Healthy Eating Index during pregnancy according to pre-gravid and gravid weight status

A Fresh Fruit and Vegetable Prescription Program for Prenatal Patients in Flint, Michigan: Baseline Food Security and Dietary Intake

Although adequate nutritional status during pregnancy is necessary to support optimal fetal development, many low-income women have poor access to fresh, high-nutrient foods. To address these challenges, a pediatric fruit and vegetable (FV) prescription program was expanded to include pregnant women, providing one prescription for fresh FVs worth 15 US dollars during each prenatal office visit for redemption at farmers'/mobile markets. This analysis describes baseline sociodemographic characteristics, food security, and dietary intake among 253 pregnant women in Flint, Michigan in 2022-23. Dietary recall data were collected and analyzed using the Automated Self-Administered 24-h Tool developed by the US National Cancer Institute, with nutrition output reported in relation to adherence to US Dietary Guidelines. Most participants (mean ± SD age 26.51 ± 4.90 years) identified as African American (53%) and were receiving publicly funded health insurance (66%). Most (75%) reported no food insecurity, yet the majority failed to meet dietary recommendations for whole grains (99.3%), vegetables (93.1%), dairy (93.1%), and fruits (69.4%). Moreover, most did not meet micronutrient recommendations through food sources, including vitamin D (100%), iron (98.6%), folic acid (98.6%), vitamin A (82.6%), calcium (68.8%), and vitamin C (62.5%). Results raise deep concerns regarding diet and nutrition among pregnant women in this US city.

Nutritional intake and determinants of nutritional quality changes from pregnancy to postpartum-a longitudinal study

Nutrient requirements vary across the reproductive cycle, but research on changes in nutritional intake and quality from pregnancy to beyond the lactation period is limited. Thus, we aimed to study nutritional intake and quality changes, among Swedish pregnant participants from late pregnancy to 18 months postpartum and to study the determinants of nutritional quality changes. Participants (n = 72) were studied longitudinally from the third trimester of pregnancy and postpartum (2 weeks 4, 12, and 18 months postpartum). At each visit, participant characteristics and 4-day food diaries were collected. Nutritional quality was assessed by energy adjusted Nutrient Rich Food Index 11.3. Linear mixed models were used to analyze the determinants of change in nutritional quality. Intakes of carbohydrate energy percentage (E%), fiber, vitamin A, vitamin C, and potassium were higher in the third trimester compared to postpartum, whereas intakes of E% protein and monounsaturated fat were lower. Adherence to recommended intakes was low at all study visits for saturated fat (4%-11%), fiber (15%-39%), vitamin D (8%-14%), folate (0%-2%), and iron (6%-21%). Overall, nutritional quality did not differ significantly from third trimester to postpartum. Shorter duration (<4 months) of lactation was negatively related to nutritional quality changes, whereas higher age was positively related to changes. In conclusion, nutritional intake from pregnancy to postpartum changed, whereas quality remained relatively stable, with age and lactation duration as determinants. Identification of people at risk of adverse dietary changes from pregnancy to the postpartum period should be further addressed in future larger and more diverse study populations.

The relationship between maternal thyroid volume, TSH levels, and Healthy Eating Index scores in BMI-matched pregnant women with hyperemesis gravidarum

OBJECTIVE

The aim is to investigate the relationship between thyroid volume measurement and healthy nutrition questionnaire scoring in pregnant women diagnosed with hyperemesis gravidarum (HEG).

METHODS

One hundred and fifty pregnant women with a BMI of 15-25 kg/m² and between the ages of 17 and 42 who were diagnosed with HEG at 11-14 weeks of gestation were included in the study. Patients with a history of any disease, drug use, and previously diagnosed eating disorders were excluded. All patients were subjected to the Healthy Eating Index (HEI) questionnaire. The cutoff value for HEI score was determined as 80 points. Patients were evaluated in two groups: group 1 (HEI <80 score) and group 2 (HEI ≥80 score). Complete urine analysis including ketonuria, and thyroid function tests including TSH, T3, and T4 levels were performed for all patients. In addition, the thyroid gland volume of every patient was measured by the same radiologist.

RESULTS

Increased thyroid gland volume was significantly associated with lower TSH levels (p = .02) and lower HEI scores (p < .001). On the other hand, it was not significantly associated with ketonuria (p = .47), and parity status (p = .82).

CONCLUSIONS

In our study, we found that there may be an increase in thyroid volume in pregnant women with HEG with lower TSH levels and eating scores. Thyroid volume may predict the patients with probable eating disorders and further studies on thyroid volume in patients with HEG may contribute to the literature.

Diet Quality and Nutritional Risk Based on the FIGO Nutrition Checklist among Greek Pregnant Women: A Cross-Sectional Routine Antenatal Care Study

The International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist is a tool for everyday antenatal clinical practice, easy to use by most healthcare professionals, aiming to initiate a conversation regarding gestational weight gain (GWG) and nutrition and identify women who might require further assessment. The present cross-sectional study aimed to apply the FIGO nutrition checklist to pregnant women attending routine antenatal care and identify nutritional risk factors. Pregnant women (n = 200) were recruited from the outpatient pregnancy clinics of two hospitals in Thessaloniki and completed the checklist. The FIGO-diet quality score and the FIGO-nutritional risk score (NRS) were calculated. The results revealed that 99% of the women exhibited at least one nutritional risk factor based on the checklist. The median FIGO diet quality score of the sample was 4.0 (3.0-5.0), with 95% of the participants responding negatively to at least one question, indicating the need for improving diet quality. Improved diet quality was noted in cases of hyperemesis gravidarum and among those receiving vitamin D supplements. A large percentage of the participants (36%) exhibited five or more nutritional risk factors, as indicated by a total FIGO-NRS below 5. Women with low middle-upper arm circumference, indicative of protein-energy malnutrition (20.6% of the sample), exhibited more nutritional risk factors compared with the rest. On the other hand, being in the third trimester of pregnancy was associated with lower nutritional risk and, subsequently, better diet quality.

Effectors of Pregorexia and Emesis among Pregnant Women: A Pilot Study

During pregnancy, women tend to improve their lifestyle habits and refine their dietary intake. Quite often, however, these dietary improvements take an unhealthy turn, with orthorexia nervosa (ON) practices being apparent. The aim of the present pilot cross-sectional study was to assess the prevalence of ON tendencies and the incidence of pica and record diet practices in a sample of pregnant women. A total of 157 pregnant women were recruited through private practice gynecologists during the first months of 2021. Nutrition-related practices were recorded, orthorexic tendencies were assessed using the translated and culturally adapted Greek version of the ORTO-15 questionnaire, pica practices were evaluated with a binary question and nausea and emesis during pregnancy (NVP) was evaluated using the translated modified Pregnancy-Unique Quantification of Emesis and Nausea (mPUQE). Only two women reported pica tendencies, with ice and snow being the consumed items. The majority (61.1%) of women reported improving their diet since conception was achieved. Folic acid and iron oral nutrient supplements (ONS) were reportedly consumed by the majority of participants (87.9% and 72.6%, respectively) and 9.6% reported using herbal medicine products. The ORTO-15 score was reduced with tertiary education attainment, ART conception, being in the third trimester of pregnancy, consumption of folic acid and MV supplements and was only increased among women who were at their first pregnancy. The majority of participants experienced severe NVP and the remaining experienced moderate NVP. NVP was associated with lower hemoglobin levels, lack of supplementary iron intake, avoidance of gluten-containing foods, as well as with increased gestational weight gain. The results highlight the need to screen pregnant women for disturbed eating behaviors and nutrition-related problems, in order to ensure a healthy pregnancy outcome.

The relationship between pre-pregnancy BMI and energy and macronutrients intakes during pregnancy in women from Yucatan, Mexico

In this observational study, our aim was to analyse the association between pre-pregnancy BMI and adequacy rates of energy and macronutrient intakes in a sample of pregnant women from Yucatan, Mexico. From September to December 2019, we collected data on socioeconomic, pregnancy, and dietary characteristics, and took anthropometric measurements of women during household visits. Pre-pregnancy BMI was calculated from measured height and self-reported body weight. Energy and macronutrient intakes (obtained from three 24-h dietary recalls) were compared with the estimated trimester-specific requirements to calculate adequacies (%). Multiple linear regression models showed that after accounting for maternal socioeconomic characteristics and perinatal variables, each unit increase in pre-pregnancy BMI was associated with decreases of 2%, 2%, and 2.6% in energy, carbohydrate, and total fat intakes, respectively. These results were significant when under- and over-reporters were excluded from the analyses. Women who enter pregnancy with higher BMI values may voluntarily or involuntarily reduce their food intake.IMPACT STATEMENTWhat is already know about this subject? Some studies have analysed the relationship between pre-pregnancy BMI categories (normal weight, overweight, and obesity) and diet quality during pregnancy, but few studies have focussed on quantitative energy and macronutrient intakes or their adequacies in relation to pre-pregnancy BMI.What do the results of this study contribute? In this sample of Mexican women belonging to a middle socioeconomic status, we found that after excluding under- and over-reporters from the analyses and accounting for maternal socioeconomic characteristics and perinatal variables, BMI was negatively associated with adequacy intake rates of energy, carbohydrates, and total fats during pregnancy.What are the implications of these findings for clinical practice and/or further research? Women who enter pregnancy with higher BMI values may voluntarily or involuntarily reduce their food intake. These results can be used to accordingly plan diet counselling during pregnancy.

Predictors of maternal dietary quality and dietary inflammation during pregnancy: An individual participant data meta-analysis of seven European cohorts from the ALPHABET consortium

BACKGROUND & AIMS

Maternal diet during pregnancy is a modifiable behaviour which plays an important role in maternal, neonatal and child health outcomes. Thus, knowledge of predictors of dietary quality and dietary inflammatory potential in European countries may contribute to developing maternal diet-related public health policies that target specific at-risk populations in Europe.

METHODS

We used harmonised data from >26,000 pregnant women enrolled in the ALSPAC, EDEN, Generation R, Lifeways, REPRO_PL, ROLO and SWS cohorts, as part of the ALPHABET consortium. Maternal dietary quality and inflammatory potential were assessed using the Dietary Approaches to Stop Hypertension (DASH) and the energy-adjusted Dietary Inflammatory Index (E-DII). We conducted an individual participant data meta-analysis to investigate the maternal sociodemographic, health and behavioural predictors of maternal diet before and during pregnancy.

RESULTS

DASH and E-DII scores were moderately correlated: from -0.63 (95% CI: -0.66, -0.59) to -0.48 (95% CI: -0.49, -0.47) across cohorts. Higher maternal age, education, household income, and physical activity during pregnancy were associated with a better dietary quality and a more anti-inflammatory diet. Conversely, multiparity and smoking during pregnancy were associated with a poorer dietary quality and a more proinflammatory diet. Women with obesity had a poorer pregnancy dietary quality than women with a normal body mass index range.

CONCLUSIONS

The results will help identify population subgroups who may benefit from targeted public health strategies and interventions aimed at improving women's dietary quality during pregnancy.

The Associations Between Maternal Socioeconomic Factors and Adequacy of Energy and Macronutrient Intakes in Pregnant Women From Yucatan, Mexico

BACKGROUND

Socioeconomic factors influence diet quality during pregnancy. However, dearth of evidence about the influence on energy and macronutrients adequacy calls for research.

OBJECTIVE

To analyze the association between socioeconomic factors and adequacy rates of energy and macronutrients intakes in pregnant women from Merida, Yucatan, Mexico.

METHODS

During September to December 2019, we applied a socioeconomic questionnaire and three 24-hour dietary recalls to 83 pregnant females resident in Merida, Yucatan. Energy and macronutrient intakes were compared with the estimated trimester-specific energy and macronutrient requirements to calculate adequacies (%). Outcome variables were average adequacy of energy, carbohydrates, total fat, and protein intakes and the main predictors were maternal education, monthly family income, working status, and marital status. Descriptive statistics of adequacy were calculated for each category of predictors. The association between socioeconomic factors and outcome variables was analyzed through simple and multiple linear regression models.

RESULTS

Adequacy rates of energy and macronutrients decreased as education and familial income levels increased, as well as among unemployed women. Consistently with these results, simple linear regressions showed that years of education, family income, and working status (i.e., women working to earn money), were negatively associated with adequacy rates of energy and macronutrients intakes. When all predictors and covariates were included in a multiple linear regression model, only having a job was significantly associated with adequacy rates. Marital status was not associated with outcomes.

CONCLUSIONS

Women in disadvantaged socioeconomic conditions (unemployed and low levels of education and familial income) show greater energy and macronutrient intakes.

Dietary Quality of Pregnant Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

Few studies have examined the dietary intake of low-income pregnant women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The aim of this study was to assess the dietary quality of WIC-enrolled pregnant women and examine associations with maternal characteristics, nutrition knowledge, and key health indicators. Fifty-one WIC-enrolled pregnant women completed two sets of 3-day food records. Food records were analyzed for nutrient content, and diet quality was assessed using the Healthy Eating Index (HEI)-2015. Since an HEI score of less than 60 is indicative of the need to improve dietary quality, participants' HEI scores were divided into two categories: <60 and ≥60. The total mean HEI score of the cohort based on analysis of the first set of food records was 59.1 ± 12.5 (range 37.1-89.2), while the mean score for the second 3 days of food records was 56.8 ± 12.7 (range 30.0-89.0). The majority of participants did not consume the minimum recommended servings of whole vegetables. Those in the <60 HEI category consumed on average less than 50% of the recommended servings of whole fruits and whole grains. The diets of the majority of participants were high in saturated fat and sodium. More than one-third did not meet the recommendations for folate and iron intake, while less than half met the RDA for vitamin D. Choline intake was insufficient based on analysis of the first 3 days of food records. Our results indicate that the dietary quality of WIC-enrolled pregnant women requires improvement.

Association between dietary inflammatory index and gestational diabetes mellitus risk in a prospective birth cohort study

OBJECTIVE

Information is limited regarding the possible relationship between diet-related inflammation and the risk of gestational diabetes mellitus (GDM). This study investigated the association between the inflammatory potential of the diet, measured by the dietary inflammatory index (DII), and GDM risk in pregnant Chinese women.

METHODS

This study included 2639 eligible women from the Tongji Maternal and Child Health Cohort. Dietary intake was assessed by a validated semiquantitative food frequency questionnaire and was used to calculate the DII score. The DII was then validated using C-reactive protein measurements in a subsample of 133 pregnant women. GDM diagnoses were collected from medical records based on the results of a 75 g oral glucose tolerance test at 24 to 28 wk gestation. Multivariable-adjusted logistic regression models were performed to estimate the odds ratios (ORs) for GDM risk by DII score, modeled continuously and in tertiles.

RESULTS

Of the 2639 participants, 13.1% were diagnosed with GDM. DII scores ranged from -4.45 to 3.15 and were positively associated with C-reactive protein (adjusted β : 1.28, 95% confidence interval [CI]: 0.16, 2.40; P trend = 0.023) when comparing DII tertile 3 (most pro-inflammatory) to tertile 1 (most anti-inflammatory). A significant and positive association was observed between DII scores and GDM risk (adjusted OR: 1.43; 95% CI: 1.05, 1.95; P trend = 0.022) comparing the highest versus lowest tertiles. The stratified analysis showed that this association was stronger in pregnant women who were overweight or obese before pregnancy (adjusted OR: 2.20; 95% CI: 1.03, 4.69).

CONCLUSIONS

These findings suggest that a higher DII score, corresponding to a more proinflammatory diet, is associated with a higher risk of GDM, particularly in pregnant women who were overweight or obese before pregnancy.

Iodine status of pregnant women with obesity from inner city populations in the United Kingdom

BACKGROUND/OBJECTIVES

Iodine is essential for foetal neurodevelopment and growth. Requirements increase in pregnancy to support increased thyroid hormone synthesis for maternal and foetal requirements, and for foetal transfer. Iodine deficiency in pregnancy is widely reported, and obesity has been associated with sub-optimal thyroid function. We evaluated iodine status and its relation with birthweight in a secondary analysis of pregnant women with obesity from multi-ethnic inner-city settings who participated in the UK Pregnancies Better Eating and Activity trial (UPBEAT).

SUBJECTS/METHODS

Iodine and creatinine concentrations were evaluated in spot urine samples in the second (15⁺⁰-18⁺⁶ weeks, n = 954) trimester of pregnancy. We assessed iodine status as urinary iodine concentration (UIC) and urinary iodine-to-creatinine ratio (UI/Cr) and applied WHO/UNICEF/IGN population threshold of median UIC > 150 µg/L for iodine sufficiency. Relationships between iodine status and birthweight were determined using linear and logistic regression with appropriate adjustment, including for maternal BMI and gestational age.

RESULTS

Median (IQR) UIC and UI/Cr in the second trimester of pregnancy were 147 µg/L (99-257) and 97 µg/g (59-165), respectively. An UI/Cr <150 μg/g was observed in 70% of women. Compared to women with UI/Cr >150 µg/g, there was a trend for women with UI/Cr <150 µg/g to deliver infants with a lower birthweight (β = -60.0 g; 95% CI -120.9 to -1.01, P = 0.05).

CONCLUSIONS

Iodine status of pregnant women with obesity from this cohort of UK women was suboptimal. Lower iodine status was associated with lower birthweight.

Factors Influencing Dietary Patterns during Pregnancy in a Culturally Diverse Society

The aim of this study was to identify dietary patterns in pregnant women and to assess the relationships between sociodemographic, lifestyle-related, and pregnancy-related factors. This is a descriptive, correlational study involving 306 pregnant women in Melilla (Spain) in any trimester of pregnancy. A validated food frequency questionnaire was used. Dietary patterns were determined via exploratory factor analysis and ordinal logistic regression using the proportional odds model. Three dietary patterns were identified: Western, mixed, and prudent. Sociodemographic, lifestyle-related, and pregnancy-related factors influencing dietary quality were established. The Western dietary pattern was considered the least recommended despite being the most common among women who live in Melilla (p = 0.03), are Christian (p = 0.01), are primiparous women (p < 0.001), and are in their first or second trimester (p = 0.02). Unemployed pregnant women were also more likely to have a less healthy dietary pattern (β = -0.716; p = 0.040). The prudent dietary pattern, the healthiest of the three, was most commonly observed among Muslim women (p = 0.01), women with more than two children (p < 0.001), and women in the third trimester of pregnancy (p = 0.02). Pregnant women who engaged in no physical activity or a low level of physical activity displayed a mixed pattern (p < 0.001). This study provides evidence on the factors influencing dietary patterns during pregnancy and suggests that more specific nutrition programmes should be developed to improve the nutritional status of pregnant women.

Methodological quality of clinical practice guidelines for nutrition and weight gain during pregnancy: a systematic review

CONTEXT

Ensuring a healthy pregnancy and achieving optimal gestational weight gain (GWG) are important for maternal and child health. Nevertheless, the nutritional advice provided during pregnancy is often conflicting, suggesting limited adherence to clinical practice guidelines (CPGs).

OBJECTIVE

The aim of this review was to identify all CPGs on maternal nutrition and GWG and to critically appraise their methodological quality.

DATA SOURCES

The MEDLINE/PubMed, Cochrane, Guidelines International Network, and BMJ Best Practice databases, along with gray literature, were searched from inception until February 2019 for CPGs and consensus, position, and practice papers.

STUDY SELECTION

Clinical practice guidelines published in English and containing advice on maternal nutrition or GWG were eligible.

DATA EXTRACTION

Two authors independently extracted data on items pertaining to maternal nutrition or GWG, and CPGs were appraised using the AGREE II instrument.

RESULTS

Twenty-two CPGs were included. All scored adequately in the "scope" domain, but most were considered inadequate with regard to stakeholder involvement, rigor of development, applicability, and editorial independence. Many CPGs lacked patient or dietician involvement, and more than half did not disclose funding sources or conflicts of interest. Guidance on GWG was based mostly on Institute of Medicine thresholds, while nutrition recommendations appeared scattered and heterogeneous.

CONCLUSION

Despite the importance of maternal nutrition and the plethora of advising bodies publishing relevant guidance, there is room for substantial improvement in terms of development standards and content of nutritional recommendations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42019120898.

Maternal obesity and its determinants: A neglected issue?

Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3-to reduce global maternal mortality and end preventable deaths of children under 5 years of age-by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.

Maternal Pregnancy Diet Quality Is Directly Associated with Autonomic Nervous System Function in 6-Month-Old Offspring

BACKGROUND

Many pregnant women are consuming diets of poor overall quality. Although many studies have linked poor prenatal diet quality to an increased risk of specific diseases in offspring, it is not known if exposure to poor prenatal diet affects core neurophysiological regulatory systems in offspring known to lie upstream of multiple diseases.

OBJECTIVE

We aimed to examine the association between prenatal diet quality and autonomic nervous system (ANS) function in infants at 6 mo of age.

METHODS

Data from 400 women (aged >18 y, with uncomplicated pregnancies) and their infants participating in the Maternal-Infant Research on Environmental Chemicals-Infant Development cohort were used to investigate links between prenatal diet quality and infant ANS function at 6 mo of age. Prenatal diet quality was assessed using the Healthy Eating Index (2010), calculated from a validated FFQ completed by women during the first trimester. Infant ANS function was measured using 2 assessments of heart rate variability (HRV) including root mean square of successive differences (RMSSD) and SD of N-N intervals (SDNN). Associations were analyzed before and after adjustment for socioeconomic status, maternal depression symptoms, maternal cardiometabolic dysfunction, breastfeeding, and prenatal smoking.

RESULTS

Poorer prenatal diet quality was associated with lower infant HRV assessed using RMSSD (B: 0.07; 95% CI: 0.01, 0.13; R2 = 0.013) and SDNN (B: 0.18; 95% CI: 0.02, 0.35; R2 = 0.011). These associations remained significant after adjustment for confounding variables [RMSSD: B: 0.09; 95% CI: 0.003, 0.18; squared semipartial correlation (sp2) = 0.14 and SDNN B: 0.24; 95% CI: 0.0, 0.49; sp2 = 0.13].

CONCLUSIONS

In a large cohort study, poorer prenatal diet quality was associated with lower offspring HRV, a marker of decreased capacity of the ANS to respond adaptively to challenge. Therefore, poor prenatal diet may play a significant role in the programming of multiple organ systems and could increase general susceptibility to disease in offspring.

Pre-Pregnancy BMI Influences the Association of Dietary Quality and Gestational Weight Gain: The SECOST Study

Poor diet quality in pregnancy could impact gestational weight gain (GWG) and consequently fetal growth and development. But today there is limited data available on gestational diet quality. This study investigated the association between diet quality in each pregnancy trimester and GWG in Malaysian women. Diet quality was assessed using the modified Healthy Eating Index for Malaysians (HEI). Total GWG was defined as the difference between measured weight at last prenatal visit and pre-pregnancy weight. About one-fourth of women (23.3%) had excessive total GWG. There were significant differences in the HEI component score across trimesters, except for fruits. Overall, overweight/obese women had lower total HEI score (51.49–55.40) during pregnancy compared to non-overweight/obese women (53.38–56.50). For non-overweight/obese women, higher total HEI scores in the second and third trimesters were significantly associated with lower risk of inadequate GWG (aOR = 0.97, 95% CI = 0.95–0.99, p = 0.01) and higher risk of excessive GWG (aOR = 1.04, 95% CI = 1.01–1.07, p = 0.03), respectively. Overweight/obese women with higher total HEI scores in the second (aOR = 1.04, 95% CI = 1.01–1.07, p = 0.02) and third trimester (aOR = 1.04, 95% CI = 1.01–1.08, p = 0.02) were significantly at higher risk for excessive GWG. Pregnant women had relatively low diet quality throughout pregnancy. Diet quality and GWG association differed according to pre-pregnancy BMI with excessive GWG more likely to be associated with higher total HEI scores in the third trimester.

Tracking of Dietary Intake and Diet Quality from Late Pregnancy to the Postpartum Period

The present study aimed to characterize dietary intake and diet quality from late pregnancy to six months postpartum. Participants (n = 28) completed 2-3 Web-based 24 h recalls at three distinct periods: (1) during the third trimester of pregnancy; (2) three months and (3) six months after delivery. Energy, macro-and micronutrient intakes (from foods and supplements), as well as the Canadian healthy eating index (C-HEI) were derived from the dietary recalls. No significant variation in energy and macronutrient intakes was observed between time points. The proportion of women taking at least one supplement decreased over time (p = 0.003). The total intake of several micronutrients (vitamins A, C, D, group B vitamins, iron, magnesium, zinc, calcium, phosphorus, manganese, and copper) decreased significantly over time (p < 0.05 for all micronutrients). The total C-HEI score and its components did not change, except for the total vegetables and fruit subscore, which decreased over time (8.2 ± 2.0 in the 3rd trimester, 7.1 ± 2.2 at three months postpartum, 6.9 ± 2.4 at 6 months postpartum, p = 0.04). In conclusion, we observed a general stability in diet quality, energy, and macronutrient intakes from the third trimester of pregnancy to six months postpartum. However, several micronutrient intakes decreased over time, mostly due to changes in supplement use.

Gestational weight gain trajectories over pregnancy and their association with maternal diet quality: Results from the PRINCESA cohort

OBJECTIVE

The aims of this study were to characterize, among pregnant Mexican women, gestational weight gain (GWG) trajectories; assess associations of maternal dietary quality score (MDQS) with GWG during early-mid pregnancy, middle pregnancy, late pregnancy, and prolonged pregnancy; and evaluate the association between MDQS and adequacy of GWG, throughout pregnancy. We hypothesized that higher MDQS adherence is protective against insufficient or excessive GWG across pregnancy and that the association between MDQS adherence and GWG would vary by prepregnancy body mass index (BMI) category.

METHODS

We analyzed data from 660 pregnant women participating in the PRINCESA (Pregnancy Research on Inflammation, Nutrition and City Environments: Systematic Analyses) cohort in Mexico City, 2009 to 2014. Repeated measures of dietary intake and mother's weight were obtained during pregnancy. Individual GWG trajectories were modeled in a multilevel regression framework. Associations between MDQS (low, medium, and high adherence) and GWG were investigated using mixed-effect regression models with linear splines.

RESULTS

Women with prepregnancy BMI of ≥30 kg/m2 had a slower rate of GWG (RGWG) compared with other categories. A higher adherence to MDQS was protective against an insufficient (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.42-0.95; P = 0.03) and an excessive RGWG (OR, 0.62; 95% CI, 0.41-0.94; P = 0.03) throughout pregnancy, adjusting for prepregnancy BMI, energy intake, maternal age, educational level, parity, fetal sex, marital status, and physical activity. Associations between diet and RGWG differed by gestational period.

CONCLUSION

A better quality diet, as measured by MDQS, was associated with appropriate GWG during pregnancy in the PRINCESA cohort.

Evidence-based recommendations for energy intake in pregnant women with obesity

BACKGROUND

In women with obesity, excess gestational weight gain (≥270 g/week) occurs in two out of three pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity.

METHODS

This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly-labeled water and whole-room indirect calorimetry and body composition as 3-compartment model by air displacement plethysmography and isotope dilution in early (13-16 weeks) and late pregnancy (35-37 weeks).

RESULTS

In pregnant women with obesity (n=54), recommended weight gain (n=8, 15%) during the second and third trimesters was achieved when energy intake was 125±52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186±29 kcal/d more than they expended (P<0.001). Energy balance affected maternal adiposity (recommended: -2.5±0.8 kg fat mass, excess: +2.2±0.5, inadequate: -4.5±0.5, P<0.001), but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared to energy requirements early in pregnancy (34±53 kcal/d, P=0.83).

CONCLUSIONS

We here provide the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure.

FUNDING

This study was funded by the National Institutes of Health (R01DK099175; Redman, U54GM104940 and P30DK072476; Core support).

TRIAL REGISTRATION

clinicaltrials.gov: NCT01954342.

Association between the Diet Quality Index Adapted for Pregnant Women (IQDAG) and excess maternal body weight

Abstract Objectives: to investigate the relationship between the Diet Quality Index Adapted for Pregnant Women (IQDAG) and excess maternal body weight. Methods: a cross-sectional study was conducted with 754 adult pregnant women, in Ribeirão Preto, São Paulo, between 2011 and 2012. The criteria proposed by Atalah were used to classify the body mass index (BMI). Adjusted multinomial logistic regression models were employed to investigate the relationship between the IQDAG and being overweight and obese, estimating the odds ratio (OR) and the 95% confidence interval (CI95%). Results: the mean (SD) age of women was 28 (5) years, 33.4% were overweight and 25.6% obese. The pregnant women with higher scores in the IQDAG were less likely to be overweight [OR= 0.56 (CI95% = 0.37-0.85)] or obese [0.43 (0.26-0.71)]; those with higher scores in the "Fiber" [0.51 (0.33; 0.78)] and "Iron" [0.62 (0.40-0.96)] components were less likely to be overweight. However, women with higher scores in the percentage of energy from ultra-processed foods were more likely to be overweight [1.72 (1.10-2.94)] or obese [5.24 (2.80-9.80)], when compared to women with lower scores. Conclusions: poorer quality maternal diets were observed among the women who were overweight and obese during pregnancy.

Adherence to the Healthy Eating Index-2015 across Generations Is Associated with Birth Outcomes and Weight Status at Age 5 in the Lifeways Cross-Generation Cohort Study

Maternal dietary quality during pregnancy is associated with offspring outcomes. These associations have not been examined in three-generation families. We investigated associations between parental and grandparental dietary quality, determined by healthy eating index (HEI)-2015, and offspring birth outcomes and weight status at age 5. The Lifeways cohort study in the Republic of Ireland comprises 1082 index-child's mothers, 333 index-child's fathers, and 707 grandparents. HEI-2015 scores were generated for all adults from prenatal dietary information collected using a validated food frequency questionnaire. In an adjusted model, greater adherence to the maternal HEI was associated with lower likelihood of low birth weight (LBW) (OR: 0.72, 95% CI: 0.50-0.99, p = 0.04). Similarly, maternal grandmothers (MGM) with higher HEI scores were less likely to have grandchildren with LBW (OR: 0.87, 95% CI: 0.61-0.96, p = 0.04) and more likely to have macrosomia (OR: 1.10, 95% CI: 1.01-1.22, p = 0.03). Higher paternal and paternal grandmothers (PGM) HEI scores were associated with lower likelihood of childhood obesity (OR: 0.89, 95% CI: 0.30-0.94, p = 0.03) and overweight (OR: 0.83, 95% CI: 0.22-0.99, p = 0.04), respectively. Mediation analysis showed significant direct relationship of MGM and PGM HEI scores on grandchildren's birthweight and obesity, respectively. In conclusion, maternal line dietary quality appears to influence fetal growth whereas paternal line dietary quality appears to influence postnatal growth.

Sociodemographic, Lifestyle, Environmental and Pregnancy-Related Determinants of Dietary Patterns during Pregnancy

Background: Characterization of dietary patterns represents a valid and meaningful measure of overall diet quality and nutrient intake. The study aims at evaluating the sociodemographic, lifestyle, environmental, and pregnancy-related determinants of maternal dietary patterns during pregnancy. Methods: The analysis was conducted on a group of pregnant women from the Polish Mother and Child Cohort (REPRO_PL). During the second trimester of pregnancy, 1306 women filled in a modified version of the validated food frequency questionnaire (FFQ). Dietary patterns were estimated using an exploratory factor analysis. Potential dietary determinants were assessed via a questionnaire or biomarker measurements (saliva cotinine level). Results: Two dietary patterns were identified. The Prudent dietary pattern was characterized by high consumption of fruit, vegetables, legumes, whole grains, poultry, and low-fat dairy products, while the Western dietary pattern included high intake of refined grains, processed meat, potatoes, and very low intake of whole grains. Clear sociodemographic, environmental, lifestyle, and pregnancy-related determinants of diet quality were established. Older age (β = 0.2; p < 0.01), higher educational level (β = 0.3; p < 0.01), and socioeconomic status (SES) (β = 0.2; p < 0.01), overweight/obesity before (β = 0.3; p < 0.01), as well as physical activity during pregnancy (β = 0.2; p = 0.01) were positive determinants of a healthier diet (increasing Prudent–Western difference in dietary pattern scores). On the other hand, parity (β = −0.2; p = 0.04) and living in small cities (β = −0.3; p = 0.02) were significantly related to a rather Western dietary pattern. Conclusions: The current study presents evidence on specific factors influencing dietary patterns. They need to be accounted for in educational programs and interventions focused on healthy diet recommendations during pregnancy.

Trimester-Specific Assessment of Diet Quality in a Sample of Canadian Pregnant Women

The present study aimed to (1) examine changes in diet quality throughout pregnancy and (2) identify maternal characteristics associated with trimester-specific diet quality. Pregnant women (n = 79) were recruited in their 1st trimester of pregnancy and completed, at each trimester, three web-based 24-hour dietary recalls, from which the Canadian Healthy Eating Index (HEI) was calculated. Physical activity, nutrition knowledge, and socio-demographic web-questionnaires were also completed. Although no variation in total HEI scores was observed across trimesters, we found an overall decrease in the following subscores: adequacy, total fruits and vegetables, unsaturated fats and saturated fats (p < 0.05). In the 1st trimester, overweight and obese pregnant women had a lower diet quality in comparison with normal-weight and underweight women (HEI scores: 63.1 ± 11.9 vs. 68.0 ± 9.3; p = 0.04). In the 3rd trimester, women younger than 28 years old, with no university degree, poorer nutrition knowledge and who reside in an urban setting, had a lower diet quality (p < 0.05). In conclusion, less educated, younger women who reside in an urban setting may be at a higher risk of poor diet quality in late pregnancy and could benefit from public health programs.

Neurodevelopment in 3-4 year old children exposed to maternal hyperglycemia or adiposity in utero

BACKGROUND

Prenatal exposure to maternal metabolic complications has been linked to offspring neurodevelopmental problems. However, no studies investigating these links have examined the role of maternal prenatal diet.

AIMS

To determine if prenatal exposure to maternal adiposity or hyperglycemia is associated with neurodevelopmental problems in 3-4 year old children, and if links persist following adjustment for confounding variables, including prenatal diet.

METHOD

808 mother-child pairs from the Maternal-Infant Research on Environmental Chemicals-Child Development Plus cohort were used to examine associations between pre-pregnancy body mass index (BMI), hyperglycemia and offspring verbal, performance and full-scale IQ scores, as well as internalizing and externalizing problems. Associations were examined before and after adjustment for prenatal diet along with home environment, maternal depression, education and prenatal smoking. Semi-partial correlations were examined post-hoc to assess the impact of each confounder in the adjusted models.

RESULTS

In the unadjusted models, BMI and hyperglycemia predicted lower verbal and full-scale IQ. BMI was also linked to externalizing problems. However, associations were not significant after adjustment. In adjusted models, post-hoc analysis revealed that prenatal diet and home environment accounted for significant variance in verbal and full-scale IQ. The home environment and maternal depression accounted for significant variance in externalizing problems.

CONCLUSION

In the adjusted models, maternal metabolic complications were not associated with offspring neurodevelopment. Even while adjusting for well-known risk factors for adverse offspring cognition (home environment, maternal depression), we show for the first time that maternal prenatal diet is an important confounder of the links between maternal metabolic complications and offspring cognition.

Dietary diversity is inversely correlated with pre-pregnancy body mass index among women in a Michigan pregnancy cohort

Background

During pregnancy, healthy maternal body weight and a nutritionally complete diet provide a favorable environment for fetal development. Yet nearly two-thirds of women of reproductive age in the United States (US) are either overweight or obese. The objective of this research was to investigate the relationship between a measure of dietary diversity and body mass index (BMI) in a sample of women enrolled in a US pregnancy cohort.

Methods

Dietary data was obtained from one 24-hour dietary recall collected during the third trimester of pregnancy (n = 40). Pre-pregnancy BMI was calculated from pre-pregnancy weight and height self-reported by survey at the time of enrollment. Using the Minimum Dietary Diversity for Women (MDD-W) indicator developed by the Food and Agriculture Organization of the United Nations, dietary data was categorized and scored.

Results

Overall, 35% of participants did not achieve minimum dietary diversity (MDD-W ≥5). In addition, 45% of participants were obese, 35% were normal weight and 20% were overweight. Women with higher BMI had lower MDD-W scores than women with lower BMI (p < 0.05). The median MDD-W for both normal and overweight women was ≥5 indicating that normal and overweight pregnant women tended to consume a diet that was high in micronutrients. Conversely, the median MDD-W for obese women was below 5 meaning these women tended to consume a diet that was low in micronutrient density. The most commonly consumed food group was grain. In addition, 75% of all participants consumed sweetened drinks. Individuals with an MDD-W score ≥5, were more likely to have consumed dark green leafy vegetables, vitamin A-rich fruits or vegetables, other vegetables and other fruits than those with MDD-W scores <5.

Discussion

In this study, we show that a food group diversity indicator that has been shown to reflect adequacy of micronutrient intake in populations from less economically developed countries may also be informative in US populations. Furthermore, these results reflect the importance of encouraging all pregnant women with less varied diets to consume more fruits and vegetables.

In Overweight or Obese Pregnant Women, Maternal Dietary Factors are not Associated with Fetal Growth and Adiposity

The aim of our study was to evaluate associations between maternal dietary factors and fetal growth and adiposity in overweight and obese women. Women randomised to the ‘Standard Care’ group of the LIMIT trial were included. Maternal dietary factors including Healthy Eating Index, total energy, fat, carbohydrates, protein, glycaemic load and index were measured using the Harvard semi-quantitative Food Frequency questionnaire at time of study entry, 28 and 36 weeks’ gestation. Fetal ultrasound measurements of biometry and adiposity were obtained at 28 and 36 weeks’ gestation. Linear regression models were used to associate between dietary factors and fetal growth and adiposity measurements. There were 721 women included in this exploratory analysis. A 10 unit increase in the log total energy was associated with a reduction in mid-thigh lean mass by 4.94 mm at 28 weeks (95% CI −9.57 mm, −0.32 mm; p = 0.036) and 7.02 mm at 36 weeks (95% CI −13.69 mm, −0.35 mm; p = 0.039). A 10 unit increase in Healthy Eating Index score was associated with a reduced mean subscapular skin fold measure at 28 weeks by 0.17 mm (95% CI −0.32 mm, −0.03 mm; p = 0.021). We did not identify consistent associations between maternal diet and measures of fetal growth and adiposity in overweight and obese women.

Adequacy of nutritional intake during pregnancy in relation to prepregnancy BMI: results from the 3D Cohort Study

Our study compares adequacy of nutritional intakes among pregnant women with different prepregnancy BMI and explores associations between nutritional intakes during pregnancy and both prepregnancy BMI and gestational weight gain (GWG). We collected dietary information from a large cohort of pregnant Canadian women (n 861) using a 3-d food record. We estimated usual dietary intakes of energy (E), macronutrients and micronutrients using the National Cancer Institute method. We also performed Pearson's correlations between nutritional intakes and both prepregnancy BMI and GWG. In all BMI categories, intakes considered suboptimal (by comparison with estimated average requirements) were noted for Fe, vitamin D, folate, vitamin B6, Mg, Zn, Ca and vitamin A. Total fat intakes were above the acceptable macronutrient distribution range (AMDR) for 36 % of the women. A higher proportion of obese women had carbohydrate intakes (as %E) below the AMDR (v. normal-weight and overweight women; 19 v. 9 %) and Na intakes above the tolerable upper intake level (v. other BMI categories; 90 v. 77-78 %). In all BMI categories, median intakes of K and fibre were below adequate intake. Intakes of several nutrients (adjusted for energy) were correlated with BMI. Correlations were detected between energy-adjusted nutrient intakes and total GWG and were, for the most part, specific to certain BMI categories. Overweight and obese pregnant women appear to be the most nutritionally vulnerable. Nutrition interventions are needed to guide pregnant women toward their optimal GWG while also meeting their nutritional requirements.

Maternal gestational weight gain and objectively measured physical activity among offspring

Objective

Animal studies have suggested that maternal weight-related factors during pregnancy can program offspring physical activity in a sex-dependent manner. However, there is limited evidence in humans. The purpose of this study was to investigate the association between maternal gestational weight gain (GWG) and offspring total physical activity (TPA) level and to determine whether these associations are moderated by sex of offspring or maternal pre-pregnancy weight status.

Method

We studied 56 boys (mean age = 3.7 years, standard deviation (SD) 0.5) and 57 girls (mean age = 3.5±0.5 years) enrolled in licensed childcare centers. TPA was objectively measured using Actical^® accelerometers. Information on pre-pregnancy body mass index (BMI), GWG, and other maternal factors were collected with a maternal health questionnaire. Associations between GWG, as a continuous variable or categorically (inadequate, adequate, and excessive), and offspring TPA were analysed using linear mixed models to take into account the intraclass correlation between the clusters (childcare centers). Models were adjusted for gestational age, accelerometer weartime, socioeconomic status, and pre-pregnancy BMI status.

Results

We found a significant sex interaction (P-value = 0.009). In boys, greater GWG was associated with decreased offspring TPA (β = -3.2 counts⋅1000⁻¹/d, 95% confidence intervals (CI) = -6.4–0.02, P-value = 0.049). In girls born to mothers categorized as overweight or obese, the association between the GWG and TPA followed an inverted U-shape curve (β for GWG squared = -0.1 counts⋅1000⁻¹/d, 95% CI = (-0.2 –-0.04), P-value = 0.005). In contrast, a U-shaped curve was found in girls born to mothers classified as lean (pre-pregnancy BMI<25 kg/m²) (β for GWG squared = 0.7 counts⋅1000⁻¹/d, 95% CI = 0.2–1.2, P-value = 0.011). In boys, TPA in offspring was higher among women with inadequate GWG compared to adequate GWG (P-value = 0.0137), whereas no significant differences were found in girls (P-value = 0.107).

Conclusion

Maternal GWG can be an important biological marker of offspring TPA. These findings support the sex-dependent early developmental programming influence of GWG on TPA.

Exploring Diet Quality between Urban and Rural Dwelling Women of Reproductive Age

Health disparities, including weight gain and obesity exist between urban and rural dwelling women. The primary aim was to compare diet quality in urban and rural women of reproductive age, and secondary analyses of the difference in macronutrient and micronutrient intake in urban and rural women, and the predictors of diet quality. Diet quality was assessed in urban (n = 149) and rural (n = 394) women by a modified version of the Dietary Guideline Index (DGI) energy, macronutrient and micronutrient intake from a food frequency questionnaire (FFQ) and predictors of diet quality. Diet quality did not significantly differ between urban and rural women (mean ± standard deviation (SD), 84.8 ± 15.9 vs. 83.9 ± 16.5, p = 0.264). Rural women reported a significantly higher intake of protein, fat, saturated fat, monounsaturated fat, cholesterol and iron and a higher score in the meat and meat alternatives component of the diet quality tool in comparison to urban women. In all women, a higher diet quality was associated with higher annual household income (>$Australian dollar (AUD) 80,000 vs. <$AUD80,000 p = 0.013) and working status (working fulltime/part-time vs. unemployed p = 0.043). Total diet quality did not differ in urban and rural women; however, a higher macronutrient consumption pattern was potentially related to a higher lean meat intake in rural women. Women who are unemployed and on a lower income are an important target group for future dietary interventions aiming to improve diet quality.

Pre-Pregnancy Body Mass Index Is Associated with Dietary Inflammatory Index and C-Reactive Protein Concentrations during Pregnancy

There have been a limited number of studies examining the association between pre-pregnancy body mass index (BMI) and dietary inflammation during pregnancy. Our aim is to examine the association between pre-pregnancy BMI and the Dietary Inflammatory Index (DII)™ and C-reactive protein (CRP) concentrations during pregnancy. The study included 631 pregnant American women from the National Health and Nutrition Examination Survey (NHANES) cross-sectional examinations from 2003 to 2012. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. The cut-offs of <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight), and ≥30 kg/m² (obese) were used to categorize the weight status of pregnant women prior to pregnancy. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a one-day 24-h recall. Multivariable linear and logistic regressions were performed to estimate beta coefficients and the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) on the association of pre-pregnancy BMI categories with the DII and CRP concentrations during pregnancy. After controlling for variables including: race/ethnicity, family poverty income ratio, education, marital status, month in pregnancy, and smoking status during pregnancy; women who were obese before pregnancy (n = 136) had increased odds for being in the highest tertile of the DII and CRP concentrations compared to women with normal weight (AORs 2.40, 95% CIs 1.01-5.71; AORs 24.84, 95% CIs 6.19-99.67, respectively). These findings suggest that women with pre-pregnancy obesity had greater odds of reporting higher DII and having elevated CRP. In conclusion, high pre-pregnancy BMI was associated with increased odds of pro-inflammatory diet and elevated CRP levels during pregnancy in the USA.

Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial

BACKGROUND

Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes.

METHODS

In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15⁺⁰-18⁺⁶ weeks' gestation), post intervention (27⁺⁰-28⁺⁶ weeks) and in late pregnancy (34⁺⁰-36⁺⁰ weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023).

RESULTS

Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes.

CONCLUSIONS

In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions.

TRIAL REGISTRATION

Current controlled trials; ISRCTN89971375.

Determinants of dietary patterns and diet quality during pregnancy: a systematic review with narrative synthesis

OBJECTIVE

To identify determinants of diet in pregnancy, by detecting factors in our multiple-determinants life course framework that are associated with dietary patterns, quality or guideline adherence.

DESIGN

A systematic review of observational studies, published in English or German, was conducted. Sociodemographic, lifestyle, environmental and pregnancy-related determinants were considered. Four electronic databases were searched in January 2015 and updated in April 2016 and a total of 4368 articles identified. Risk of bias was assessed using adapted Newcastle-Ottawa Scales.

SETTING

High- and upper-middle-income countries.

SUBJECTS

Pregnant or postpartum women reporting their dietary intake during pregnancy.

RESULTS

Seventeen publications of twelve studies were included and compared narratively due to heterogeneity. Diet in pregnancy was patterned along a social gradient and aligned with other health behaviours before and during pregnancy. Few studies investigated the influence of the social and built environment and their findings were inconsistent. Except for parity, pregnancy determinants were rarely assessed even though pregnancy is a physiologically and psychologically unique period. Various less well-researched factors such as the role of ethnicity, pregnancy intendedness, pregnancy ailments and macro-level environment were identified that need to be studied in more detail.

CONCLUSIONS

The framework was supported by the literature identified, but more research of sound methodology is needed in order to conclusively disentangle the interplay of the different determinants. Practitioners should be aware that pregnant women who are young, have a low education or do not follow general health advice appear to be at higher risk of inadequate dietary intake.

Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy

Although the positive association between pre-pregnancy overweight and obesity with excessive gestational weight gain is well known, it is not clear how pre-pregnancy weight status is associated with gestational weight gain through maternal diet during pregnancy. This study aimed to examine the relationship between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Our study included 795 U.S. pregnant women from the National Health and Nutrition Examination Survey, 2003–2012. Pre-pregnancy body mass index (BMI) was calculated based on self-reported pre-pregnancy weight and height. The cutoff points of <18.5 (underweight), 18.5–24.9 (normal), 25.0–29.9 (overweight), and 30 kg/m² (obese) were used to categorize pregnant women’s weight status. Diet quality during pregnancy was assessed by the Healthy Eating Index (HEI)-2010 based on a 24-h recall. Multivariable logistic regressions were used to estimate the odds ratios (OR) and 95% confidence intervals (CI). For all pregnant women included in this study, the mean HEI-2010 (±standard error of the mean (SEM)) was 50.7 (±0.9). Women with obese pre-pregnancy BMI demonstrated significantly lower HEI-2010 compared to those with underweight and normal pre-pregnancy BMI, respectively. In an unadjusted model, women with pre-pregnancy obesity BMI had increased odds for being in the lowest tertile of HEI-2010 (33.4 ± 0.5) compared to those with underweight pre-pregnancy BMI (OR 5.0; 95% CI 2.2–11.4). The inverse association between pre-pregnancy overweight and obesity status and diet quality during pregnancy persisted even after we controlled for physical activity levels (adjusted OR (AOR) 3.8; 95% CI 1.2–11.7, AOR 5.4; 95% CI 2.0–14.5, respectively). Serum folate concentration (ng/mL) was significantly higher in underweight women compared to overweight women (23.4 ± 1.7 vs. 17.0 ± 0.8, p < 0.05). Serum iron concentration (ng/dL) was significantly higher in normal weight women compared to overweight women (86.2 ± 5.0 vs. 68.9 ± 3.0, p < 0.05). An inverse association was found between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Poor diet quality as measured by HEI-2010 was shown among overweight and obese women. Nutrition education and interventions need to be targeted to those women entering pregnancy as overweight and obese.

Health Behaviours during Pregnancy in Women with Very Severe Obesity

The health behaviours of pregnant women with very severe obesity are not known, though these women are at high risk of pregnancy complications. We carried out a prospective case-control study including 148 very severely obese (BMI >40 kg/m²) and 93 lean (BMI <25 kg/m²) pregnant women. Diet, physical activity, smoking, alcohol and folic acid consumption were assessed by questionnaire in early and late (16 and 28 weeks gestation) pregnancy. Circulating levels of iron, vitamin B12 and folate and other essential trace elements and minerals were measured in a subset at each time point. The findings biochemically confirmed that very severely obese women consumed diets that were energy-rich but poor in essential micronutrients. A third of all women met physical activity recommendations for pregnancy. A third of very severely obese women and two thirds of lean women took folic acid supplements prior to pregnancy. Very severely obese women were more likely to smoke but less likely to drink alcohol than lean women (all p < 0.05). Women with very severe obesity have low self-reported intakes and circulating levels of essential micronutrients in pregnancy and few follow current recommendations for pregnancy nutrition and lifestyle. These high-risk women represent a group to target for education about health behaviours prior to and during pregnancy.

Use of a DVD to provide dietary and lifestyle information to pregnant women who are overweight or obese: a nested randomised trial

Background

We conducted a nested randomised trial to evaluate the effect of an educational DVD, providing information about healthy food choices and exercise during pregnancy, on diet and physical activity, among pregnant women who were overweight or obese.

Methods

We conducted a nested randomised trial within the context of the LIMIT randomised trial. Women were eligible with a singleton pregnancy between 10 and 20 weeks gestation, and body mass index at the time of their first antenatal appointment of ≥25 kg/m². All women who were randomised to the Lifestyle Advice Group of the LIMIT trial received a series of consultations with both research dieticians and research assistants, in addition to standard written dietary and exercise materials (Standard Materials Group). Women randomised to the DVD Group received the same consultations and written materials, and additionally received an educational DVD (DVD Group). The primary study outcome was the Healthy Eating Index. Other study outcomes included physical activity, and gestational weight gain. Women completed a qualitative evaluation of all the materials provided.

Results

1,108 women in the LIMIT Lifestyle Advice Group participated in the nested trial, with 543 women randomised to the DVD Group, and 565 women to the Standard Materials Group. Women who received the DVD compared with those who did not, had a higher mean Healthy Eating Index at 36 weeks gestation (73.6 vs 72.3; adjusted mean difference 1.2; 95% CI 0.2 to 2.3; p = 0.02), but not at 28 weeks gestation (73.2 vs 73.5; adjusted mean difference −0.1; 95% CI −1.1 to 0.9; p = 0.82). There were no statistically significant differences in physical activity or total gestational weight gain. While most women evaluated the materials positively, frequency of utilisation was poor.

Conclusions

Ongoing attention to the delivery of information is required, particularly with the increased use and availability of digital and multi-media interactive technologies.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12607000161426

Greek pregnant women demonstrate inadequate micronutrient intake despite supplement use

BACKGROUND/AIM

Maternal diet is important in the outcome of pregnancy and the health of the children. The present cross-sectional study aimed to assess the use of dietary supplements during pregnancy and define the maternal characteristics associated with supplement use.

METHODS

The diet of 100 childbearing women was recorded for three consecutive days and micronutrient supplementation was added to the dietary intake and the median values were used in the analyses.

RESULTS

The majority of the participants (92%) consumed at least one supplement. Supplementation of folic acid (FA) was significantly lower during the third trimester compared to the second (p ≤ .007). Higher intake of Ca and Fe supplements was observed in the second trimester (p ≤ .001). The use of supplements contributed to an attenuated consumption of all reported micronutrients (Mg, Ca, FA, and Fe, p ≤ .001). The principal components analysis revealed that the most important factor contributing to supplementation was primiparity.

CONCLUSIONS

Overall, a high prevalence of micronutrient supplementation during pregnancy was observed without ensuring adequacy in the micronutrient intake. The increased rates of supplement users might be the result of an act for balancing diet in unplanned pregnancies.

Factors affecting breast-feeding initiation in Greece: What is important?

OBJECTIVE

to investigate the association between breast-feeding initiation and socio-demographic, lifestyle-related, clinical and lactation-related factors in a sample of mothers living in Greece.

DESIGN

cross-sectional study.

SETTING

Tertiary University Hospital, maternity ward.

PARTICIPANTS

428 mothers were interviewed (43.2% response rate) from February until December 2009, using a structured face-to-face questionnaire after at least 24 hours from childbirth.

MEASUREMENTS AND FINDINGS

71.0% of mothers were Greeks and 29.0% immigrants; the mean age was 32.0 years. 44.4% initiated exclusive breast feeding, 7.9% artificial milk -feeding and 47.7% partial feeding. In the multivariate analysis, exclusive breast feeding was inversely related to maternal body mass index (BMI) at the beginning of gestation (odds ratio (OR)=0.93, 95% confidence intervals (95%CI)=0.89-0.98) and caesarean section (OR=0.54, 95% CI=0.35-0.84). Lactation-related factors which favourably affected exclusive breast-feeding initiation included previous breast-feeding experience (OR=2.29, 95% CI=1.39-3.78), information about breast feeding (OR=2.38, 95% CI=1.41-4.01) and rooming-in (OR=1.62 95% CI=1.03-2.54), whilst any breast feeding was favourably affected by encouraging women to breast feed (OR=5.42, 95% CI=1.90-15.50), providing information about breast feeding (OR=6.92, 95% CI=2.53-18.89), and rooming-in (OR=6.93 95% CI=2.01-23.88), and negatively associated with caesarean section (OR=0.11, 95% CI=0.03-0.39). Being an immigrant mother was also positively associated with any breast-feeding initiation (OR=7.97, 95% CI=1.02-62.19). Maternal age, education and income, as well as, smoking status, were not associated with any breast-feeding initiation.

KEY CONCLUSIONS

maternal BMI and immigrant status, information provided by midwives and encouragement, rooming-in and mode of childbirth (caesarean section), were found to be important for breast-feeding initiation in this study population. No other indicator of socio-demographic status was found to be associated with breast-feeding initiation.

IMPLICATIONS FOR PRACTICE

focus should be given to pregnant women with higher BMI at the beginning of pregnancy, and women who had undergone caesarean section. Breast-feeding information and encouragement should be provided to all women in the maternity ward, along with the dedicated practice of rooming-in, in order to promote and increase breast-feeding initiation rates.

The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial

BACKGROUND

Overweight and obesity is a significant health concern during pregnancy. Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity.

METHODS

We conducted a randomised controlled trial, in which pregnant women with a body mass index≥25 kg/m2, and singleton gestation between 10(+0) to 20(+0) weeks were recruited and randomised to Lifestyle Advice (involving a comprehensive dietary and lifestyle intervention over their pregnancy) or Standard Care. Within the intervention group, we conducted a nested randomised trial in which a subgroup of women were further randomised to receive access to supervised group walking sessions in addition to the standard information presented during the intervention contacts (the Walking group) or standard information only. The outcome measures were maternal dietary intake, (including food groups, macronutrient and micronutrient intake, diet quality (using the Healthy Eating Index; HEI), dietary glycaemic load, and glycaemic index) and maternal physical activity. Women completed the Harvard Semi-Structured Food Frequency Questionnaire, and the Short Questionnaire to Assess Health-enhancing Physical Activity (SQUASH), at trial entry, 28 and 36 weeks' gestational age, and 4 months postpartum. Analyses were performed on an intention-to-treat basis, using linear mixed effects models with adjustment for the stratification variables.

RESULTS

Women randomised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day, as well as increased consumption of fibre, and reduced percentage energy intake from saturated fats (P<0.05 for all). Maternal HEI was significantly improved at both 28 (73.35±6.62 versus 71.86±7.01; adjusted difference in means 1.58; 95% CI 0.89 to 2.27; P<0.0001) and 36 (72.95±6.82 versus 71.17±7.69; adjusted difference in means 1.77; 95% CI 1.01 to 2.53; P<0.0001) weeks. There were no differences in dietary glycaemic index or glycaemic load. Women randomised to Lifestyle Advice also demonstrated greater total physical activity (adjusted difference in means 359.76 metabolic equivalent task units (MET) minutes/week; 95% CI 74.87 to 644.65; P=0.01) compared with women receiving Standard Care. The supervised walking group was poorly utilised.

CONCLUSIONS

For women who are overweight or obese, antenatal lifestyle advice improves maternal diet and physical activity during pregnancy. Please see related articles: http://www.biomedcentral.com/1741-7015/12/163 and http://www.biomedcentral.com/1741-7015/12/201.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426).

A mixed-methods study on factors influencing prenatal weight gain in ethnic-minority women

INTRODUCTION

Gaining too much weight in pregnancy is associated with perinatal complications and increases the risks of future obesity for both women and their infants. Unfortunately, women enrolled in intervention trials have seen little improvement in adherence to prenatal weight gain recommendations compared to women receiving standard prenatal care. Therefore, the purpose of this descriptive mixed-methods study was to explore factors related to excessive weight gain in pregnancy.

METHODS

Nonpregnant nulliparous women, currently pregnant women, and postpartum women (N = 43) were recruited from a health center serving an inner-city minority community. Women completed questionnaires on knowledge, self-efficacy, and behaviors related to nutrition, exercise, and prenatal weight gain. Fifteen of these women participated in focus groups. Focus group data were analyzed using ATLAS.ti (Scientific Software Development GmbH, Berlin, Germany). Codes were created, themes were identified, and consensus was reached through multiple iterations of the analysis by study personnel.

RESULTS

Excessive weight gain was common. Nutritional knowledge was poor and significantly lower among nonpregnant nulliparous women. Women felt sure that they could engage in healthy behaviors, but few did so. Participants in focus groups identified multiple barriers to healthy behaviors in pregnancy and made suggestions on how to help women more readily make improvements in these behaviors.

DISCUSSION

Strategies identified in this study such as providing focused education directed at nonpregnant nulliparous women, stressing portion control, helping women better manage their cravings, and providing more pragmatic support and resources need to be explored in future research.

The views and attitudes of health professionals providing antenatal care to women with a high BMI: a qualitative research study

BACKGROUND

The prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m(2) and over.

METHODS

A qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n=10), one with continuity of care midwives (n=18) and one with obstetricians (n=5). Data were analysed using Interpretative Phenomenological Analysis (IPA).

FINDINGS

Six dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women.

CONCLUSION

Health professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals.

Maternal dietary counseling reduces total and LDL cholesterol postpartum

OBJECTIVE

The aim of this study was to investigate the effects of dietary counseling on blood lipid concentrations during and after pregnancy.

METHODS

Partcipants (N = 256) were randomized into three study groups: dietary counseling with probiotics or placebo and a control group at first trimester of pregnancy. Diet quality was evaluated from food records by an index of healthy eating and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, apolipoproteins A-I and B, and lipoprotein (a) were measured at the first and third trimesters of pregnancy and 1, 6, and 12 mo postpartum.

RESULTS

During pregnancy, no differences in lipid values were noted among the groups, but postpartum TC and LDL-C were lower in both dietary counseling groups compared with controls (P = 0.027 and P = 0.012, respectively). Higher points on the healthy eating index, normal weight, and regular exercise were associated with a more favorable lipid profile at 12 mo after delivery.

CONCLUSION

Maternal dietary counseling may lower maternal TC and LDL-C levels postpartum. A healthy lifestyle during pregnancy and postpartum may benefit women's cardiovascular health.

A qualitative study of motivators and barriers to healthy eating in pregnancy for low-income, overweight, African-American mothers

Poor diet quality is common among low-income, overweight, African-American mothers, placing them at high risk for adverse pregnancy outcomes. We sought to better understand the contextual factors that may influence low-income African-American mothers' diet quality during pregnancy. In 2011, we conducted semi-structured interviews with 21 overweight/obese, pregnant African Americans in Philadelphia, PA, all of whom received Medicaid and were eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children. Two readers independently coded the interview transcripts to identify recurrent themes. We identified 10 themes around motivators and barriers to healthy eating in pregnancy. Mothers believed that consuming healthy foods, like fruits and vegetables, would lead to healthy babies and limit the physical discomforts of pregnancy. However, more often than not, mothers chose foods that were high in fats and sugars because of taste, cost, and convenience. In addition, mothers had several misconceptions about the definition of healthy (eg, "juice is good for baby"), which led to overconsumption. Many mothers feared they might "starve" their babies if they did not get enough to eat, promoting persistent snacking and larger portions. Living in multigenerational households and sharing resources also limited the mothers' control over food choices and made consuming healthy foods especially difficult. Despite the good intentions of low-income African-American mothers to improve diet quality during pregnancy, multiple factors worked together as barriers to healthy eating. Interventions that emphasize tasty and affordable healthy food substitutes, address misconceptions, and counsel mothers about true energy needs in pregnancy may improve low-income, African-American, overweight/obese mothers' diet quality.

Pregnancy Weight Gain Limitation by a Supervised Nutritional Program Influences Placental NF-κB/IKK Complex Expression and Oxidative Stress

OBJECTIVE

Nuclear factor kappa B (NF-κB) pathway and oxidative stress participate in endothelial dysfunction, which is one of the causes of pre-eclampsia. Among the human antioxidant mechanisms, there are the enzymes catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD). Our aim was to measure NF-κB, its inhibitor (IKK) and oxidative stress in placenta and umbilical cord of pregnant women submitted to a supervised nutritional program.

METHODS

TWO GROUPS WERE CONFORMED: A) 14 pregnant women with individualized nutritional counseling, and B) 12 pregnant women without nutritional guidance. NF-κB and IKK were assessed by real time PCR (RT-PCR). Enzymatic activity of CAT, GPx, lipoperoxidation (LPO) and SOD were also evaluated.

RESULTS

Pregnant women that followed a supervised nutritional program had lower levels of systolic (p=0.03) and diastolic pressure (p=0.043) although they were heavier than the control group (p=0.048). Among all the women, the Spearman correlation was positive between weight gain and placental NF-κB expression (1, p≤0.01). In the placenta, women with nutritional advice had lower enzymatic activity of GPx (p≤0.038) and showed a tendency of IKK to be higher than in women without a nutritional supervised program.

CONCLUSION

A supervised nutritional program in pregnancy offers a proven option to control weight gain, hypertension, NF-κB/IKK complex expression and oxidative stress reactions in the placenta.

Update of the Healthy Eating Index: HEI-2010

The Healthy Eating Index (HEI) is a measure of diet quality in terms of conformance with federal dietary guidance. Publication of the 2010 Dietary Guidelines for Americans prompted an interagency working group to update the HEI. The HEI-2010 retains several features of the 2005 version: (a) it has 12 components, many unchanged, including nine adequacy and three moderation components; (b) it uses a density approach to set standards, eg, per 1,000 calories or as a percentage of calories; and (c) it employs least-restrictive standards; ie, those that are easiest to achieve among recommendations that vary by energy level, sex, and/or age. Changes to the index include: (a) the Greens and Beans component replaces Dark Green and Orange Vegetables and Legumes; (b) Seafood and Plant Proteins has been added to capture specific choices from the protein group; (c) Fatty Acids, a ratio of polyunsaturated and monounsaturated to saturated fatty acids, replaces Oils and Saturated Fat to acknowledge the recommendation to replace saturated fat with monounsaturated and polyunsaturated fatty acids; and (d) a moderation component, Refined Grains, replaces the adequacy component, Total Grains, to assess overconsumption. The HEI-2010 captures the key recommendations of the 2010 Dietary Guidelines and, like earlier versions, will be used to assess the diet quality of the US population and subpopulations, evaluate interventions, research dietary patterns, and evaluate various aspects of the food environment.

A decrease in diet quality occurs during pregnancy in overweight and obese women which is maintained post-partum

BACKGROUND

Ensuring adequate dietary intake during pregnancy has important implications for optimising maternal and fetal health. It is not known whether diet quality is altered over pregnancy and the post-partum period.

OBJECTIVE

The aim of this study was to perform a comprehensive assessment of diet quality in overweight and obese women during pregnancy and early post-partum.

DESIGN

In a prospective cohort study, n=301 overweight or obese pregnant women completed a food frequency questionnaire at study entry (10-20 weeks gestation), 28 weeks gestation, 36 weeks gestation and 4 months post-partum for assessment of macronutrient and micronutrient intake and diet quality by the Healthy Eating Index (HEI).

RESULTS

Energy, macronutrient and dietary sources of micronutrients did not alter across pregnancy or post-partum. The HEI was of below average quality in 31.0% of women at baseline. This decreased from week 28 (P<0.001) and was maintained at a lower level post-partum such that HEI levels were lower compared with study entry (53.3±12.7 versus 56.7±10.1, P<0.001). The HEI decrease occurred in association with decreases in the milk, meat and unsaturated oil components, and increases in the proportion of energy from solid fats, alcohol and added sugars (P<0.001), and was independently predicted by the socioeconomic index for areas score (β=-0.011, s.e.=0.011, P=0.031).

CONCLUSION

We report for the first time that dietary quality decreases across pregnancy and is maintained at this reduced level in the early post-partum period in overweight and obese women. Dietary interventions aimed at improving diet quality should be targeted to early pregnancy and post-partum.