Introduction: The demographic shift amongst pregnant women, including older age and increasing obesity, has resulted in an increased risk of cardiometabolic complications during pregnancy, particularly gestational diabetes. This paper presents physical activity and gestational diabetes data in a multi-ethnic urban Australian population. Methods and analysis: The PROMOTE cohort study is an ongoing prospective pregnancy cohort study recruiting pregnant participants < 16 weeks gestation at a large urban public teaching hospital with high social and cultural diversity in Sydney, Australia. Participants are surveyed about their physical activity levels, dietary quality, emotional wellbeing and socio-demographic status using validated tools. Participants are consented for use of routinely collected clinical and social data, including medical conditions, body mass index (BMI), blood pressure (BP) and glycaemia. Follow-up is from routinely collected data. Results: A total of 459 participants were recruited between February 2022 and February 2024. Physical activity levels at recruitment were sufficiently active, low active and inactive in 39%, 45% and 16% of participants. Participation in moderate or vigorous physical activity was reported in 19% and 16% of participants, respectively. Participation in vigorous physical activity occurred in 10% of those with GDM vs. 17% of those without GDM (p = 0.11). Participation in any moderate/vigorous physical activity was reported in 20% of those with GDM vs. 30% of those without GDM (p = 0.058). Compared to inactive behaviour, the unadjusted odds ratio of developing GDM amongst those participating in any moderate/vigorous physical activity was 0.58 (95% CI 0.33–0.97), p = 0.045. Participation in any moderate/vigorous physical activity showed an association with lower oral glucose tolerance test levels at 1 h (7.49 vs. 8.17 mmol/L, p = 0.002). Participation in any vigorous activity was associated with lower oral glucose tolerance test levels at 1 h (7.25 vs. 8.11, p = <0.001). Conclusions: Uptake of existing physical activity recommendations is low. Gestational diabetes risk showed a trend toward variation by intensity of physical activity, with a trend toward greater intensity being associated with a possible lower rate of gestational diabetes.

Introduction: The PROMOTE cohort study is a prospective pregnancy cohort study that seeks to improve the understanding of cardiometabolic risk and determinants, such as diet, during pregnancy in a multi-ethnic population. Increasing age and obesity has resulted in an increased risk of cardiometabolic complications during pregnancy, including gestational diabetes. Trials of lifestyle interventions have so far produced mixed results, partly due to a wide variation in the methods, duration, adherence and type of dietary intervention. There is a need for high quality data about dietary habits in pregnancy, particularly in multi-ethnic populations. Objectives: In this study, we report the dietary habits of women in early pregnancy in the population of interest. We report early data seeking to assess the relationship between dietary patterns and risks of gestational diabetes. Methods and analysis: The PROMOTE cohort study is a prospective pregnancy cohort study recruiting pregnant participants with <16 weeks gestation in an area of high social and cultural diversity in western Sydney, Australia. The participants are surveyed about their physical activity levels, diet quality, emotional wellbeing and sociodemographic status using validated tools. Participants have consented to the use of routinely collected clinical and social data, including medical conditions, body mass index (BMI), blood pressure (BP) and glycaemia. The follow-up is from routinely collected data. This paper presents dietary data. Results: A total of 459 participants were recruited (n = 459), including 416 with GDM data available, at the conclusion of the first 2 years of recruitment. No participants met national dietary guideline recommendations. Fifty-six participants (n = 56, 13%) met a pragmatic composite standard of favourable diet, defined as two servings of vegetables and two servings of fruit per day, with a maximum of one discretionary serving per day. Over half the participants (n = 215, 51%) reported an adequate daily fruit intake. In total, 7 participants ate at least five servings of vegetables per day (n = 7, 1.7%), 61 participants (14.7%) ate three or more servings of vegetables per day and 212 (51.2%) participants reported one discretionary item per day. The data suggest that few women meet dietary recommendations in pregnancy. The association between dietary habits and GDM was unable to be assessed. The study was underpowered to detect an association due to the highly skewed distribution of dietary patterns in our population. Conclusions: The uptake of dietary recommendations was very low in our sample. This represents a major population health concern. Multi-level approaches are urgently needed to address poor dietary habits in pregnancy.