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Aims: To examine the prospective association between fibroblast growth factor 21 (FGF21) and risk of gestational diabetes mellitus (GDM) and the modifying effect of overweight/obesity for this association. Methods: Serum FGF21 levels were measured at 6–15 weeks of gestation among 332 GDM cases and 664 matched controls. Conditional logistic regression was used to evaluate its association with GDM risk. Interaction analyses on multiplicative and additive scales were conducted to investigate the modifying effect of overweight/obesity. Results: Elevated FGF21 levels were associated with a higher risk of GDM in multivariable models, but the positive association was attenuated after further adjustment for pre‐pregnancy body mass index (BMI). A significant multiplicative interaction was noted between FGF21 (both continuous and dichotomous) and pre‐pregnancy BMI (p for interaction = 0.049 and 0.03), and the association was only significant in participants with pre‐pregnancy BMI ≥24 kg/m2. When participants were grouped based on pre‐pregnancy BMI (≥24 and <24 kg/m2) and FGF21 levels (≥median and

Objective: To examine the association of a combined healthy lifestyle in early pregnancy with gestational diabetes mellitus (GDM) risk. Design, setting and population: A Chinese prospective cohort study with 6980 pregnant women. Methods: Individual modifiable lifestyle factors were assessed in early pregnancy and a combined lifestyle score was derived from the sum of the lifestyle factors, with a higher score indicating a healthier lifestyle. The association of a combined healthy lifestyle with GDM risk was examined. Main outcome measures: Gestational diabetes mellitus was diagnosed in middle pregnancy according to the International Association of Diabetes and Pregnancy Study Group criteria or diagnoses in medical records. Results: Overall, 501 (7.2%) pregnant women were diagnosed with GDM. Being physically active (total energy expenditure in upper three quintiles, i.e. ≥100.1 metabolic equivalent of task [MET]‐hours/week; odds ratio [OR] 0.76, 95% confidence interval [CI] 0.63–0.92), healthy diet (total intake of vegetables and fruits ≥5 times/day; OR 0.74, 95% CI 0.59–0.94), sufficient sleep (night‐time sleep duration ≥7 hours/night; OR 0.66, 95% CI 0.48–0.90) and healthy weight (early‐pregnancy BMI <24.0 kg/m2; OR 0.57, 95% CI 0.46–0.71) were associated with lower GDM risk. The GDM risk decreased linearly across the combined lifestyle score (Ptrend <0.001): women with 2, 3 and 4 lifestyle factors compared with those with 0–1 factor had 38% (OR 0.62, 95% CI 0.46–0.84), 57% (OR 0.43, 95% CI 0.31–0.58) and 66% (OR 0.34, 95% CI 0.22–0.52) lower risks of GDM, respectively. Conclusion: A healthy lifestyle in early pregnancy was associated with a substantially lower GDM risk. [ABSTRACT FROM AUTHOR]

To evaluate the prospective associations of nighttime sleep duration, midday napping, and sleep quality during early pregnancy with gestational diabetes mellitus (GDM) risk among Chinese pregnant women. Sleep-related information was assessed by the Pittsburgh Sleep Quality Index in baseline surveys during the 6–15 (mean 10.3) gestational weeks. GDM was diagnosed during 24–28 gestational weeks according to the Chinese Guidelines on Diagnosis and Management of Hyperglycemia in Pregnancy (2022). Multivariable logistic regression models with adjustments for socio-demographic and lifestyle factors were used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the associations of sleep traits with GDM risk. We identified 503 incident GDM cases among 6993 participants. Compared with women who slept for 7–9 hours/night in early pregnancy, those who slept <7 hours/night showed a higher risk of GDM (OR, 1.75; 95 % CI: 1.20–2.54), whereas those who slept >9 hours/night showed no significant association for GDM risk (OR, 1.01; 95 % CI: 0.78–1.30). Compared with women with absolutely no napping, those with ≤60 and > 60 min/day midday napping showed no significant association for GDM risk (OR, 0.82; 95 % CI: 0.64–1.05 for ≤60 min/day midday napping; OR, 0.87; 95 % CI: 0.66–1.15 for >60 min/day midday napping). Poor sleep quality was not associated with GDM risk compared with good quality (OR, 0.90; 95 % CI: 0.72–1.12). A short nighttime sleep duration during early pregnancy was associated with a higher risk of GDM, which was independent of midday napping, sleep quality and lifestyle factors. [Display omitted] • The associations of sleep traits with gestational diabetes mellitus (GDM) have not been thoroughly examined. • This study investigated the prospective associations of sleep traits during early pregnancy with GDM risk among Chinese. • Short nighttime sleep duration was associated with an increased risk of GDM in the relatively large prospective cohort. • The study highlights the importance of maintaining adequate nighttime sleep duration during early pregnancy. [ABSTRACT FROM AUTHOR]