Predominantly night-time feeding and maternal glycaemic levels during pregnancy

Maternal pregnancy diet quality, night eating, and offspring metabolic health: the GUSTO study

BACKGROUND

We investigated the understudied influence of maternal diet quality, food timing, and their interactions during pregnancy on offspring metabolic health.

METHODS

Maternal diet at 26-28 weeks' gestation was assessed using a 24-h recall and adherence to the modified-healthy-eating-index (HEI-SGP) reflects diet quality. Predominant night-eating (PNE) was defined as consuming >50% of total daily energy intake from 19:00 to 06:59. Outcomes were offspring composite metabolic syndrome score and its components measured at age 6 years. Multivariable linear regressions adjusted for relevant maternal and child covariates assessed associations of diet quality and PNE with these outcomes.

RESULTS

Up to 758 mother-child pairs were included. The mean(SD) maternal HEI-SGP score was 52.3(13.7) points (theoretical range: 0-100) and 15% of the mothers demonstrated PNE. Maternal diet quality showed inverse relationship with offspring Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) [β(95% CI): -0.08(-0.15, -0.02) per-10-point HEI-SGP increment; P = 0.012]. Maternal PNE was associated with a higher offspring HOMA-IR [0.28(0.06, 0.50); P = 0.012], with similar estimates after adjustment for children's BMI and diet quality; the association was stronger for boys (P-interaction<0.001) and among mothers with lower diet quality (

CONCLUSIONS

Maternal PNE and low dietary quality were associated with a higher level of insulin resistance in early childhood, especially among boys.

IMPACT

We demonstrated that maternal predominant night-eating behavior and low-quality diet are associated with higher offspring insulin resistance. Maternal low-quality diet and predominant night-eating behavior synergistically interact to influence offspring insulin resistance, particularly among boys. While maternal diet quality and food timing impact the mother's health, their influence on offspring long-term health outcomes through developmental programming is not well understood. Our findings highlight the significance of maternal food timing and calls for further studies on its influence on child health through developmental programming. Targeting both dietary quality and food timing during pregnancy could be a promising intervention strategy.

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Affiliation(s)

Ling-Wei Chen Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan. Master of Public Health Program, College of Public Health, National Taiwan University, No. 17 Xu-Zhou Road, Taipei, 10055, Taiwan. A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore.
See Ling Loy Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
Mya Thway Tint A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Navin Michael A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore
Yi Ying Ong Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Jia Ying Toh A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore
Peter D Gluckman Liggins Institute, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
Kok Hian Tan Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
Yap-Seng Chong A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore
Keith M Godfrey MRC Lifecourse Epidemiology Centre & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 6YD, Southampton, UK
Johan G Eriksson A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore Department of General Practice and Primary Health Care, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland Folkhälsan Research Center, Topeliusgatan 20, 00250, Helsinki, Finland
Fabian Yap Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore Department of Pediatric Endocrinology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
Yung Seng Lee A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore Khoo Teck Puat- National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
Mary F F Chong A*STAR Institute for Human Development and Potential (A*STAR IHDP), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore

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Nighttime eating during pregnancy and infant adiposity at 6 months of life

Introduction

Chrononutrition studies the relation between diet, circadian rhythms and metabolism, which may alter the metabolic intrauterine environment, influencing infant fat-mass (FM) development and possibly increasing obesity risk.

Aim

To evaluate the association of chrononutrition in pregnancy and infant FM at 6 months.

Methods

Healthy pregnant women and term-babies (n = 100pairs) from the OBESO cohort (2017-2023) were studied. Maternal registries included pregestational body-mass-index (BMI), gestational complications/medications, weight gain. Diet (three 24 h-recalls, 1 each trimester) and sleep-schedule (first and third trimesters) were evaluated computing fasting (hours from last-first meal), breakfast and dinner latencies (minutes between wake up-breakfast and dinner-sleep, respectively), number of main meals/day, meal skipping (≥1 main meal/d on three recalls) and nighttime eating (from 9:00 pm-5:59 am on three recalls). Neonatal weight, length, BMI/age were assessed. At 6 months, infant FM (kg, %; air-displacement plethysmography) was measured, and FM index (FMI-kgFM/length2) computed. Exclusive breastfeeding (EBF) was recorded. Multiple linear regression models evaluated the association between chrononutrition and 6 month infant FM.

Results

Mean fasting was 11.7 ± 1.3 h; breakfast, dinner latency were 87.3 ± 75.2, 99.6 ± 65.6 min, respectively. Average meals/day were 3.0 ± 0.5. Meal skipping was reported in 3% (n = 3) of women and nighttime eating in 35% (n = 35). Most neonates had normal BMI/age (88%, n = 88). Compared to those who did not, mothers engaged in nighttime-eating had infants with higher %FM (p = 0.019). Regression models (R 2 ≥ 0.308, p ≤ 0.001) showed that nighttime eating was positively associated with %FM (B: 2.7, 95%CI: 0.32-5.16). When analyzing women without complications/medications (n = 80), nighttime eating was associated with higher FM [%FM, B: 3.24 (95%CI: 0.59-5.88); kgFM, B: 0.20 (95%CI: 0.003-0.40); FMI, B: 0.54 (95%CI: 0.03-1.05)]. Infant sex and weight (6 months) were significant, while maternal obesity, pregnancy complications/medications, parity, energy intake, birth-BMI/age, and EBF were not.

Conclusion

Maternal nighttime eating is associated with higher adiposity in 6 month infants.

Association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy

To analyse the association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy. A prospective cohort study was conducted with 100 pregnant women. Data collection occurred once during each gestational trimester. The assessment of sleep quality and duration was performed using the Pittsburgh Sleep Quality Index. Food intake was assessed using three 24-h recalls in each trimester. Body weight was measured during the three trimesters, and height was measured only once to calculate the BMI. Linear regression analyses were performed to associate sleep duration and quality with food consumption and weight gain variables. Longer sleep duration was associated with a later dinner in the first trimester (β = 0·228, P = 0·025) and earlier in the third trimester (β = -0·223, P = 0·026), in addition to a later morning snack in the second trimester (β = 0·315, P = 0·026). Worse sleep quality was associated with higher total energy intake (β = 0·243, P = 0·044), total fat (β = 0·291, P = 0·015) and the chrononutrition variables such as a higher number of meals (β = 0·252, P = 0·037), higher energetic midpoint (β = 0·243, P = 0·044) and shorter fasting time (β = -0·255, P = 0·034) in the third trimester. Sleep quality was also associated with a higher BMI in the first trimester of pregnancy (β = 0·420, P = < 0·001). Most of the associations found in the present study show that poor sleep is associated with higher energy and fat intake and higher BMI. Longer sleep duration was associated with a later dinner in early pregnancy and an earlier dinner in late pregnancy, as well as with a later morning snack in the second trimester of pregnancy.

Associations of predominant night-eating with plasma glycemic status and continuous glucose monitoring measures among pregnant women

BACKGROUND & AIMS

To examine whether predominant night-eating, defined as more than 50% of total daily energy intake consumed between 1900 and 0659 h, is associated with glycemic outcomes in pregnancy.

METHODS

This was a prospective cohort study of 277 healthy pregnant women with complete 4-day dietary intake records at 18-24 weeks gestation, recruited from KK Women's and Children's Hospital, Singapore. Primary outcomes were fasting, 1-h, and 2-h plasma glucose after a 75-g oral glucose tolerance test at 24-28 weeks gestation. Secondary outcomes were gestational diabetes mellitus (GDM), fasting insulin, homeostasis model assessment of insulin resistance (HOMA2-IR), β-cell function (HOMA2-%B), and continuous glucose monitoring (CGM) measures. Glucose variables in continuous form were loge-transformed before analyses.

RESULTS

Predominant night-eating (11.6%) was associated with higher fasting glucose (geometric mean ratio (95% confidence interval) 1.05 (1.01, 1.08)) and 1-h glucose (1.11 (1.01, 1.21)), but not with 2-h glucose or GDM risk. Predominant night-eating women had lower fasting insulin (0.77 (0.63, 0.95)), lower HOMA2-IR (0.78 (0.64, 0.97)), and lower HOMA2-%B (0.77 (0.67, 0.89)) than their predominant day-eating counterparts. For CGM measures, predominant night-eating was associated with higher mean glucose (1.07 (1.00, 1.15)), higher glucose management indicator (1.05 (1.00, 1.10)), and higher overall glucose levels throughout 24 h (1.10 (1.02, 1.19)). All these associations were adjusted for socio-demographic, lifestyle factors, and diet composition.

CONCLUSION

Predominant night-eating was mainly associated with less desirable glycemic outcomes during pregnancy. Future studies should explore dietary interventions aimed at reducing consumption of relatively more calories at night than day during pregnancy.

Maternal melatonin levels and temporal dietary intake: results from MY-CARE cohort study

Chrononutrition emerges as a novel approach to promote circadian alignment and metabolic health by means of time-of-the-day dietary intake. However, the relationship between maternal circadian rhythm and temporal dietary intake during pregnancy remains understudied. This study aimed to determine the change in melatonin levels in pregnant women across gestation and its association with temporal energy and macronutrient intake. This was a prospective cohort involving 70 healthy primigravidas. During the second and third trimesters, pregnant women provided salivary samples collected at 9:00, 15:00, 21:00, and 3:00 h over a 24 h day for melatonin assay. Data on chrononutrition characteristics were collected using a 3-day food record. Parameters derived from melatonin measurements including mean, amplitude, maximal level, area under the curve with respect to increase (AUC_I), and area under the curve with respect to ground (AUC_G) were computed. A rhythmic melatonin secretion over the day that remained stable across trimesters was observed among the pregnant women. There was no significant elevation in salivary melatonin levels as pregnancy advanced. In the second trimester, higher energy intake during 12:00-15:59 h and 19:00-06:59 h predicted a steeper melatonin AUC_I (β=-0.32, p = 0.034) and higher AUC_G (β = 0.26, p = 0.042), respectively. Macronutrient intake within 12:00-15:59 h was negatively associated with mean melatonin (Fat: β=-0.28, p = 0.041) and AUC_G (Carbohydrate: β=-0.37, p = 0.003; Protein: β=-0.27, p = 0.036; Fat: β=-0.32, p = 0.014). As pregnant women progressed from the second to the third trimester, a flatter AUC_I was associated with a reduced carbohydrate intake during 12:00-15:59 h (β=-0.40, p = 0.026). No significant association was detected during the third trimester. Our findings show that higher energy and macronutrient intakes particularly during 12:00-15:59 h and 19:00-06:59 h are associated with the disparities in maternal melatonin levels. Findings suggest the potential of time-based dietary approaches to entrain circadian rhythm in pregnant women.

Chrononutrition during Pregnancy and Its Association with Maternal and Offspring Outcomes: A Systematic Review and Meta-Analysis of Ramadan and Non-Ramadan Studies

Much evidence suggests that food intakes and eating patterns are major determinants of the phase of peripheral circadian clocks, and desynchronization between them is thought to contribute to the development of metabolic disorders. However, much remains to be understood about how different dimensions of chrononutrition during pregnancy affect pregnant women's and their offspring's health outcomes. Therefore, we systematically reviewed and integrated all emerging evidence on chrononutrition during pregnancy (including meal skipping, meal frequency, night eating, and (Ramadan) fasting) and their relationships with maternal and offspring outcomes. The results suggest that meal skipping and night eating during pregnancy were generally associated with adverse pregnancy and birth outcomes, whereas no strong conclusion could be reached for meal frequency. In our meta-analysis, Ramadan fasting did not seem to be related with birth weight or gestational age at birth, but evidence for other mother-offspring outcomes was inconsistent. To further elucidate the effect of chrononutrition factors on maternal and offspring health outcomes, larger and well-conducted prospective cohort and interventional studies are needed. In addition, information on covariates such as physical activity, sleep, diet quality and quantity, fasting days, fasting period per day, and trimester exposure should also be collected and considered during analysis.

Eating Patterns during Pregnancy and Postpartum and Their Association with Diet Quality and Energy Intake

This study investigates the relationship between meal-specific eating patterns during pregnancy and postpartum with maternal diet quality and energy intake. Participants in a prospective cohort study completed 24-h dietary recalls three times throughout both pregnancy and 1 year postpartum (n = 420). Linear regressions estimated the associations of eating frequency (number of daily main meals and eating occasions), meal and energy regularity (meal skipping and variation of daily energy intake), and intake timing patterns (distribution of energy intake throughout the day, derived using principal component analysis) with daily energy intake and diet quality (Healthy Eating Index-2015, calculated daily and overall, across both pregnancy and postpartum). Eating frequency was positively associated with energy intake and daily diet quality. Irregular meals were associated with lower energy intake in pregnancy but not postpartum and with lower pregnancy and postpartum diet quality. Energy irregularity was not associated with energy intake or diet quality. Higher postpartum diet quality was associated with a morning energy intake pattern (versus late morning/early afternoon or evening). Differences in these associations between pregnancy and postpartum suggest that efforts to support optimal energy intake and diet quality by modifying eating patterns may require specific strategies for pregnancy and postpartum.

Is chronotype associated with dietary intake and weight gain during pregnancy? A prospective and longitudinal study

OBJECTIVES

The effects of chronotype on dietary intake and weight gain during pregnancy have not been addressed in the literature. The aim of this study was to analyze the effect of chronotype on eating patterns, energy, and macronutrient intake and distribution, as well as weight gain during pregnancy.

METHODS

This was a prospective cohort study carried out with 100 pregnant women in the first, second, and third gestational trimesters. Dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine recalls. Energy and macronutrient intake and distribution were evaluated at meals throughout the day. Chronotype was derived from midsleep time on free days, and the scores obtained were categorized into tertiles. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of chronotype and gestational trimester on eating patterns, daily energy, macronutrient distribution, and weight gain.

RESULTS

Pregnant women with values for midsleep time on free days indicative of eveningness have breakfast later and also have higher energy and carbohydrate intake at dinner than "morning" women. Pregnant "morning" women showed better diet quality in terms of milk and dairy and saturated fat. Also, despite the tendency for all tertiles to gain excess weight during pregnancy, we found that pregnant women with a tendency to eveningness had worse adequacy of gestational weight gain in the third trimester than "morning" women (2.24 ± 0.25 versus 1.22 ± 0.14, P < 0.001).

CONCLUSION

Pregnant women with a tendency to eveningness consume breakfast later in the day and exhibit greater consumption of energy and carbohydrates in the evening, as well as a worse standard of gestational weight gain in the third trimester. Our results emphasize the importance of considering chrononutrition variables in prenatal nutritional guidelines to promote maternal and fetal health.

Meal Timing and Glycemic Control during Pregnancy-Is There a Link?

Hyperglycemia during pregnancy and gestational diabetes mellitus (GDM) constitute an important public health problem due to their prevalence and long-term health consequences both for the mother and offspring. Results from studies in rodents and some clinical investigations suggest that meal time manipulation may be a potential lifestyle approach against conditions involving perturbations in glucose homeostasis (e.g., hyperglycemia, insulin resistance, diabetes, etc.). The purpose of this review is to summarize and critically evaluate the current literature on the role of meal timing and daily nutrient distribution on glycemic control during pregnancy. Only a small number of mostly observational studies have assessed the role of meal timing in glucose homeostasis during pregnancy. Food consumption earlier in the day and short-term fasting with adequate nutrient intake may improve glycemic control during the second and third trimester of gestation. Considering that the field of chrononutrition is still in its infancy and many questions remain unanswered, future prospective and carefully designed studies are needed to better understand the role of meal timing in metabolic homeostasis and maternal and fetal health outcomes during pregnancy.

Chrononutrition during Pregnancy: A Review on Maternal Night-Time Eating

Evidence from women working night shifts during pregnancy indicates that circadian rhythm disruption has the potential to adversely influence pregnancy outcomes. In the general population, chronodisruption with the potential to affect pregnancy outcomes may also be seen in those with high energy intakes in the evening or at night. However, maternal night eating during pregnancy remains understudied. This narrative review provides an overview of the prevalence, contributing factors, nutritional aspects and health implications of night eating during pregnancy. We derived evidence based on cross-sectional studies and longitudinal cohorts. Overall, night eating is common during pregnancy, with the estimated prevalence in different populations ranging from 15% to 45%. The modern lifestyle and the presence of pregnancy symptoms contribute to night eating during pregnancy, which is likely to coexist and may interact with multiple undesirable lifestyle behaviors. Unfavorable nutritional characteristics associated with night eating have the potential to induce aberrant circadian rhythms in pregnant women, resulting in adverse metabolic and pregnancy outcomes. More research, particularly intervention studies, are needed to provide more definite information on the implications of night eating for mother-offspring health.

Changes in amino acid profiles and liver alterations in pregnant rats with a high carbohydrate/low protein diet

INTRODUCTION AND AIM

Intake of a high-carbohydrate, low-protein diet (HCD/LPD) during pregnancy promotes metabolic disturbances. It has been suggested that liver function during pregnancy contributes to the synthesis of proteins necessary for fetal development during this stage. The liver is a site of response to the synthesis of macronutrients such as proteins. However, it is unknown how HCD/LPD is associated with modifications to the amino acid profiles and hepatic alterations in the maternal environment during pregnancy.

MATERIALS AND METHODS

A transverse longitudinal study was done in primiparous mothers during gestation (G) (G1 day 1, G5 day 5, G15 day 15, and G20 day 20). Histological analysis was used to assess hepatic alterations, and amino acid profiles in the liver were analyzed with high performance liquid chromatography (HPLC). Food and water intake was quantified, and peripheral biochemical indicators in serum were measured.

RESULTS

Mothers with HCD/LPD had increased micro and macro vesicles of fat, necrosis, and inflammation in the liver on G5. The total concentration of hepatic amino acids increased by 40% on G1, 17% on G5, and 25% on G15; and, there was a 12% decrease on G20. The following increases were observed in the liver on G1: arginine 68%, histidine 75%, alanine 18%, methionine 71%, and phenylalanine 51% (p>0.05); on G5: arginine 12%, methionine 34%, and phenylalanine 83% (p>0.05); on G15: arginine and phenylalanine 66%, tryptophan 81% and histidine 60.4% (p>0.05); and on G20: arginine 32% (p>0.05). No weight loss, changes in food consumption, or hepatomegaly occurred.

CONCLUSIONS

HCD/LPD during pregnancy in primiparous mothers may promote development of fat vesicles. Possibly, this condition causes metabolic adaptations and nitrogen management reflected in decreased levels of serum urea and altered amino acid profiles in the liver.

Higher energy intake at night effects daily energy distribution and contributes to excessive weight gain during pregnancy

OBJECTIVE

The aim of this study was to analyze the effect of nighttime energy intake on daily energy and macronutrient distribution and weight gain during pregnancy.

METHODS

This was a prospective cohort study carried out with 100 pregnant women and the data collection occurred once per trimester. A dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine dietary recalls. The distribution of energy and macronutrient intake was evaluated at meals throughout the day in each trimester and overall pregnancy. Women were classified as having "lower" or "higher" nighttime intake (1900 to 0559) if consumption in this period were below or above the median of the population, respectively, for at least two trimesters. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of nighttime intake and gestational trimesters on daily energy distribution and weight gain.

RESULTS

In overall pregnancy, the higher group consumed a higher percentage of energy and macronutrients in the evening meals, and less energy, proteins, and lipids in morning meals when compared with the lower group. Also, women in the higher group had greater excessive weight gain in the third trimester compared with the lower group.

CONCLUSION

Pregnant women with a higher energy intake at night had a lower percentage of energy, protein, and lipid intake in morning meals and a higher percentage of energy and macronutrient intake in the evening meals during pregnancy. A worse standard of gestational weight gain in the third trimester was also observed in pregnant women with a higher energy intake at night.

Effects of timing of food intake on eating patterns, diet quality and weight gain during pregnancy

Studies have suggested that meal timing plays a role in nutritional health, but this subject has not been sufficiently studied in pregnant women. We analysed the effect that timing of food intake has on eating patterns, diet quality and weight gain in a prospective cohort study with 100 pregnant women. Data were collected once per trimester: 4th-12th, 20th-26th and 30th-37th weeks. Food intake was evaluated using three 24-h dietary recalls, which were used to assess eating patterns and diet quality. Distribution of energy and macronutrient intake throughout the day was considered eating patterns. Diet quality was assessed using the Brazilian Healthy Eating Index-Revised. Weight gain was evaluated during each trimester. Women were classified as early or late timing of the first and last eating episodes if these values were below or above the median of the population, respectively (first eating episode = 08.38 hours; last eating episode = 20.20 hours). Generalised estimating equation models adjusted for confounders were used to determine the effects of timing of the first and last eating episodes (groups) and gestational trimesters (time) (independent variable) on eating patterns, diet quality and weight gain (dependent variables). Early eaters of the first eating episode have a higher percentage of energy and carbohydrate intake in morning and a lower at evening meals. They also have a better diet quality for fruit components when compared with late eaters of the first eating episode. Our results emphasise the importance of considering meal timing in the nutritional antenatal guidelines to promote maternal-fetal health.

Associations of Circadian Eating Pattern and Diet Quality with Substantial Postpartum Weight Retention

Besides food quantity and quality, food timing and frequency may contribute to weight regulation. It is unclear if these factors during pregnancy can influence maternal weight retention after childbirth. We thus aimed to examine the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months in an Asian cohort. We assessed circadian eating pattern and diet quality of 687 women using 24-h dietary recalls at 26–28 weeks’ gestation. We calculated PPWR by subtracting maternal weight in the first trimester from weight at 18-month postpartum and defined substantial PPWR as ≥5 kg weight retention. Multivariable binary logistic regression was performed. Overall, 16% of women had substantial PPWR. After the confounders adjustment, night eating, defined by greater night-time caloric intake (odds ratio 1.95; 95% confidence interval 1.05, 3.62), and lower diet quality, classified by median score of the Healthy Eating Index (1.91; 1.17, 3.10), were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night fasting duration and number of eating episodes. In conclusion, alignment of eating time with day–night cycles and diet quality during pregnancy may play a role in PPWR, with possible implications for long-term obesity risk.

Maternal night-time eating and sleep duration in relation to length of gestation and preterm birth

BACKGROUND & AIMS

Maternal metabolic disturbance arising from inappropriate meal timing or sleep deprivation may disrupt circadian rhythm, potentially inducing pregnancy complications. We examined the associations of maternal night-time eating and sleep duration during pregnancy with gestation length and preterm birth.

METHODS

We studied 673 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal energy intake by time of day and nightly sleep duration were assessed at 26-28 weeks' gestation. Based on 24-h dietary recall, night-eating was defined as consuming >50% of total energy intake from 1900 to 0659 h. Short sleep duration was defined as <6 h night sleep. Night-eating and short sleep were simultaneously analyzed to examine for associations with a) gestation length using multiple linear regression, and b) preterm birth (<37 weeks' gestation) using logistic regression.

RESULTS

Overall, 15.6% women engaged in night-eating, 12.3% had short sleep and 6.8% delivered preterm. Adjusting for confounding factors, night-eating was associated with 0.45 weeks shortening of gestation length (95% CI -0.75, -0.16) and 2.19-fold higher odds of delivering preterm (1.01, 4.72). Short sleep was associated with 0.33 weeks shortening of gestation length (-0.66, -0.01), but its association with preterm birth did not reach statistical significance (1.81; 0.76, 4.30).

CONCLUSIONS

During pregnancy, women with higher energy consumption at night than during the day had shorter gestation and greater likelihood of delivering preterm. Misalignment of eating time with day-night cycles may be a contributing factor to preterm birth. This points to a potential target for intervention to reduce the risk of preterm birth. Observations for nightly sleep deprivation in relation to gestation length and PTB warrant further confirmation.

Relation of plasma tryptophan concentrations during pregnancy to maternal sleep and mental well-being: The GUSTO cohort

BACKGROUND

Evidence suggests a relation between plasma tryptophan concentrations and sleep and mental well-being. As no studies have been performed in pregnant women, we studied the relation of plasma tryptophan concentrations during pregnancy with sleep quality, and mood during and after pregnancy.

METHODS

Pregnant women (n = 572) from the Growing Up in Singapore Towards healthy Outcomes study completed the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI) at 26-28 weeks gestation and three months post-delivery. Plasma tryptophan concentrations were measured at 26-28 weeks gestation. Poisson regressions estimated prevalence ratios (PR) for the association between tryptophan and poor sleep quality (PSQI global score > 5), probable antenatal depression (EPDS ≥ 15) and probable anxiety (STAI-state ≥ 41) were calculated adjusting for covariates.

RESULTS

Mean plasma tryptophan concentrations was 48.0µmol/L (SD: 8.09). Higher plasma tryptophan concentrations were associated with a lower prevalence of antenatal poor sleep quality adjusting for covariates [PR: 0.88 (95% CI 0.80, 0.97) per 10µmol/L], especially in those participants who also suffered from anxiety symptoms [PR: 0.80 (95% CI 0.67, 0.95)]. No associations were observed between tryptophan concentrations during pregnancy and postnatal sleep quality or mental well-being.

LIMITATION

Subjective measures were used to assess sleep and mental well-being.

CONCLUSIONS

We observed that higher plasma tryptophan concentrations were associated with a 12% lower prevalence of poor sleep quality during pregnancy, in particular among those with anxiety symptoms. These findings suggest the importance of having adequate tryptophan concentrations during pregnancy.

Sleep and Dietary Patterns in Pregnancy: Findings from the GUSTO Cohort

Evidence on the association between sleep, diet, and eating behaviors in pregnant women is lacking. We examine this in a cohort of apparently healthy pregnant women. At 26-28 weeks gestation, 497 participants completed the Pittsburgh Sleep Quality Index to assess sleep and a 24-h recall to assess dietary intake. Diet quality was assessed by the Healthy Eating Index for pregnant women in Singapore (HEI-SGP) score and previously derived dietary patterns (vegetables-fruit-rice, seafood-noodles, and pasta-cheese-meat pattern). Eating behaviors studied included the longest night-time fasting interval, frequency of consumption occasions, energy from discretionary foods, and nighttime eating. Adjusted means were estimated between poor/good quality and short/normal sleepers using linear regressions, including covariates. Good sleep quality versus poor sleep quality, was associated with better diet quality (mean HEI-SGP 54.6 vs. 52.0; p = 0.032), greater adherence to the vegetables-fruit-rice pattern (mean 0.03 vs. -0.15; p = 0.039), lesser adherence to the seafood-noodle pattern (mean -0.14 vs. 0.03; p = 0.024), and a trending lower calories from discretionary foods (mean 330.5 vs. 382.6 kcal; p = 0.073), after adjusting for covariates. After additional adjustment for anxiety, only sleep quality and the seafood-noodle pattern remained significantly associated (p = 0.018). Short sleep was not associated with any diet or eating behavior. In conclusion, good sleep quality is associated with a better diet quality and a greater adherence to the vegetable-fruit-rice pattern, but with lesser adherence to the seafood-noodle diets in pregnant women.

Plasma Vitamin D Deficiency Is Associated With Poor Sleep Quality and Night-Time Eating at Mid-Pregnancy in Singapore

Plasma 25-hydroxyvitamin D (25OHD) deficiency, poor sleep quality, and night-time eating, have been independently associated with adverse pregnancy outcomes, but their inter-relationships are yet to be evaluated. We aimed to investigate the associations between maternal plasma 25OHD status and sleep quality and circadian eating patterns during pregnancy. Data on pregnant women (n = 890) from a prospective cohort (Growing Up in Singapore Towards healthy Outcomes) were analyzed. Plasma 25OHD concentration was measured, while the Pittsburgh sleep quality index (PSQI) and 24-h dietary recall were administered to women at 26-28 weeks' gestation. Plasma 25OHD status was defined as sufficient (>75 nmol/L), insufficient (50-75 nmol/L), or deficient (<50 nmol/L). Poor sleep quality was defined by a total global PSQI score >5. Predominantly day-time (pDT) and predominantly night-time (pNT) were defined according to consumption of greater proportion of calories (i.e., >50%) from 07:00-18:59 and from 19:00-06:59, respectively. After adjustment for confounders, women with plasma 25OHD deficiency had higher odds of poor sleep quality (odds ratio (OR) 3.49; 95% confidence interval (CI) 1.84-6.63) and pNT eating (OR: 1.85; 95% CI 1.00-3.41) than those who were 25OHD sufficient. Our findings show the association of maternal plasma 25OHD deficiency with poor sleep quality and pNT eating at mid-pregnancy.

Maternal Circadian Eating Time and Frequency Are Associated with Blood Glucose Concentrations during Pregnancy

BACKGROUND

Synchronizing eating schedules to daily circadian rhythms may improve metabolic health, but its association with gestational glycemia is unknown.

OBJECTIVE

This study examined the association of maternal night-fasting intervals and eating episodes with blood glucose concentrations during pregnancy.

METHODS

This was a cross-sectional study within a prospective cohort in Singapore. Maternal 24-h dietary recalls, fasting glucose, and 2-h glucose concentrations were ascertained at 26-28 wk gestation for 1061 women (aged 30.7 ± 5.1 y). Night-fasting intervals were based on the longest fasting duration during the night (1900-0659). Eating episodes were defined as events that provided >50 kcal, with a time interval between eating episodes of ≥15 min. Multiple linear regressions with adjustment for confounders were conducted.

RESULTS

Mean ± SD night-fasting intervals and eating episodes per day were 9.9 ± 1.6 h and 4.2 ± 1.3 times/d, respectively; fasting and 2-h glucose concentrations were 4.4 ± 0.5 and 6.6 ± 1.5 mmol/L, respectively. In adjusted models, each hourly increase in night-fasting intervals was associated with a 0.03 mmol/L decrease in fasting glucose (95% CI: -0.06, -0.01 mmol/L), whereas each additional daily eating episode was associated with a 0.15 mmol/L increase in 2-h glucose (95% CI: 0.03, 0.28 mmol/L). Conversely, night-fasting intervals and daily eating episodes were not associated with 2-h and fasting glucose, respectively.

CONCLUSIONS

Increased maternal night-fasting intervals and reduced eating episodes per day were associated with decreased fasting glucose and 2-h glucose, respectively, in the late-second trimester of pregnancy. This points to potential alternative strategies to improve glycemic control in pregnant women. This study was registered at www.clinicaltrials.gov as NCT01174875.