Dietary intake in pregnant women in a Spanish Mediterranean area: as good as it is supposed to be?

Advances in the composition, efficacy, and mimicking of human milk phospholipids

Phospholipids are the essential components of human milk, contributing to the enhancement of cognitive development, regulation of immune functions, and mitigation of elevated cholesterol levels. Infant formulas supplemented with phospholipids can change the composition, content, and globule membrane structure of milk lipids, improving their digestive properties and nutritional value. However, mimicking phospholipids in infant formulas is currently limited, and the supplemented standards of phospholipid species and amounts in infant formulas are unknown. Consequently, there is a significant difference between the phospholipids in infant formulas and those in human milk. This article reviews the recent progress in human milk phospholipid research, aiming to describe the composition, content, and positive effects of human milk phospholipids, as well as summarises the dietary sources of phospholipid supplementation and the current state of human milk phospholipid mimicking in infant formulas. This review provides clear directions for research on mimicking human milk phospholipids and evaluating the nutritional functions of phospholipids in infants.

Perinatal dietary patterns and symptomatic depression: A prospective cohort study

To promote maternal and infant health, there is a need to optimise the dietary pattern of pregnant women to reduce perinatal depression. This prospective cohort study was conducted from June 2020 to February 2022, 300 women from a medical center were interviewed during late pregnancy and at 4-6 weeks postpartum. Dietary patterns were derived by factor analysis using a semiquantitative food frequency questionnaire. Symptomatic depression was defined using the Edinburgh Postpartum Depression Scale (EPDS, ranged 0-30). Their dairy, vegetable and fruit intakes were below the Taiwanese recommendations for pregnant women. Symptomatic depression (EPDS ≥10) affected 31.3% in the third trimester and 35.7% postpartum. Pre- and post-EPDS scores were positively correlated (r = 0.386, p < 0.001). Approximately 55% of those depressed before delivery were also depressed postpartum. For late pregnancy, four dietary patterns were identified ('Good oil', 'Vegetables and fruits', 'Omnivorous' and 'Refined-grain and organ meats'). Dietary patterns were classified according to quartiles (Q). Higher omnivorous pattern scores reduced the risk of depression. For prenatal depression, with Q1 as a reference, the risk was reduced by 38% for Q2, 43% for Q3 and 59% for Q4 (p for trend = 0.068). These findings became evident postpartum (reduced risk by 68% for Q2, 69% for Q3 and 70% for Q4 (p = 0.031; p for trend = 0.0032). The association between dietary patterns and depression encourages the routine nutritional management of pregnant women.

Diet quality and nutrient density in pregnant women according to adherence to Mediterranean diet

Background and aims

The dietary pattern followed during pregnancy, specifically healthy dietary patterns such as the Mediterranean diet, is a key factor in the mother's and the offspring's health. Pregnant women dietary intake is not enough to cover the micronutrient requirements of pregnancy, and higher adherence to the Mediterranean diet may improve dietary quality and nutritional density. The aim of the present study was to describe the dietary nutrient intake and diet quality during pregnancy and to evaluate whether a high adherence to Mediterranean diet was associated with a more adequate intake of micronutrients.

Methods

This was a cross-sectional study with 1,356 pregnant women selected during the routine second trimester ultrasound scan (19-23 weeks' gestation). Energy and nutrient intake were calculated using a validated 151-item semi-quantitative food frequency questionnaire and nutrient density was estimated dividing the absolute nutrient intake by total energy intake. Adherence to the Mediterranean diet was evaluated with a 17-item Mediterranean diet adherence score. The criterion used for risk of inadequate nutrient intake has been set below two thirds (2/3) of the dietary reference intakes. The differences were assessed by multivariate linear regression models adjusted for confounders.

Results

A significant proportion of pregnant women had an inadequate intake of macro and micronutrient that was lower in those with high adherence to the Mediterranean diet (≥12 points, n = 122, 19%), including calcium (the Mediterranean diet high adherence 2.5% vs. low adherence 26.7%, p < 0.001), magnesium (0% vs. 7.6%, p = 0.001), iron (24.5% vs. 74.1%, p < 0.001), and vitamin B9 (0% vs. 29.8%, p < 0.001), vitamin C (0% vs. 1.9%, p = 0.033), and vitamin D (61.5% vs. 92.8%, p < 0.001) intake. High adherence to Mediterranean diet was associated with higher intake of protein, monounsaturated fatty acids, fiber, vitamins (B1, B9, C, D), calcium, magnesium, iron, zinc, phosphor, potassium, essential fatty acids, and α-linolenic acid, and with a lower intake of α-linoleic acid and trans fatty acids as compared to low adherence to Mediterranean diet.

Conclusion

High adherence to Mediterranean diet was associated with higher diet quality and lower proportion of inadequate micro and macronutrient intake. The Mediterranean diet promotion, particularly among pregnant women, may be a useful and public health strategy to avoid overweight and nutrient deficiencies.

HBM4EU-MOM: Prenatal methylmercury-exposure control in five countries through suitable dietary advice for pregnancy - Study design and characteristics of participants

BACKGROUND

Seafood is a major source of vital nutrients for optimal fetal growth, but at the same time is the main source of exposure to methylmercury (MeHg), an established neurodevelopmental toxicant. Pregnant women must be provided with dietary advice so as to include safely fish in their diet for nutrition and mercury control. The aim of this work is to present the design of a multicentre randomized control trial (RCT), which combines human biomonitoring (HBM) with dietary interventions using seafood consumption advice to pregnant women for MeHg control, and to collect information about other possible sources of exposure to mercury. It also presents the materials developed for the implementation of the study and the characteristics of the study participants, which were self-reported in the first trimester of pregnancy.

METHODS

The "HBM4EU-MOM" RCT was performed in the frame of the European Human Biomonitoring Initiative (HBM4EU) in five coastal, high fish-consuming European countries (Cyprus, Greece, Spain, Portugal and Iceland). According to the study design, pregnant women (≥120/country, ≤20 weeks gestational age) provided a hair sample for total mercury assessment (THg) and personal information relevant to the study (e.g., lifestyle, pregnancy status, diet before and during the pregnancy, information on seafood and factors related to possible non-dietary exposures to mercury) during the first trimester of pregnancy. After sampling, participants were randomly assigned to "control" (habitual practices) or "intervention" (received the harmonized HBM4EU-MOM dietary advice for fish consumption during the pregnancy and were encouraged to follow it). Around child delivery, participants provided a second hair sample and completed another tailored questionnaire.

RESULTS

A total of 654 women aged 18-45 years were recruited in 2021 in the five countries, primarily through their health-care providers. The pre-pregnancy BMI of the participants ranged from underweight to obese, but was on average within the healthy range. For 73% of the women, the pregnancy was planned. 26% of the women were active smokers before the pregnancy and 8% continued to smoke during the pregnancy, while 33% were passive smokers before pregnancy and 23% remained passively exposed during the pregnancy. 53% of the women self-reported making dietary changes for their pregnancy, with 74% of these women reporting making the changes upon learning of their pregnancy. Of the 43% who did not change their diet for the pregnancy, 74% reported that their diet was already balanced, 6% found it difficult to make changes and 2% were unsure of what changes to make. Seafood consumption did not change significantly before and during the first trimester of pregnancy (overall average ∼8 times per month), with the highest frequency reported in Portugal (≥15 times per month), followed by Spain (≥7 times per month). During the first-trimester of pregnancy, 89% of the Portuguese women, 85% of the Spanish women and <50% of Greek, Cypriot and Icelandic women reported that they had consumed big oily fish. Relevant to non-dietary exposure sources, most participants (>90%) were unaware of safe procedures for handling spillage from broken thermometers and energy-saving lamps, though >22% experienced such an incident (>1 year ago). 26% of the women had dental amalgams. ∼1% had amalgams placed and ∼2% had amalgams removed during peri-pregnancy. 28% had their hair dyed in the past 3 months and 40% had body tattoos. 8% engaged with gardening involving fertilizers/pesticides and 19% with hobbies involving paints/pigments/dyes.

CONCLUSIONS

The study design materials were fit for the purposes of harmonization and quality-assurance. The harmonized information collected from pregnant women suggests that it is important to raise the awareness of women of reproductive age and pregnant women about how to safely include fish in their diet and to empower them to make proper decisions for nutrition and control of MeHg, as well as other chemical exposures.

Dietary intake and socio-economic predictors of inadequate energy and nutrient intake among women of childbearing age in Karamoja sub-region of Uganda

BACKGROUND

Karamoja sub-region is the most food insecure part of Eastern Africa. The poor status of food security in the sub-region is reflected in the high rate of undernutrition among women of childbearing age (WCBA) and children under 5 years (CUFY). The sub-region is unique in Uganda in terms of cultural diversity, agro-ecology and rainfall pattern and agricultural practices. However, the influence of these unique characteristics on dietary intake of WCBA in the sub-region is less understood. Therefore, this study examined dietary intake and socio-economic predictors of inadequate energy and nutrient intake among WCBA in Karamoja sub-region.

METHODS

A longitudinal study design was used involving 755 WCBA in the harvesting season where 635 were followed-up in the planting season. Data were collected using 24-h recall, dietary diversity and socio-economic and demographic questionnaires.

RESULTS

Intake of energy and nutrients were generally significantly higher (p < 0.05) during the planting season than in the harvesting season. Irrespective of the district, physiological status and season, household consumption of plant-based foods was far higher than intake of animal-based foods dominated by starchy stables (76-100%), dark green leafy vegetables (70-100%) and legumes, nuts and seeds (22-97%) depending on the district. Majority of the respondents had two meals (breakfast: 65-100%; supper: 90-100%) with up to 45% of WCBA who consumed alcohol across meal times. .Overall on average, 57.7, 66.6, 78.5, 60.3, 67.7 and 93.7% of WCBA did not meet the recommended daily allowance (RDA) for energy, protein, calcium, iron, zinc and folic acid, respectively. Binary logistic regression revealed that inadequate intake of energy and nutrients significantly increased (p < 0.05) with the status of being lactating/breastfeeding and was influenced by age of WCBA, number of women married, education level and occupation of the household head depending on season.

CONCLUSIONS

This study demonstrated that dietary intake of WCBA in Karamoja sub-region was inadequate. Age of WCBA, number of women married, education level and occupation of the household head and spouse and being a lactating/breastfeeding mother were the key socio-economic and demographic factors that influenced inadequate intake of energy and nutrients among WCBA.

Mediterranean Dietary Pattern and Cardiovascular Risk in Pregnant Women

Nutrition during pregnancy is one of the most important factors that determine the health of a mother and the proper development of her fetus. The main objective of this study was to analyze the association between adherence to a Mediterranean dietary (MedDiet) pattern and cardiovascular (CV) risk factors in pregnant women. Accordingly, we carried out an observational, population-based study using data from pregnant women present in a hospital during the entire course of their pregnancy. Adherence to the MedDiet was assessed using the MedDiet score questionnaire. Our study identified that 87.25% (95%CI: 83.48-90.27) of the women had a cardiovascular risk in relation to their dietary intake. Women with diet-related CV risk were more likely to smoke (p = 0.004), weighed more at the beginning of pregnancy, engaged in little physical activity, and had lower adherence to the MedDiet pattern than women without a diet-related CV risk. Dietary analysis showed low consumption of cereals, vegetables, and fish, which failed to satisfy the recommended portions in Spain. Adequate adherence to the MedDiet was found for 54.2% of women who were considered to be without CV risk and 45.8% of women with CV risk. Our data suggest that the MedDiet could be improved in relation to the consumption of cereals, vegetables, and fish during pregnancy in order to reduce CV risk.

Association between modes of delivery and postpartum dietary patterns: A cross-sectional study in Northwest China

Objective

Puerperae’ dietary patterns (DPs) during the puerperium may be influenced by the mode of delivery, but population studies on this topic are scarce. This study aims to explore the relationship between DPs and different modes of delivery among puerperae.

Methods

A cross-sectional study was conducted on 3,345 parturients in Lanzhou, China. The postpartum food intake was measured by a food frequency questionnaire (FFQ). Factor analysis was used to determine the DPs. Multiple linear regression was employed to examine the association between the mode of delivery and DP.

Results

In this study, two DPs, i.e., traditional and modern DPs, were identified. Traditional DP was characterized by high energy-adjusted intake of tubers, coarse cereals, rice, whole grains, fishery products, and eggs. Modern DP included a high intake of coffee, non-sugary drinks, wine, tea, and fishery products. Compared with participants with vaginal delivery (reference category), cesarean section had an inverse association with modern DP (β: −0.11, 95% CI: −0.36, −0.09). A significant interaction was found between education level, monthly household income, alcohol drinking, and modes of delivery. The inverse association between cesarean section and modern DP or the intake of coffee was significant among puerperae with higher or lower monthly household income. However, the inverse association between cesarean section and traditional DP was only found among puerperae with higher monthly household income. Moreover, among the participants with high education, cesarean section was positively associated with intake of vegetables.

Conclusion

Cesarean puerperae with higher levels of education and those with lower and higher monthly household income had less unhealthy foods intake than those who had vaginal delivery. They need to be accounted for in educational programs and interventions focused on healthy diet recommendations in puerperium.

Longitudinal Nutritional Intakes in Italian Pregnant Women in Comparison with National Nutritional Guidelines

Background: Nutritional quality during pregnancy is crucial for mother and child health and their short/long-term outcomes. The aim of this study is to evaluate the adherence to nutritional recommendations in Italy during the three pregnancy trimesters in Normal Weight (NW) and Over Weight (OW) women. Methods: Data from a multicenter randomized controlled trial included 176 women (NW = 133; OW = 43) with healthy singleton pregnancies enrolled within 13 + 6 weeks of gestation. Dietary intake was assessed every trimester by a Food Frequency Questionnaire. Results: OW and NW had similar gestational weight gain. However, as Institute of Medicine (IOM) recommend lower gestational weight gain (GWG) for OW, they exceeded the suggested range. In both groups, caloric intake during the three trimesters never met recommendations. Protein intake in first and second trimester was higher than recommendations, as was sugars percentage. Dietary fiber intake was lower in OW. Polyunsaturated fatty acids, calcium, iron and folic acid requirements were never satisfied, while sodium intake exceeded recommendations. Conclusions: NW and OW women in Italy do not adhere to nutritional recommendations during pregnancy, with lower caloric intake, protein and sugars excess and inadequacies in micronutrients intake. Pregnant women in Italy should be provided with an adequate counseling and educational intervention as well as supplementation when indicated.

Relationship between Eating Habits, Physical Activity and Tobacco and Alcohol Use in Pregnant Women: Sociodemographic Inequalities

Pregnant women must maintain or acquire healthy habits during pregnancy to protect both their own health and their child's. Such habits include an adequate eating pattern along with good adherence to the intake of certain supplements, practice of moderate physical activity and avoiding the consumption of toxic products such as tobacco and alcohol. The objective of this study is to assess the interrelation between such habits and their association with sociodemographic variables. To such end, a cross-sectional study was conducted with a representative sample of pregnant women who attended the scheduled morphology echography consultation at the 20th gestational week in their reference public hospital in the city of Seville (Spain). Results: Younger pregnant women and with lower educational levels are the ones that present the worst eating habits and the highest smoking rate. Pregnant women with lower educational levels are the least active. Non-smoking pregnant women present better eating habits than those who smoke. Pregnant women with lower educational levels are those who accumulate more unhealthy habits during pregnancy. This should be taken into account when planning the health care provided to pregnant women and in public health intersectoral policies.

Nutritional Inadequacy: Unraveling the Methodological Challenges for the Application of the Probability Approach or the EAR Cut-Point Method-A Pregnancy Perspective

The aim of this study was to unravel the methodological challenges when exploring nutritional inadequacy, involving 608 healthy pregnant women. The usual intake of twenty-one nutrients was recorded by employing a validated FFQ. Simulated datasets of usual intake were generated, with randomly imposed uncertainty. The comparison between the usual intake and the EAR was accomplished with the probability approach and the EAR cut-point method. Point estimates were accompanied by bootstrap confidence intervals. Bootstrap intervals applied on the risk of inadequacy for raw and simulated data tended in most cases to overlap. A detailed statistical analysis, aiming to predict the level of inadequacy, as well as the application of the EAR cut-point method, along with bootstrap intervals, could effectively be used to assess nutrient inadequacy. However, the final decision for the method used depends on the distribution of nutrient-intake under evaluation. Irrespective of the applied methodology, moderate to high levels of inadequacy, calculated from FFQ were identified for certain nutrients (e.g., vitamins C, B6, magnesium, vitamin A), while the highest were recorded for folate and iron. Considering that micronutrient-poor, obesogenic diets are becoming more common, the underlying rationale may help towards unraveling the complexity characterizing nutritional inadequacies, especially in vulnerable populations.

Validity and Reproducibility of a Food Frequency Questionnaire to Assess Nutrients Intake of Pregnant Women in the South-East of Spain

Proper nutrition during pregnancy is pivotal to maintain good health for the child and the mother. This study evaluates the reproducibility and validity of a food frequency questionnaire (FFQ) designed to assess nutrient intake during pregnancy in the GENEIDA (Genetics, Early life Environmental Exposures and Infant Development in Andalusia) prospective birth cohort study. In addition, the nutrient intake was estimated and then compared with European guidelines and other studies. Diet information was collected from 690 pregnant women using a FFQ administered at two periods of pregnancy (used for the reproducibility study) and 24-h dietary recall (for the validity study). Statistical approaches included Spearman's correlation coefficient and percentage agreement, classifying women into the same or adjacent quintiles to assess reproducibility, and limits of agreement (LoA) to evaluate validity. In the study of reproducibility, significant correlations for nutrients adjusted for total energy had an average of 0.417. Moreover, the percentage of subjects classified in the same quintile for nutrient intakes were above 66%. In the validation study, the significant correlation for nutrients adjusted for total energy had an average of 0.272. Nevertheless, the percentage of results in the LoA was above 94%. Our results were similar to other studies suggesting that the FFQ used is a valid tool of collect dietary intakes for South-East Spanish pregnant women.

Maternal Factors Associated with Levels of Fatty Acids, Specifically n-3 PUFA during Pregnancy: ECLIPSES Study

An optimal fatty acid (FA) profile during pregnancy, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), is essential for the health of the mother and child. Our aim was to identify the socioeconomic and maternal lifestyle factors associated with serum FA concentration in pregnant women. A longitudinal study was conducted on 479 pregnant women, who were assessed during the first (T1) and third (T3) trimesters of pregnancy. Data on maternal characteristics, food consumption, and lifestyle were collected. Serum FA concentrations were analysed by a gas chromatography–mass spectrometry combination. The multiple linear regression showed that high educational level and older age were significantly associated with higher EPA and DHA concentrations and lower values of n-6/n-3 and arachidonic acid (AA)/EPA in T1 and/or T3. Regarding diet—fish and seafood consumption increased EPA concentration and reduced n-6/n-3 and AA/EPA values in both trimesters, whereas its consumption increased DHA concentration only in T1. Smoking was associated with lower DHA concentration in T1 and higher values of n-6/n-3 ratio in both trimester. Overweight and obesity were associated with higher values of n-6/n-3 ratio and AA/EPA ratio in T1. A statistically non-significant association was observed with saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA). In conclusion, high educational levels, older age, fish, seafood consumption, and/or non-smoking, are factors that influence better omega-3 polyunsaturated fatty acid (n-3 PUFA) profile in both trimesters of pregnancy. Further research is needed to go in-depth into these findings and their health consequences.

Food Group Intake of Pregnant Jordanian Women Based on the Three Pregnancy Trimesters

Inadequate diets have adverse effects on maternal, fetal, and, possibly, childhood health. This cross-sectional study aimed to examine daily food group intake of pregnant Jordanian women during the three pregnancy trimesters and to compare these to the recommended servings of the five food groups reported by The United States Department of Agriculture and My Plate Plan. A total of 283 pregnant Jordanian women were recruited during their antenatal visits. Data were obtained by interviewer-administered structured questionnaires. Our results showed that 1.1% of participants consumed the recommended number of servings for all five food groups during pregnancy and 10.2% did not consume the minimum number of servings of the five food groups. Nearly half of the participants in the first trimester met the recommended daily servings for three food groups but only approximately two-third of participants met the minimum recommended daily servings for one or two food groups in the second and third trimesters. Consumption of grains and sweets was significantly higher in the third trimester compared with the first and second trimesters. Overall, the majority of pregnant Jordanian women in this study did not consume the recommended number of servings for all five food groups during pregnancy.

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.

Analysis of the Impact of the Confinement Resulting from COVID-19 on the Lifestyle and Psychological Wellbeing of Spanish Pregnant Women: An Internet-Based Cross-Sectional Survey

(1) Background: This study aimed to analyze the impact of the confinement due to the COVID-19 pandemics on the eating, exercise, and quality-of-life habits of pregnant women. (2) Methods: This was an internet-based cross-sectional survey which collected information about adherence to the Mediterranean diet, physical exercise, health-related quality of life (HRQoL), and perceived obstacles (in terms of exercise, preparation for delivery, and medical appointments) of pregnant women before and after the confinement. The survey was conducted in 18–31 May 2020. (3) Results: A total of 90 pregnant women participated in this study. There was a significant decrease in the levels of physical activity (p < 0.01) as well as in HRQoL (p < 0.005). The number of hours spent sitting increased by 50% (p < 0.001), 52.2% were unable to attend delivery preparation sessions because these had been cancelled. However, there were no significant differences in the eating pattern of these women (p = 0.672). Conclusions: These results suggest the need to implement specific online programs to promote exercise and reduce stress, thus improving the HRQoL in this population, should similar confinements need to occur again for any reason in the future.

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.

Nutrient Intake during Pregnancy and Post-Partum: ECLIPSES Study

Pregnancy and post-partum are critical periods in which nutritional intake is essential to maternal and child health. Our aim was to describe dietary intake during pregnancy and post-partum and assess its adequacy. A longitudinal study was conducted on 793 pregnant women. Data about maternal characteristics, health, diet and lifestyle were assessed. Energy and nutritional intake were compared to the Recommended Dietary Allowances (RDA). The results showed that the intake of energy (82.6%), protein (80.6%) and carbohydrate (99.5%) was adequate (above 80% of RDA) during pregnancy, as were vitamins C, B2 and B12; but vitamin D, iron and folate intake were a long way from RDA (below 35%). Similar results were observed for the post-partum period although fiber, and vitamins E and C decreased compared to intake during pregnancy. In conclusion, although nutritional requirements increase during gestation, pregnant women did not increase their energy and nutritional intake during pregnancy and postpartum and they had a high risk of deficient intake of vitamin D, iron and folates during pregnancy, and therefore, of developing an unfavorable nutritional status, contrary to health recommendations. These findings underscore the necessity of intensive nutrition programs during and after pregnancy.

Dietary Iron Intake in Pregnant Women in Europe: A Review of 24 Studies from 14 Countries in the Period 1991-2014

OBJECTIVE

Assessment of dietary iron intake in pregnant women in Europe.

DESIGN

Review. Setting. Literature search of dietary surveys reporting the intake of dietary iron using the PubMed and Google Scholar databases covering the years 1990-2019.

SUBJECTS

Healthy pregnant women.

RESULTS

24 dietary surveys/studies in 14 European countries were included. Nine studies (38%) used Food Frequency Questionnaires, which yielded significantly higher iron intake than studies using Dietary Records. Results from Dietary Record studies in 11 countries showed that iron intake varied between 8.3-15.4 mg/day with an estimated "median" value of 10-11 mg/day. Spain, Bosnia, and Poland reported an intake of 8.3-10.1 mg/day, Croatia, England, Norway, and Finland an intake of 10.2-11.4 mg/day, and Germany, Portugal, Czech Republic, and Greece an intake of 12.2-15.4 mg/day. The recommended iron intake in the various countries varied from 14.8-30 mg/day. In all studies, 60-100% of the women had a dietary iron intake below the recommended intake.

CONCLUSIONS

In Europe, the majority of pregnant women have a dietary iron intake, which is markedly below the recommended intake. This contributes to a low iron status in many pregnant women. Most guidelines do not advice routine iron supplements, while two guidelines (World Health Organization and Nordic Nutrition Recommendations) recommend routine iron supplementation during pregnancy. Within the European community, we need to reach consensus on the various guidelines and on the issue of iron supplementation. We should establish common European standardized dietary methods, uniform Dietary Reference Values, and uniform statistical methods in order to perform more reliable comparisons between studies in different countries.

Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort

Background

A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines.

Objective

This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG).

Design

We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy.

Results

Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level.

Discussion

Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes.

Conclusions

This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.

Food Consumption during Pregnancy and Post-Partum. ECLIPSES Study

Inadequate maternal diet can adversely affect mother and child. Our aim was to assess adherence to the Spanish dietary guidelines and to the Mediterranean diet, to analyze changes in diet during pregnancy and post-partum, and to identify maternal factors associated with food consumption. A total of 793 healthy pregnant women were recruited during the first prenatal visit and followed until the post-partum period. Data from the clinical history, anthropometric measurements, and lifestyle habits were collected. Food consumption was evaluated using a food frequency questionnaire. The results show that in pregnant women the consumption of healthy foods did not meet recommendations, whereas consumption of red and processed meat and sweet food exceeded recommendations. The results also show a medium adherence to the Mediterranean diet that remained unchanged throughout pregnancy. A significant decrease was observed in the consumption of fruits, followed by vegetables and then salted and sweet cereals from pregnancy to post-partum. A better adherence to the Mediterranean diet has been reported by pregnant women that are older, of higher social class, and higher education level, and who do not smoke nor drink (p < 0.005). In conclusion, the diet of pregnant women from Spain departs from recommendations, medium adherence to the Mediterranean diet was maintained throughout the pregnancy and post-partum, and a decreasing consumption of healthy food from the first trimester to the post-partum period was observed. Maternal factors such as age, social class, education, and smoking influence diet quality.

The Concentration of Omega-3 Fatty Acids in Human Milk Is Related to Their Habitual but Not Current Intake

This study determined fatty acid (FA) concentrations in maternal milk and investigated the association between omega-3 fatty acid levels and their maternal current dietary intake (based on three-day dietary records) and habitual dietary intake (based on intake frequency of food products). Tested material comprised 32 samples of human milk, coming from exclusively breastfeeding women during their first month of lactation. Milk fatty acids were analyzed as fatty acid methyl ester (FAME) by gas chromatography using a Hewlett-Packard 6890 gas chromatograph with MS detector 5972A. We did not observe any correlation between current dietary intake of omega-3 FAs and their concentrations in human milk. However, we observed that the habitual intake of fatty fish affected omega-3 FA concentrations in human milk. Kendall’s rank correlation coefficients were 0.25 (p = 0.049) for DHA, 0.27 (p = 0.03) for EPA, and 0.28 (p = 0.02) for ALA. Beef consumption was negatively correlated with DHA concentrations in human milk (r = −0.25; p = 0.046). These findings suggest that current omega-3 FA intake does not translate directly into their concentration in human milk. On the contrary, their habitual intake seems to markedly influence their milk concentration.

Do Current Fortification and Supplementation Programs Assure Adequate Intake of Fat-Soluble Vitamins in Belgian Infants, Toddlers, Pregnant Women, and Lactating Women?

Abstracts: Adequate intakes of fat-soluble vitamins are essential to support the growth and development of the foetus, the neonate, and the young child. By means of an online self-administered frequency questionnaire, this study aimed to evaluate the intake of vitamins A, D, E, and K in Belgian infants (n = 455), toddlers (n = 265), pregnant women (n = 161), and lactating women (n = 165). The contribution of foods, fortified foods, and supplements on the total intake was quantified. 5% of toddlers, 16% of pregnant women, and 35% of lactating women had an inadequate vitamin A intake. Conversely, excessive vitamin A intakes were associated with consumption of liver (products). Furthermore, 22% of infants were at risk for inadequate vitamin D intake due to the lack of prophylaxis, while consumption of highly dosed supplements posed a risk for excessive intakes in 6%-26% of infants. Vitamin D intake in pregnant women and lactating women was inadequate (median of 51%, respectively, 60% of the adequate intake). In all groups, the risk for inadequate intake of vitamin E and K was low. Contribution of fortified foods to vitamin A, D, E, and K intake was minor, except in toddlers. National fortification strategies should be investigated as an alternative or additional strategy to prevent vitamin D and A deficiency. There is a need to revise and set uniform supplement recommendations. Finally, non-users of vitamin D prophylaxis need to be identified for targeted treatment.

Factors associated with adherence to nutritional recommendations before and during pregnancy

Several epidemiologic studies and clinical trials have demonstrated the value of balanced nutrition during pregnancy. This study aimed to examine the degree of adherence to nutritional recommendations among 1,175 pregnant Spanish women and the factors associated with such adherence to pre-pregnancy and during the first half of pregnancy. Data were collected during June 2004-March 2007 and included socio-demographic and lifestyle factors. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed using logistic regression models to identify factors associated with adherence to dietary recommendations. Before pregnancy, slightly less than one quarter of the pregnant women (21 percent) did not meet the recommended intake of both vegetables and cereals, and 50 percent did not meet the recommended intake of fruits. Yet most of the participants exceeded the recommended values for proteins. During pregnancy, the adherence for all food types decreased. Factors associated with adherence to the nutritional recommendations were similar before and during pregnancy. Adherence to the Spanish Society of Community Nutrition dietary recommendations was lower among pregnant women who were younger, from a low social class, smokers, and had a low level of physical activity. These findings suggest that nutritional education should become an essential part of antenatal care.

Adequacy of nutritional intake from food and supplements in a cohort of pregnant women in Québec, Canada: the 3D Cohort Study (Design, Develop, Discover)

Background: Assessments of the dietary intakes in various populations suggest that pregnant women have difficulty meeting all their nutritional requirements through diet alone. Few large-scale studies have considered both food sources and supplements in assessing the adequacy of nutritional intakes during pregnancy.Objective: Our study aimed to assess nutritional intakes during pregnancy by examining dietary sources and supplements. It then compared these findings with Dietary Reference Intakes.Design: We conducted a nutrition study in a large pregnancy cohort using a 3-d food record during the second trimester of pregnancy. Detailed information about supplement consumption was obtained by interview at each prenatal visit. We estimated the distribution of total usual intakes for energy, macronutrients, and micronutrients for 1533 pregnant women.Results: A third of the participants had total fat intakes that exceeded the Acceptable Micronutrient Distribution Range. A majority of women (85%) had sodium intakes above the Tolerable Upper Intake Level (UL). Median intakes for fiber and potassium were lower than Adequate Intakes. Dietary intakes of vitamin B-6, magnesium, and zinc were below the Estimated Average Requirements (EARs) for 10-15% of the women. A majority of the women had dietary intakes below the EARs for iron (97%), vitamin D (96%), and folate (70%). When we considered micronutrient intakes from both food and supplements, we found that the prevalence of inadequate intake was <10% for all nutrients except vitamin D (18%) and iron (15%), whereas 32% and 87% of the women had total intakes above the ULs for iron and folic acid, respectively.Conclusions: The level of intake of some nutrients from food alone remains low in the diets of pregnant women. Supplement use reduces the risk of inadequate intake for many micronutrients, but diet-related issues during pregnancy remain and deserve to be addressed in public health interventions. This trial was registered at clinicaltrials.gov as NCT03113331.

Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women

BACKGROUND

A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age.

METHODS

Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9-20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model.

RESULTS

The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04).

CONCLUSIONS

We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov database, NCT01001689 . https://clinicaltrials.gov/ct2/show/NCT01001689?term=NCT01001689&rank=1 .

Systematic Review on N-3 and N-6 Polyunsaturated Fatty Acid Intake in European Countries in Light of the Current Recommendations - Focus on Specific Population Groups

BACKGROUND

Earlier reviews indicated that in many countries adults, children and adolescents consume on an average less polyunsaturated fatty acids (PUFAs) than recommended by the Food and Agriculture Organisation/World Health Organisation.

SUMMARY

The intake of total and individual n-3 and n-6 PUFAs in European infants, children, adolescents, elderly and pregnant/lactating women was evaluated systematically.

RESULTS

The evaluations were done against recommendations of the European Food Safety Authority. Key Messages: Fifty-three studies from 17 different European countries reported an intake of total n-3 and n-6 PUFAs and/or individual n-3 or n-6 PUFAs in at least one of the specific population groups: 10 in pregnant women, 4 in lactating women, 3 in infants 6-12 months, 6 in children 1-3 years, 11 in children 4-9 years, 8 in adolescents 10-18 years and 11 in elderly >65 years. Mean linoleic acid intake was within the recommendation (4 energy percentage [E%]) in 52% of the countries, with inadequate intakes more likely in lactating women, adolescents and elderly. Mean α-linolenic acid intake was within the recommendation (0.5 E%) in 77% of the countries. In 26% of the countries, mean eicosapentaenoic acid and/or docosahexaenoic acid intake was as recommended. These results indicate that intake of n-3 and n-6 PUFAs may be suboptimal in specific population groups in Europe.

Women who take n-3 long-chain polyunsaturated fatty acid supplements during pregnancy and lactation meet the recommended intake

The aim of the current study was to estimate total intake and dietary sources of eicosapentaenoic acid (EPA), docosapentanoic (DPA), and docosahexaenoic acid (DHA) and compare DHA intakes with the recommended intakes in a cohort of pregnant and lactating women. Twenty-four-hour dietary recalls and supplement intake questionnaires were collected from 600 women in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort at each trimester of pregnancy and 3 months postpartum. Dietary intake was estimated in 2 ways: by using a commercial software program and by using a database created for APrON. Only 27% of women during pregnancy and 25% at 3 months postpartum met the current European Union (EU) consensus recommendation for DHA. Seafood, fish, and seaweed products contributed to 79% of overall n-3 long-chain polyunsaturated fatty acids intake from foods, with the majority from salmon. The estimated intake of DHA and EPA was similar between databases, but the estimated DPA intake was 20%-30% higher using the comprehensive database built for this study. Women who took a supplement containing DHA were 10.6 and 11.1 times more likely to meet the current EU consensus recommendation for pregnancy (95% confidence interval (CI): 6.952-16.07; P<0.001) and postpartum (95% CI: 6.803-18.14; P<0.001), respectively. Our results suggest that the majority of women in the cohort were not meeting the EU recommendation for DHA during pregnancy and lactation, but taking a supplement significantly improved the likelihood that they would meet recommendations.

Dietary and health profiles of Spanish women in preconception, pregnancy and lactation

The nutritional status and lifestyle of women in preconception, pregnancy and lactation determine maternal, fetal and child health. The aim of this cross-sectional study was to evaluate dietary patterns and lifestyles according the perinatal physiological status in a large sample of Spanish women. Community pharmacists that were previously trained to collect the data recruited 13,845 women. General information, anthropometric measurements, physical activity, unhealthy habits and dietary data were assessed using a validated questionnaire. Mean values and percentages were used as descriptive statistics. The t-test, ANOVA or chi-squared test were used to compare groups. A score that included dietary and behavioral characteristics was generated to compare lifestyles in the three physiological situations. The analysis revealed that diet quality should be improved in the three stages, but in a different manner. While women seeking a pregnancy only met dairy recommendations, those who were pregnant only fulfilled fresh fruits servings and lactating women only covered protein group requirements. In all cases, the consumption allowances of sausages, buns and pastries were exceeded. Food patterns and unhealthy behaviors of Spanish women in preconception, pregnancy and lactation should be improved, particularly in preconception. This information might be useful in order to implement educational programs for each population group.

Changes in beverage consumption from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study

OBJECTIVE

To describe changes in consumption of different types of beverages from pre-pregnancy to early pregnancy, and to examine associations with maternal age, educational level and BMI.

DESIGN

Cross-sectional design. Participants answered an FFQ at inclusion into a randomized controlled trial, the Fit for Delivery (FFD) trial, in median gestational week 15 (range: 9-20), reporting current consumption and in retrospect how often they drank the different beverages pre-pregnancy.

SETTING

Eight local antenatal clinics in southern Norway from September 2009 to February 2013.

SUBJECTS

Five hundred and seventy-five healthy pregnant nulliparous women.

RESULTS

Pre-pregnancy, 27 % reported drinking alcohol at least once weekly, compared with none in early pregnancy (P<0.001). The percentage of women drinking coffee (38 % v. 10 %, P<0.001), sugar-sweetened beverages (10 % v. 6 %, P=0.011) and artificially sweetened beverages (12 % v. 9 %, P=0.001) at least daily decreased significantly from pre-pregnancy to early pregnancy, while the percentage of women who reported to drink water (85 % v. 92 %, P<0.001), fruit juice (14 % v. 20 %, P=0.001) and milk (37 % v. 42 %, P=0.001) at least daily increased significantly. From pre-pregnancy to early pregnancy higher educated women reduced their consumption frequency of coffee significantly more than women with lower education. Older women reduced their consumption frequency of coffee and artificially sweetened beverages and increased their consumption frequency of fruit juice and milk significantly more than younger women.

CONCLUSIONS

There is a significant change in beverage consumption from pre-pregnancy to early pregnancy among Norwegian nulliparous women.

Association between dietary carbohydrate intake quality and micronutrient intake adequacy in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project

Epidemiological research confirms that the prevalence of suboptimal micronutrient intakes across Europe is an emerging concern in terms of public health. The aim of the present study was to investigate the association between a new index of carbohydrate (CHO) quality and micronutrient intake adequacy in the ‘Seguimiento Universidad de Navarra (SUN)’ cohort. The baseline assessment extended from 1999 to March 2012. We assessed 16 841 participants who completed a validated 136-item semi-quantitative FFQ at baseline. We created a new index to evaluate CHO quality for the following four criteria: dietary fibre intake; glycaemic index; whole grains:total grains ratio; solid CHO:total CHO ratio. The subjects were classified into quintiles according to this index. We evaluated the intakes of Zn, I, Se, Fe, Ca, K, P, Mg, Cr and vitamins B1, B2, B3, B6, B12, C, A, D, E and folic acid. The probability of intake adequacy was evaluated using the estimated average requirement cut-point approach and the probabilistic approach. Logistic regression analysis was used to assess the nutritional adequacy according to the CHO quality index (CQI). Participants in the highest quintile of CQI were found to have the lowest prevalence of inadequacy. A higher quality of CHO intake was found to be associated with a lower risk of nutritional inadequacy in comparison with the lowest quintile of CQI (adjusted OR 0·06, 95 % CI 0·02, 0·16;Pfor trend < 0·001). A higher CQI was found to be strongly associated with better micronutrient intake adequacy in the young Mediterranean cohort, stressing the importance of focusing nutritional education not only on CHO quantity, but also on quality.

Dietary folate intake and blood biomarkers reveal high-risk groups in a Mediterranean population of healthy women of childbearing potential

BACKGROUND/AIMS

An important public health issue is monitoring folate inadequacy in women of childbearing potential. The aim of the present study was to investigate associations between folate intake, red blood cell (RBC) folate, total homocysteine (tHcy) and the MTHFR 677T allele.

METHODS

A total of 204 women were enrolled in a cross-sectional study. Folate intake was assessed by a food frequency questionnaire, and RBC folate, tHcy and MTHFR C677T genotype were determined.

RESULTS

About half of the women had a decreased RBC folate level (<305 nmol/l) and all were <906 nmol/l, even though 51% of the subjects reported use of supplements. Overall 91.5% had a high Hcy concentration. Notably, younger women, and those with a low level of education, were shown to be at higher risk of inadequate RBC folate levels. Additionally, younger women were also at higher risk of carrying the TT genotype, particularly unfavorable in the setting of a low folate status.

CONCLUSIONS

Our study revealed significant folate deficiency in our Mediterranean population and higher than ideal Hcy concentrations, thus emphasizing that in these groups an improvement in the folate status is needed via a food-based approach or supplement. Consequently, public health policy strategies aiming at improved supplementation are required.