21.0 (3.1) | Both | No |
[30] Gao et al., 2021 | Singleton pregnancy, age from 18 to 45 years, gestational age from 8 to 16 weeks | Blank items > 10 on FFQ, missing values for any vegetables or fruits, extreme energy intake, unavailable OGTT data or OGTT performed before FFQ, multiple pregnancies, pre-gestational diabetes | 2231 | GDM: 185 Control: 2046 | Q1: 28.2 ± 3.4 Q4: 28.0 ± 3.5 | Q1: 21.0 ± 2.6 Q4: 20.6 ± 2.5 | Both | Yes |
[31] Sun et al., 2021 | Singleton pregnancy, gestational age from 6 to 14 weeks, no chronic metabolic disease | Missing data from the dietary recall or the OGTT, GDM history, extreme total energy intake (higher or lower) | 1453 | GDM: 523 Control: 930 | Q1: 28.8 Q4: 28.4 | Q1: 21.1 Q4: 20.4 | Both | No |
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Jorquera, G.; Fornes, R.; Cruz, G.; Thomas-Valdés, S. Association of Polyphenols Consumption with Risk for Gestational Diabetes Mellitus and Preeclampsia: A Systematic Review and Meta-Analysis. Antioxidants 2022, 11, 2294. https://doi.org/10.3390/antiox11112294
Jorquera G, Fornes R, Cruz G, Thomas-Valdés S. Association of Polyphenols Consumption with Risk for Gestational Diabetes Mellitus and Preeclampsia: A Systematic Review and Meta-Analysis. Antioxidants. 2022; 11(11):2294. https://doi.org/10.3390/antiox11112294
Chicago/Turabian StyleJorquera, Gonzalo, Romina Fornes, Gonzalo Cruz, and Samanta Thomas-Valdés. 2022. "Association of Polyphenols Consumption with Risk for Gestational Diabetes Mellitus and Preeclampsia: A Systematic Review and Meta-Analysis" Antioxidants 11, no. 11: 2294. https://doi.org/10.3390/antiox11112294