As women who experience Gestational Diabetes Mellitus (GDM) are at considerably greater risk of developing type 2 diabetes in life, prevention of GDM is particularly important. The objectives of this research were to identify lifestyle predictors associated with GDM in a developing country and to validate a physical activity questionnaire for assessing total energy expenditure in a Pakistani population. / A prospective cohort study of 750 South Asian women recruited early in gestation was conducted in Karachi, Pakistan. Eligibility criteria included South Asian origin and ≤ 18 weeks gestation. Data on physical activity, diet, socio-demographic covariates, weight, height and body composition were obtained at recruitment and women were followed to assess GDM status at ≥ 26 weeks of gestation. / Logistic regression analysis of data from 611 women to assess the impact of age, body fat percentage, height, family history of diabetes, parity, level of education, rate of weight gain during pregnancy, and daily energy expenditure on the development of GDM was undertaken. The risk of GDM increased with increasing maternal age (yr), OR 1.13 (CI 1.06-1.21), body fat (%), OR 1.07 (CI 1.03-1.13), and decreased with daily energy expenditure (100 kcal), OR 0.89 (CI 0.79-0.99). Replacing body fat (%) with pre-gravid BMI provided similar results. Using a nested case (n=49) control (n=98) study design, conditional logistic regression analysis was conducted to assess the association between total energy, macronutrient and fiber intake and GDM. The risk of GDM decreased with increasing amounts of protein as a percentage of total energy intake, OR 0.75 (CI 0.60-0.95). / The Monitoring trends and determinants of cardiovascular disease Optional Study of Physical Activity (MOSPA) questionnaire was assessed against a Caltrac accelerometer (n=50). Subjects wore a caltrac accelerometer for 5 consecutive days. A correlation of 0.51 (P<0.01) was found between MOSPA questionnaire and Caltrac accelerometer values. / Advanced maternal age and body fat (%) predicted increased risk for GDM while physical activity was protective. Hence, prevention strategies should target increasing physical activity, sufficient to alter body composition, in this South Asian population.

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