CONTEXT: The putative association between pro-inflammatory and hyperinsulinemic dietary patterns and susceptibility to gestational diabetes mellitus (GDM) remains unclear. OBJECTIVE: We aimed to compare the risk associated with the Mediterranean diet, as well as insulinemic and pro-inflammatory dietary patterns, in relation to the occurrence of GDM, and evaluate their predictive value. METHODS: We prospectively followed 8495 women from the Maternal and Infant Health cohort in Hefei, China (2015-2021). Using a food frequency questionnaire, we calculated the empirical dietary inflammatory pattern (EDIP), the empirical dietary index for hyperinsulinemia (EDIH) score, and the Mediterranean diet (MD) score. GDM was diagnosed based on a 2-hour 75-gram oral glucose tolerance test conducted between 24 to 28 weeks of gestation. Logistic regression was used to estimate the risk of GDM, while receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of the empirical dietary index for GDM. RESULTS: Participants who followed hyperinsulinemic or pro-inflammatory dietary patterns to the greatest extent had a higher risk of developing GDM. The odds ratio (OR) for the highest quartile compared to the lowest quartile were 1.39 (95% CI, 1.30-1.49) for EDIH and 2.40 (95% CI, 1.88-3.01) for EDIP. The OR for the lowest quartile compared to the highest quartile was 1.33 (95% CI, 1.14-1.55) for MD. The ROC curve analysis indicated that the combination of EDIP and EDIH (AUC = 0.81
95% CI, 0.78-0.82
P = .003) can effectively predict the occurrence of GDM. CONCLUSION: Utilizing both empirical dietary indexes, EDIP and EDIH, might offer a potentially more effective approach in preventing GDM when compared to solely focusing on adherence to the MD pattern.