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

Is the Underreporting of Energy Intake Associated with Chrononutritional and Clinical Parameters During Pregnancy?

INTRODUCTION

Underreporting of food intake corresponds to distortions in self-reported food consumption and can lead to inadequacies in dietary prescriptions, which play an important role in preventing excessive weight gain during pregnancy. Recent studies in the field of chrononutrition indicate that meal times influence the quality, quantity, and distribution of calories throughout the day.

OBJECTIVE

To evaluate the association of energy intake underreporting with chrononutritional and clinical variables throughout pregnancy.

MATERIAL AND METHODS

Prospective cohort study carried out with 100 pregnant women followed up in the three gestational trimesters. Food intake assessment was conducted using three 24-h dietary recalls. Chrononutritional variables evaluated included eating duration, overnight fasting, timing of first and last meals, and the number of eating episodes. The clinical variables evaluated were the adequacy of weight gain and fasting glucose. The occurrence of underreporting was calculated using the Goldberg method and the pregnant women were categorized into three groups: Underreporters (UR), Potential Underreporters (PUR) and Normal Reporters (NR). Generalized estimating equations (GEE) adjusted for confounders were used to assess the association between three groups of levels of energy notification (independent variables) and chrononutritional and clinical variables (dependent variables) throughout pregnancy.

RESULTS

Underreporters group reported having first meal later (mean ± standard error: UR-9:26 ± 0:11 vs PUR-8:34 ± 0:09 and NR-8:32 ± 0:08), last meal earlier (UR-19:47 ± 0:10 vs PUR-20:17 ± 0:07 and NR-20:46 ± 0:08), shorter eating duration (UR-10:22 ± 0:14 vs PUR-11:43 ± 0:12 and NR-12:12 ± 0:12), longer overnight fasting (UR-10:58 ± 0:08 vs PUR-10:30 ± 0:08 and NR-10:05 ± 0:08), lower number of eating episodes (UR-4.16 ± 0.13 vs PUR-4.90 ± 0.12 and NR-5.11 ± 0.12), exhibited higher fasting glucose (UR-80.33 ± 1.30 vs NR-74.45 ± 1.90) during pregnancy and greater excessive weight gain in the third trimester (UR-2.20 ± 0.26 vs NR-1.58 ± 0.19).

CONCLUSION

Distinct chrononutritional patterns observed in women who underreported food intake suggest that underreporting is associated not only with overall food intake but also with meal patterns, particularly the timing of the first and last meals of the day. Further studies are needed to validate this hypothesis.

Metabolic outcomes in women 6 months and 2 years after preeclampsia versus normotensive pregnancy: A P4 study

Preeclampsia is associated with an increased risk of long-term cardiometabolic disease; however, little is known regarding metabolic factors in the early postpartum years potentially contributing to these health disparities. This study aimed to compare body composition, serum biochemical parameters, energy balance and diet 6 months and 2 years after normotensive pregnancy versus preeclampsia. This is the longitudinal metabolic sub-study of the Postpartum Physiology, Psychology and Paediatric cohort study. Women were assessed 6 months and 2 years after normotensive pregnancy (n = 118) and preeclampsia (n = 47). Metabolic measures included anthropometry, body composition via bioelectrical impedance analysis, serum biochemical parameters, diet via a food recall diary, and 24-h energy expenditure using SenseWear Armbands. Two years postpartum, women after preeclampsia continued to have significantly higher weight (median 67.1 kg vs. 63.1 kg, p = .04) compared to normotensive pregnancies, in addition to higher LDL cholesterol levels (2.7 ± 0.8 mmol/L vs. 2.4 ± 0.6 mmol/L, p = .03). These women were also more likely to have an elevated HOMA-IR score ≥2.08 (44% vs. 19%, p = .01). For all women in our study, waist-to-hip ratio, percent fat mass and activity-associated energy expenditure improved overtime. However, HDL cholesterol levels deteriorated, and excess saturated fat and sodium intake persisted from 6 months postpartum. Therefore, two years after preeclampsia, women remain at greater metabolic risk than their normotensive counterparts, with greater weight, LDL cholesterol and markers of insulin resistance, potentially contributing to long-term cardiovascular morbidity and requiring early intervention.

Diet quality from early pregnancy through 1-y postpartum: a prospective cohort study

BACKGROUND

Although diet quality during pregnancy and postpartum is important for multiple parent and child outcomes, within-person changes in diet quality throughout these periods have not been extensively examined.

OBJECTIVES

This study investigated diet quality from early pregnancy through 1 y postpartum and examined differences by sociodemographic characteristics in participants receiving obstetric care in Chapel Hill, North Carolina, United States.

METHODS

Participants completed 24-h dietary recalls at 6 study visits (each pregnancy trimester and 6 wk, 6 mo, and 1 y postpartum) (n = 383). Between-visit mean Healthy Eating Index-2015 (HEI) scores (min = 0, max = 100) were compared using the population ratio (PR) method. The NCI usual intakes method estimated the distribution of HEI scores in pregnancy and postpartum; unpaired t-tests compared usual mean HEI scores by covariates; paired t-tests compared differences between mean pregnancy and postpartum.

RESULTS

The total HEI mean ± standard error scores (NCI method) were 61.4 ± 0.8 in pregnancy and 61.7 ± 0.9 in postpartum. Mean HEI scores differed by sociodemographic characteristics, particularly education, marital status, and federal assistance participation. The highest scores were observed in participants with at least a bachelor's degree (64.1 ± 0.9 in pregnancy, 64.5 ± 1.0 in postpartum, n = 257) and those with other non-Hispanic White race/ethnicity (64.7 ± 1.8 in pregnancy, 66.4 ± 2.2 in postpartum). There were no between-visit differences in mean total HEI scores (PR). Although differences were observed in some mean HEI component scores between pregnancy and postpartum visits, they were small (mostly <1 point) in magnitude and in inconsistent directions.

CONCLUSIONS

Stable total HEI mean scores suggest that adherence to dietary guidelines was consistent throughout pregnancy and postpartum in this sample. Although some sociodemographic characteristics may identify individuals at greater risk of diet-related pregnancy complications, low diet quality was pervasive throughout all subgroups and reflects an urgent need for widespread improvement.

Implementation of Postpartum Nutritional Interventions in Healthcare, Community and eHealth: A Systematic Review

OBJECTIVES

The efficacy of interventions targeting lifestyle habits, particularly dietary habits, among postpartum women is well established. However, whether these results can be translated into tangible changes in the care and services provided to this population remains unclear. Therefore, the aim is to examine the implementation outcomes of postpartum nutritional interventions delivered in healthcare, community, or eHealth settings.

METHODS

A search was conducted in the MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library databases in July 2024, to identify all relevant studies. Included studies had to report at least 1 of the 8 implementation outcomes studied: acceptability, adoption, appropriateness, implementation cost, feasibility, fidelity, penetration, and sustainability. Study selection and data extraction were performed by two independent reviewers. Descriptive analysis of reported outcomes was performed.

PROSPERO ID

CRD42022351411.

RESULTS

Of the 8907 unique studies identified, 26 interventions (24 publications) were included.There was a great heterogeneity among interventions studied and implementation outcomes reported. Acceptability, feasibility, and fidelity were the most studied implementation outcomes. Overall, postpartum nutritional interventions were found to be acceptable and useful, but improvements were suggested by participants, such as more frequent contacts and longer programs. Recruitment, retention, participation, and penetration rates widely varied across studies. Challenges hindering the delivery of nutritional interventions were reported by participants, such as lack of time and the presence of medical conditions following delivery. CONCLUSIONS FOR PRACTICE: This review demonstrates the potential for the delivery and implementation of nutritional interventions in real-world settings during the postpartum period.

Bone development in fetuses with intrauterine growth restriction caused by maternal endocrine-metabolic dysfunctions

Intrauterine growth restriction (IUGR) affects a large proportion of infants, particularly in underdeveloped countries. Among the main causes of IUGR, maternal endocrine-metabolic dysfunction is highlighted, either due to its high incidence or due to the severity of the immediate and mediated changes that these dysfunctions cause in the fetus and the mother. Although the effects of endocrine and metabolic disorders have been widely researched, there are still no reviews that bring together and summarize the effects of these conditions on bone development in cases of IUGR. Therefore, the present literature review was conducted with the aim of discussing bone changes observed in fetuses with IUGR caused by maternal endocrine-metabolic dysfunction. The main endocrine dysfunctions that occur with IUGR include maternal hyperthyroidism, hypothyroidism, and hypoparathyroidism. Diabetes mellitus, hypertensive disorders, and obesity are the most important maternal metabolic dysfunctions that compromise fetal growth. The bone changes reported in the fetus are, for the most part, due to damage to cell proliferation and differentiation, as well as failures in the synthesis and mineralization of the extracellular matrix, which results in shortening and fragility of the bones. Some maternal dysfunctions, such as hyperthyroidism, have been widely studied, whereas conditions such as hypoparathyroidism and gestational hypertensive disorders require further study regarding the mechanisms underlying the development of bone changes. Similarly, there is a gap in the literature regarding changes related to intramembranous ossification, as most published articles only describe changes in endochondral bone formation associated with IUGR. Furthermore, there is a need for more research aimed at elucidating the late postnatal changes that occur in the skeletons of individuals affected by IUGR and their possible relationships with adult diseases, such as osteoarthritis and osteoporosis.

Maternal diet quality trajectories from pregnancy to 3.5 years postpartum and associated maternal factors

PURPOSE

This study examined maternal diet quality trajectories from pregnancy to 3.5 years postpartum and associated maternal factors.

METHODS

Data of 473 Australian women from the Healthy Beginnings Trial were used. A food frequency questionnaire collected dietary intake in pregnancy and 1, 2 and 3.5 years postpartum. Diet quality scores were calculated using the 2013 Dietary Guideline Index (DGI-2013) and RESIDential Environments Guideline Index (RDGI). Group-based trajectory modelling identified diet quality trajectories from pregnancy to 3.5 years postpartum. Multivariable logistic regression investigated factors associated with maternal diet quality trajectories.

RESULTS

Two stable trajectories of low or high diet quality were identified for the DGI-2013 and RDGI. Women who smoked had higher odds of following the low versus the high DGI-2013 (OR 1.77; 95%CI 1.15, 2.75) and RDGI (OR 1.80; 95%CI 1.17, 2.78) trajectories, respectively. Women who attended university had lower odds of following the low versus the high DGI-2013 (OR 0.41; 95%CI 0.22, 0.76) and RDGI (OR 0.38; 95%CI 0.21, 0.70) trajectories, respectively. Women who were married had lower odds of following the low versus the high DGI-2013 trajectory (OR 0.39; 95%CI 0.17, 0.89), and women who were unemployed had higher odds of following the low versus the high RDGI trajectory (OR 1.78; 95%CI 1.13, 2.78). Maternal age, country of birth, household composition and pre-pregnancy body mass index were not associated with diet quality trajectories.

CONCLUSION

Maternal diet quality trajectories remained stable from pregnancy to 3.5 years postpartum. Women who smoked, completed high school or less, were not married or were unemployed tended to follow low, stable diet quality trajectories.

Hedonic hunger, ultra-processed food consumption, and the moderating effects of impulsivity in pregnant individuals with body mass index ≥ 25

Evidence suggests higher hedonic hunger (preoccupation with/desire to consume food for pleasure) is associated with greater ultra-processed food (UPF) consumption in non-pregnant individuals with higher, but not lower, self-report impulsivity or delay discounting. The current study tested the association between hedonic hunger and UPF consumption, and the moderating effects of self-report impulsivity and delay discounting, during pregnancy. Individuals (N = 220) with body mass index (BMI)≥25 completed the Power of Food Scale, 24-h dietary recalls, and Barratt Impulsiveness Scale-Version 11 in early-mid pregnancy. A subset enrolled in an ancillary study (n = 143) completed a Delay Discounting Task. Linear regression and moderation models covaried for age, gestational age, pre-pregnancy BMI, and socioeconomic status. The association between hedonic hunger and UPF consumption was nonsignificant (p = 0.47). Self-report impulsivity was not a significant moderator (p = 0.11), but delay discounting was (p = 0.01). Simple slopes analysis revealed a one-unit increase in hedonic hunger was associated with 7% lower UPF intake among participants with lower (M+1SD) delay discounting (p = 0.01) and 1% higher UPF intake among those with higher (M-1SD) delay discounting (p = 0.57). Findings contrast those from research with non-pregnant samples and indicate lower delay discounting may serve as a protective factor, associated with reduced UPF consumption at higher levels of hedonic hunger, during pregnancy.

Supplementation with antioxidant micronutrients in pregnant women with obesity: a randomized controlled trial

BACKGROUND/OBJECTIVE

Obesity increases maternal morbidity and adversely affects child health. Maternal inflammation may play a role in adverse outcomes. The objective of this study was to determine whether providing a higher dose of antioxidant micronutrients to pregnant women with obesity would raise concentrations of key antioxidant vitamins and impact inflammation and oxidative stress during pregnancy.

SUBJECTS/METHODS

This was a double-blind, randomized controlled trial. We recruited pregnant women with a body mass index (BMI) ≥ 30 kg/m2 at their initial prenatal visit ( < 13 weeks gestation) and collected blood and urine samples at baseline, 24-28 weeks, and 32-36 weeks to measure micronutrient concentrations (vitamin C, E, B6 and folate), markers of inflammation (C-reactive protein, interleukin-6, 8, and 1β) and oxidative stress (8-epi-PGF2α and malondialdehyde). We collected maternal and infant health data from enrollment to delivery as secondary outcomes. We enrolled 128 participants (64 in each arm), and 98 (49 in each arm) completed follow-up through delivery.

INTERVENTION

Both groups received a standard prenatal vitamin containing the recommended daily allowance of micronutrients in pregnancy. In addition, the intervention group received a supplement with 90 mg vitamin C, 30 αTU vitamin E, 18 mg vitamin B6, and 800 μg folic acid, and the control group received a placebo.

RESULTS

The intervention group had higher vit B6 (log transformed (ln), β 24-28 weeks: 0.76 nmol/L (95% CI: 0.40, 1.12); β 32-36 weeks: 0.52 nmol/L (95% CI: 0.17, 0.88)) than the control group. Vitamins C, E, erythrocyte RBC folate concentrations did not differ by randomization group. The intervention did not impact biomarkers of inflammation or oxidative stress. There were no differences in maternal or neonatal clinical outcomes by randomization group.

CONCLUSIONS

Higher concentrations of antioxidant vitamins during pregnancy increased specific micronutrients and did not impact maternal inflammation and oxidative stress, which may be related to dosing or type of supplementation provided.

CLINICAL TRIAL REGISTRATION

Clinical Trial Identification Number: NCT02802566; URL of the Registration Site: www.

CLINICALTRIALS

gov .

Nutritional Status of Breastfeeding Mothers and Impact of Diet and Dietary Supplementation: A Narrative Review

Adequate nutrition during breastfeeding is crucial for ensuring the good health of mothers and babies. Despite the high energy and nutrient demands of breastfeeding, lactating women are often vulnerable from a nutritional perspective. The nutritional focus during breastfeeding tends to be on the newborn, often neglecting the mother's diet. Therefore, in the present narrative review, nutrient intakes were compared with the dietary reference values (DRVs) proposed by the European Food Safety Authority (EFSA) as well as by the World Health Organization/Food and Agriculture Organization (WHO/FAO). In the diets of lactating mothers, dietary inadequacies were observed in the intake of some vitamins, such as folic acid, vitamin B12, vitamin A, and vitamin D, and in the intake of certain minerals like calcium, iron, and iodine; polyunsaturated omega-3 fatty acid deficiencies, primarily in eicosapentaenoic acid and docosahexaenoic acid, were also observed. On the other hand, the debate on the necessity of supplementation during lactation continues; the need for nutritional supplementation during lactation depends on many factors, such us mothers' eating habits. There seems to be a positive association between nutritional supplementation of the lactating mother and the concentration of certain nutrients in human milk. The present narrative review provides an update on the nutritional status (fatty acids and micronutrients) of breastfeeding mothers and the impact of diet and dietary supplementation on human milk composition.

Experiences of Physical Activity, Healthy Eating and Quality of Life During and Following Pregnancy in Overweight and Obese Postpartum Women

OBJECTIVES

This retrospective study explored the experiences of women with overweight or obesity regarding physical activity, diet and quality of life leading up to, during, and following pregnancy.

METHODS

A qualitative descriptive design was adopted, whereby data collected through semi-structured interviews were analysed using thematic analysis. Throughout the interviews, individuals were asked to describe their barriers to a healthy lifestyle during and following pregnancy.

RESULTS

Ten women (34.5 ± 5.2 years old, BMI 30.4 ± 3.5 kg·m- 2) who were between 12 and 52 weeks postpartum participated. A range of themes were identified when discussing barriers to physical activity and healthy eating during and following pregnancy. For example, tiredness, especially in the third trimester of pregnancy, and a lack of support at home, was often cited as preventing engagement in exercise and healthy eating practices. A lack of convenience when attending exercise classes, medical complications following the birth and the cost of attending pregnancy-specific classes were identified as barriers to exercise engagement. Cravings and nausea were identified as barriers to healthy eating during pregnancy. Quality of life was positively associated with exercise and healthy eating, whilst a lack of sleep, loneliness and a loss of freedom since the baby had arrived negatively influenced quality of life.

DISCUSSION

Postpartum women with overweight and obesity experience many barriers when attempting to engage in a healthy lifestyle during and following pregnancy. These findings can be used to inform the design and delivery of future lifestyle interventions in this population.

Dietary Patterns in Pregnancy and the Postpartum Period and the Relationship with Maternal Weight up to One Year after Pregnancy Complicated by Gestational Diabetes

This multicentric cohort study aimed to describe changes in dietary patterns during pregnancy and postpartum and the association with BMI variation at six and twelve months postpartum in women with gestational diabetes mellitus (GDM). Between 2014 and 2018, we enrolled women with GDM in prenatal clinics of the Brazilian National Health System and followed them for one year postpartum. The dietary patterns during pregnancy and the postpartum period were obtained by factorial analysis. The relationship between these patterns and variation in postpartum BMI was evaluated by Poisson regression with robust variance adjusted for confounders. We identified three dietary patterns in 584 women, two healthy (generally healthy and Dash type), which were associated with less weight gain (RR 0.77 CI 95% 0.62-0.96 and RR 0.71 CI 95% 0.57-0.88, respectively). The high-risk pattern (based on ultra-processed, high-calorie foods and sweetened drinks) was associated with weight gain (RR 1.31 CI 95% 1.07-1.61 and RR 1.26 CI 95% 1.01-1.59) in six and twelve months postpartum, respectively. Although the participants learned about healthy dieting during pregnancy, dietary habits worsened from pregnancy to postpartum, especially, with lower consumption of fruits and dairy and higher consumption of sweetened beverages, with consequent weight gain postpartum. Postpartum support is needed to prevent weight gain and obesity.

Maternal Obesity and Patterns in Postnatal Diet, Physical Activity and Weight among a Highly Deprived Population in the UK: The GLOWING Pilot Trial

Preconception obesity is associated with adverse pregnancy outcomes and deprivation. The postnatal period provides an opportunity for preconception intervention. There is a lack of published postnatal behaviour and weight data to inform intervention needs. Secondary analysis of the GLOWING study explored postnatal diet, physical activity (PA) and weight among women living with obesity in deprivation. Thirty-nine women completed food frequency and PA questionnaires and provided weight measurement(s) between 3-12 months postnatal. Women's diet and PA fell short of national guidelines, especially for fruit/vegetables (median 1.6-2.0 portions/day) and oily fish (0-4 g/day). PA was predominantly light intensity. Patterns in weight change across time points indicated postnatal weight loss compared with 1st (median -0.8 to -2.3 kg) and 3rd-trimester weights (-9.0 to -11.6 kg). Weight loss was higher among women without excessive gestational weight gain (GWG) (-2.7 to -9.7 kg) than those with excessive GWG (2.3 to -1.8 kg), resulting in postnatal weight measurements lower than their 1st trimester. These pilot data suggest preconception interventions should commence in pregnancy with a focus on GWG, and postnatal women need early support to achieve guideline-recommendations for diet and PA. Further research in a larger population could inform preconception intervention strategies to tackle inequalities in maternal obesity and subsequent pregnancy outcomes.

Interactive effect of prepregnancy overweight/obesity and GDM history on prevalence of GDM in biparous women

BACKGROUND

Prepregnancy overweight/obesity (OWO) and gestational diabetes mellitus (GDM) history may increase the prevalence of GDM in parous women, but little is known about their potential combined effect on the prevalence of GDM in biparous women.

OBJECTIVE

This study aims to explore the interactive effect of prepregnancy overweight/obesity (OWO) and GDM history on the prevalence of GDM in biparous women.

METHODS

A retrospective study was conducted on 16,282 second-birth women who delivered a single neonate at ≧28 weeks of gestation twice. Logistic regression was used to assess the independent and multiplicative interactions of prepregnancy overweight/obesity (OWO) and GDM history on the risk of GDM in biparous women. Additive interactions were calculated using an Excel sheet that was made by Anderson to calculate relative excess risk.

RESULTS

A total of 14,998 participants were included in this study. Both prepregnancy OWO and GDM history were independently associated with an increased risk of GDM in biparous women (odds ratio (OR) = 19.225, 95% confidence interval (CI) = 17.106, 21.607 and OR = 6.826, 95% CI = 6.085, 7.656, respectively). The coexistence of prepregnancy OWO and GDM history was associated with GDM, with an adjusted OR of 1.754 (95% CI, 1.625, 1.909) compared to pregnant women without either condition. The additive interaction between prepregnancy OWO and GDM history was found to be not significant with regard to GDM in biparous women.

CONCLUSIONS

Prepregnancy OWO and GDM history both increase the risk of GDM in biparous women and have multiplicative interactions but not additive interactions.

Maternal overweight and obesity and its associated factors and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected black South African pregnant women

AIM

This study aimed to investigate various variables between maternal overweight and/or obesity versus normal-weight pregnant black South African women living with and without human immunodeficiency virus (HIV).

METHODS

A cross-sectional study design was employed. A total of 200 pregnant women were enrolled in the study, categorized according to body mass index (BMI) (kg/m² ) into two groups: (1) overweight/obese (≥25 kg/m² ) (n = 97); and (2) nonoverweight/nonobese (<25 kg/m² ) (n = 103), where 90 were HIV-infected and 110 were HIV-uninfected. The differences between the maternal BMI categories were assessed using Fisher's exact t-test and the χ² test. Simple and multiple logistic regression analyses were used to determine factors associated with maternal overweight and obesity.

RESULTS

Multiple logistic regression analysis showed that maternal age (odds ratio [OR]: 1.061; 95% confidence interval [CI] 1.008-1.117; p = 0.023) and gestational age (OR: 1.121; 95% CI 1.005-1.251; p = 0.041) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. For maternal health outcomes, multiple logistic regression analysis showed that hypertensive disorders (OR: 0.273; 95% CI 0.124-0.601; p = 0.001) and anemia (OR: 2.420; 95% CI 1.283-4.563; p = 0.006) were significantly associated with maternal overweight/obesity in both HIV-infected and HIV-uninfected. The overweight/obese HIV-infected participants (OR: 0.233; 95% CI 0.075-0.717; p = 0.011) had increased odds for developing hypertensive disorders compared to HIV-uninfected overweight/obese participants (OR: 0.471; 95% CI 0.172-1.291; p = 0.143).

CONCLUSIONS

Maternal overweight/obesity in both HIV-infected and HIV-uninfected pregnant black South African women was significantly associated with maternal age, gestational age, HPT disorders, and anemia. Maternal overweight/obesity decreased the odds for anemia, but increased the odds for the development of HPT disorders, especially in the HIV-infected pregnant women.

Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches

This study sought to determine data collection approaches in Australian cohort studies and explore the potential impact on reported prenatal alcohol exposure (PAE) prevalence and patterns. Inclusion criteria were that studies related to a general Australian antenatal population where PAE was assessed and reported. Studies were excluded if they were not peer reviewed, examined the prevalence of PAE in pregnancies complicated by alcohol-use disorders, or were published in a language other than English. A systematic search of five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) was conducted. Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. Results were synthesised using MetaXL. Data from 16 separate birth cohorts (n = 78 articles) were included. Included cohorts were either general cohorts that included alcohol as a variable or alcohol-focused cohorts that were designed with a primary focus on PAE. PAE prevalence was estimated as 48% (95% CI: 38 to 57%). When subgroup analysis was performed, estimates of PAE prevalence when self-administered surveys and interviews were used for data collection were 53% (95% CI: 41% to 64%) and 43% (95% CI: 28% to 59%), respectively. Use of trained assessors was an influencing factor of the prevalence estimates when data were collected via interview. Alcohol-focused studies reported higher prevalence of PAE, regardless of method of survey administration. Where interviewer training is not possible, self-administered questionnaires will likely provide the most reliable PAE estimates. No funding sources are relevant to mention. Review was registered with PROSPERO (CRD42020204853).

Transcriptomic responses are sex-dependent in the skeletal muscle and liver in offspring of obese mice

Infants born to obese mothers are more likely to develop metabolic disease, including glucose intolerance and hepatic steatosis, in adult life. We examined the effects of maternal obesity on the transcriptome of skeletal muscle and liver tissues of the near-term fetus and 3-mo-old offspring in mice born to dams fed a high-fat and -sugar diet. Previously, we have shown that male, but not female, offspring develop glucose intolerance, insulin resistance, and liver steatosis at 3 mo old. Female C57BL6/J mice were fed normal chow or an obesogenic high-calorie diet before mating and throughout pregnancy. RNAseq was performed on the liver and gastrocnemius muscle following collection from fetuses on embryonic day 18.5 (E18.5) as well as from 3-mo-old offspring from obese dams and control dams. Significant genes were generated for each sex, queried for enrichment, and modeled to canonical pathways. RNAseq was corroborated by protein quantification in offspring. The transcriptomic response to maternal obesity in the liver was more marked in males than females. However, in both male and female offspring of obese dams, we found significant enrichment for fatty acid metabolism, mitochondrial transport, and oxidative stress in the liver transcriptomes as well as decreased protein concentrations of electron transport chain members. In skeletal muscle, pathway analysis of gene expression revealed sexual dimorphic patterns, including metabolic processes of fatty acids and glucose, as well as PPAR, AMPK, and PI3K-Akt signaling pathways. Transcriptomic responses to maternal obesity in skeletal muscle were more marked in female offspring than males. Female offspring had greater expression of genes associated with glucose uptake, and protein abundance reflected greater activation of mTOR signaling. Skeletal muscle and livers in mice born to obese dams had sexually dimorphic transcriptomic responses that changed from the fetus to the adult offspring. These data provide insights into mechanisms underpinning metabolic programming in maternal obesity.NEW & NOTEWORTHY Transcriptomic data support that fetuses of obese mothers modulate metabolism in both muscle and liver. These changes were strikingly sexually dimorphic in agreement with published findings that male offspring of obese dams exhibit pronounced metabolic disease earlier. In both males and females, the transcriptomic responses in the fetus were different than those at 3 mo, implicating adaptive mechanisms throughout adulthood.

Dietary intake and lifestyle practices of eastern mediterranean postpartum women before and during COVID-19 pandemic: An internet-based cross-sectional survey

Background

During the lockdown period, a substantial group of these women reported lifestyle changes.

Aim

The aim of the study is to characterize the dietary patterns, intake and the adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Eastern Mediterranean postartum women.

Methods

An internet-based cross-sectional survey was used to collect the data. The survey was carried out among 1,939 postpartum women from five countries from the Eastern Mediterranean region. Change in dietary intake from the five food groups and the adherence to USDA's daily recommendations were assessed.

Findings

There was a significant increase in the mean (SD) consumption of all the food groups, including bread, rice, and other cereals, fruits, vegetables, milk and milk products, white and red meat, and nuts during the pandemic. Around 84% of participants reported no/low adherence (0–2) to USDA guidelines, whereas only 15% reported moderate or high adherence (3–5) to the guidelines before the pandemic. However, there was an increase in the proportion of subjects reporting moderate/high adherence (22%) during the pandemic.

Discussion and conclusions

A substantial proportion of our study participants reported a lower dietary intake than the recommended amounts, and low adherence to the five food groups. Reasonable and applicable actions should be taken to protect postpartum women and their children from the effects of low dietary intake, particularly during pandemics and lockdowns. More researches are needed to identify the modifiable factors which could improve the nutritional status of the postpartum women during the pandemic.

Dietary intakes in pregnant women with previous bariatric surgery

PURPOSE

To (1) assess dietary intakes of pregnant women with previous bariatric surgery in comparison with Dietary Reference Intakes (DRIs); (2) compare their dietary intakes as well as their diet quality with a control group of pregnant women with no history of bariatric surgery.

METHODS

Twenty-eight (28) pregnant women with previous surgery (sleeve gastrectomy, n = 7 and biliopancreatic diversion with duodenal switch, n = 21) were matched for pre-pregnancy body mass index with 28 pregnant women with no history of bariatric surgery. In at least one trimester, participants completed a minimum of 2 Web-based 24-h dietary recalls from which energy, macro- and micronutrient intakes as well as the Canadian Healthy Eating Index (C-HEI) were derived.

RESULTS

No differences were observed for energy intake between groups. All women had protein intakes within the recommended range, but most women with previous surgery had carbohydrate (67%) and dietary fiber intakes (98%) below recommendations. In both groups, mean total fat, saturated fatty acids, free sugars and sodium intakes were above recommendations, as opposed to mean vitamin D, folic acid and iron dietary intakes below recommendations for most women. Compared with the control group, pregnant women with previous bariatric surgery had lower overall C-HEI scores.

CONCLUSION

These results suggest that pregnant women with previous bariatric surgery would benefit from a nutritional follow-up throughout their pregnancy.

LEVEL OF EVIDENCE

III: Evidence obtained from well-designed cohort or case-control analytic studies.

Healthier diet associated with reduced risk of excessive gestational weight gain: A Chinese prospective cohort study

Limited studies have examined the associations between diet quality and gestational weight gain (GWG) among Chinese pregnant women, adopting Chinese GWG guidelines. We prospectively investigate the associations of diet quality, using the Chinese Healthy Diet Index for Pregnancy (CHDI-P), which assessed diet quality from 'Diversity', 'Adequacy' and 'Limitation' dimensions with overall 100 points, with GWG among participants enroled in Southwest China. Food consumption was collected by 24 h dietary recalls for three consecutive days and CHDI-P scores were divided into tertiles. GWG was calculated according to the weight measured before delivery and classified into adequate weight gain (AWG), insufficient weight gain (IWG) and excessive weight gain(EWG) following Chinese GWG guidelines. Multinomial regression analyses and stratified analyses by pre-pregnancy body mass index were performed to estimate the association between CHDI-P and GWG. A total of 1416 participants were recruited in early pregnancy, and 971 and 997 participants were respectively followed up in middle and late pregnancy. The mean CHDI-P score was 56.44 ± 6.74, 57.07 ± 7.44 and 57.38 ± 7.94 points in early, middle and late pregnancy, respectively. Women in the lowest CHDI-P scores group had an increased risk of EWG in middle (OR = 1.53, 95% confidence interval [CI] = 1.08-2.17) and late pregnancy (OR = 1.71, 95% CI = 1.21-2.41) than women in the highest group, while overweight/obese women had a greater risk of EWG in late pregnancy (OR = 4.25, 95% CI = 1.30-13.90). No association was found between the CHDI-P scores and IWG. Poor diet quality in middle and late pregnancy was associated with a higher risk of EWG.

Longitudinal changes in circulating concentrations of inflammatory markers throughout pregnancy: are there associations with diet and weight status?

The natural inflammation occurring during pregnancy can, under certain conditions, be associated with adverse pregnancy outcomes. This study aimed to: 1) quantify changes in circulating concentrations of leptin, adiponectin, interleukin-6 (IL-6) and C-reactive protein (CRP) across trimesters of pregnancy, according to pre-pregnancy body mass index (ppBMI); and 2) examine the trimester-specific associations between the inflammatory markers' concentrations, a Mediterranean diet score (MDS) and the dietary inflammatory index (DII). We measured leptin, adiponectin and IL-6 by ELISA, and CRP by high-sensitivity immunonephelometry, in blood samples from 79 pregnant women (age: 32.1 ± 3.7 years; ppBMI: 25.7 ± 5.8 kg/m2). Three web-based 24h recalls were completed at each trimester and used to compute the MDS and the DII. CRP concentrations remained stable across trimesters, whereas concentrations of leptin and IL-6 increased, and adiponectin concentrations decreased (p<0.001). Changes in leptin and adiponectin concentrations also differed according to ppBMI categories (p<0.05). As for the dietary scores, the only significant association was observed in the second trimester between leptin concentrations and the MDS (r=-0.26, p<0.05). In conclusion, ppBMI and the progression of pregnancy itself probably supplant the potential associations between diet and the inflammation occurring during that period. Novelty: • Circulating leptin and IL-6 concentrations increased across trimesters whereas CRP was stable, and adiponectin decreased. • Variations in circulating leptin and adiponectin concentrations differed by ppBMI categories. • Very few associations were observed between dietary scores and inflammatory markers.

Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'

Understanding women's perceptions of eating behaviors and dietary patterns can inform the 'teachable moment' model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.

Exploration of Diet Quality by Obesity Severity in Association with Gestational Weight Gain and Distal Gut Microbiota in Pregnant African American Women: Opportunities for Intervention

OBJECTIVE

To conduct an exploratory examination of dietary patterns and quality during pregnancy in African-American women who were class I, II, or III obese, and those women with normal pre-pregnancy body mass index (pBMI), as well to identify dietary factors associated with GWG, and changes in the distal gut microbiome. African American women represent the largest group affected by pre-pregnancy obesity, a risk factor for several adverse birth outcomes.

METHODS

This prospective study investigated the association between diet, distal gut microbiome, and GWG among African-American women (n = 21) with obesity (n = 15) compared to women with a normal pre-pregnancy body mass index (pBMI) (n = 6) at two time points, 27-29 and 37-39 weeks gestation. Dietary patterns associated with obesity severity and GWG gain were assessed using Welch's T-test and Mann-Whitney U. The association between the gut microbiome and dietary patterns was assessed using a regression-based kernel association test and the adaptive microbiome-based sum of powered score test.

RESULTS

In early pregnancy, dietary intake of Total Fruits and Greens and Beans was significantly different between pBMI and GWG groups; significance was 0.022 and 0.028 respectively. Women with Class II/III obesity and those with GWG above guidelines had Healthy Eating Index (HEI) scores below 50, meeting less than 75% of dietary guidelines, and did not meet recommendations for fruit and vegetable or fiber intake. We found no significant associations between the microbiome composition and diet (HEI Scores).

CONCLUSIONS FOR PRACTICE

Overall, the results indicate that women with pBMI obesity are not meeting minimum dietary guidelines for nutrient intakes during pregnancy, specifically fruits, vegetables, and fiber, regardless of GWG. Interventions for African-American women with pre-pregnancy obesity, with a focus on increasing consumption of fruits and vegetables, would be beneficial to control GWG and improve birth outcomes.

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.

The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy

Women with maternal obesity, an unhealthy lifestyle before and during pregnancy and excess gestational weight gain have an increased risk of adverse pregnancy and birth outcomes that can also increase the risk of long-term poor health for them and their children. Pregnant women have frequent medical appointments and are highly receptive to health advice. Healthcare professionals who interact with women during pregnancy are in a privileged position to support women to make lasting healthy lifestyle changes that can improve gestational weight gain and pregnancy outcomes and halt the intergenerational nature of obesity. Midwives and obstetrical nurses are key healthcare professionals responsible for providing antenatal care in most countries. Therefore, it is crucial for them to build and enhance their ability to promote healthy lifestyles in pregnant women. Undergraduate midwifery curricula usually lack sufficient lifestyle content to provide emerging midwives and obstetrical nurses with the knowledge, skills, and confidence to effectively assess and support healthy lifestyle behaviours in pregnant women. Consequently, registered midwives and obstetrical nurses may not recognise their role in healthy lifestyle promotion specific to healthy eating and physical activity in practice. In addition, practising midwives and obstetrical nurses do not consistently have access to healthy lifestyle promotion training in the workplace. Therefore, many midwives and obstetrical nurses may not have the confidence and/or skills to support pregnant women to improve their lifestyles. This narrative review summarises the role of midwives and obstetrical nurses in the promotion of healthy lifestyles relating to healthy eating and physical activity and optimising weight in pregnancy, the barriers that they face to deliver optimal care and an overview of what we know works when supporting midwives and obstetrical nurses in their role to support women in achieving a healthy lifestyle.

Food consumption and household income of pregnant and lactating women

OBJECTIVE

To look at the relationship between food consumption patterns and household income in pregnant and lactating women, in Malili District, East Luwu Regency, South Sulawesi.

METHOD

This study was an analytical survey, using a cross-sectional approach with 128 respondents consisting of 42 pregnant women and 86 lactating mothers. Data collection using questionnaires with interview techniques. Data analysis using bivariate analysis using the chi-square test and fisher exact test.

RESULTS

Of the total respondents there were high-risk age <20 years and >35 years 20%, low education 47%, housewives 84%, and low income 45%, high income 55%. The results showed that nutritional intake obtained a value of p=0.002 (p<0.05) which showed that there were differences in fat intake in pregnant women and breastfeeding mothers, whereas in energy, protein, carbohydrate, vitamin C, and FE intake there were no differences. In the consumption pattern, fruit intake, vegetable intake has no relationship with household income but the chi-square test on staple foods obtained a value of p=0.03 (p<0.05) which indicates that there is a relationship between food consumption and income.

CONCLUSION

There is a relationship between staple food consumption and household income in pregnant and lactating women.

Pregnant Women Living with Obesity: A Cross-Sectional Observational Study of Dietary Quality and Pregnancy Outcomes

Good maternal nutrition is key to optimal maternal and foetal health. A poor-quality diet is often associated with obesity, and the prevalence and severity of maternal obesity has increased significantly in recent years. This study observed dietary intakes in pregnant women living with obesity and assessed the quality of their diet. In total, 140 women with a singleton pregnancy, aged > 18 years and BMI ≥ 35 kg/m², were recruited from antenatal clinics, weighed and completed food diaries at 16-, 28- and 36-weeks' gestation. Clinical data were recorded directly from the women's medical records. Nutrient intake was determined using 'Microdiet^TM', then compared to Dietary Reference Values (DRVs). Energy intakes were comparable with DRVs, but intakes of sugar and saturated fatty acids were significantly higher. Intake of fibre and several key micronutrients (Iron, Iodine, Folate and Vitamin D) were significantly low. Several adverse obstetric outcomes were higher than the general obstetric population. Women with obesity, often considered 'over nourished', may have diets deficient in essential micronutrients, often associated with poor obstetric outcomes. To address the intergenerational transmission of poor health via poor diets warrants a multi-disciplinary approach focusing away from 'dieting' onto positive messages, emphasising key nutrients required for good maternal and foetal health.

Effects of a Prenatal Lifestyle Intervention in Routine Care on Maternal Health Behaviour in the First Year Postpartum-Secondary Findings of the Cluster-Randomised GeliS Trial

Lifestyle interventions during pregnancy were shown to beneficially influence maternal dietary behaviour and physical activity, but their effect on health behaviour after delivery is unclear. The objective of this secondary analysis was to investigate the sustained effect of a lifestyle intervention in routine care on maternal health behaviour during the first year postpartum. The cluster-randomised controlled "Healthy living in pregnancy" (GeliS) study included 2286 pregnant women. Data on maternal health behaviour were collected at 6-8 weeks (T1pp) and one year postpartum (T2pp) using validated questionnaires. The intervention group showed a lower mean intake of fast food (T1pp: p = 0.016; T2pp: p < 0.001) and soft drinks (T1pp: p < 0.001), a higher mean intake of vegetables (T2pp: p = 0.015) and was more likely to use healthy oils for meal preparation than the control group. Dietary quality rated by a healthy eating index was higher in the intervention group (T1pp: p = 0.093; T2pp: p = 0.043). There were minor trends towards an intervention effect on physical activity behaviour. The proportion of smokers was lower in the intervention group (p < 0.001, both time points). The lifestyle intervention within routine care modestly improved maternal postpartum dietary and smoking behaviours.

Dietary Quality and Sociodemographic and Health Behavior Characteristics Among Pregnant Women Participating in the New York University Children's Health and Environment Study

Maternal diet, prior to and during pregnancy, plays an important role in the immediate and long-term health of the mother and her offspring. Our objectives were to assess diet quality among a large, diverse, urban cohort of pregnant women, and examine associations with sociodemographic and health behavior characteristics. Data were from 1,325 pregnant women enrolled in New York University Children's Health and Environment Study (NYU CHES). Diet quality was assessed using the Healthy Eating Index (HEI)-2015. Mean total HEI-2015 score was 74.9 (SD = 8.5); 376 (28%), 612 (46%), 263 (20%), and 74 (6%) of women had scores that fell into the grade range of A/B, C, D, and F, respectively. Mean HEI-2015 component scores were high for fruit and whole grains and low for protein-related, sodium, and fat-related components. In multivariable linear regression models, Hispanic women scored 1.65 points higher on the total HEI-2015 (95% CI: 0.21, 3.10) compared to non-Hispanic White women, while younger age (<30 years), parity, single status, pre-pregnancy obesity, smoking, pre-existing hypertension, moderate/severe depressive symptoms, not meeting physical activity recommendations, and not taking a vitamin before pregnancy were associated with ~1.5–5-point lower mean total HEI-2015 scores. Diet is a modifiable behavior; our results suggest a continued need for pre-conceptional and prenatal nutritional counseling.

Does stress attenuate motivation for healthful eating in pregnancy and postpartum?

Despite high motivation for healthful eating during pregnancy, maternal diet quality is inadequate. During pregnancy, women may relax effortful control over eating to reduce stress; thus, stress may override motivation to eat healthfully. This secondary analysis of data from the Pregnancy Eating Attributes Study longitudinal cohort investigated associations of motivation for healthful eating and perceived stress with diet quality during pregnancy (n = 365) and postpartum (n = 266), and investigated whether stress modifies associations of motivation with diet quality. Women (M_age = 31.3; gestational age ≤ 12 weeks) were recruited from the Chapel Hill, North Carolina area and completed multiple 24-h diet recalls (once each trimester of pregnancy, and at 4-6 weeks, 6 months, and 1 year postpartum) and validated measures of perceived stress and motivation for healthful eating (autonomous and controlled). Hierarchical multiple regressions tested associations of diet quality (Healthy Eating Index-2015) with stress, motivation, and their interactions. Additionally, themes extracted from previously-analyzed focus groups conducted with a subsample of participants were re-examined for content relevant to stress, motivation, and diet. Pregnancy and postpartum diet quality was positively associated with autonomous motivation, but was unassociated with controlled motivation and stress. Interaction terms did not appreciably improve model fit. Focus group participants described both internal and external forces contributing to their motivation for healthy eating during pregnancy and described the impact of stress on eating behaviors through amplification of food cravings. Future research is needed to identify influences on maternal motivation for healthful eating.

Maternal macro- and micronutrient intake six months after hypertensive versus normotensive pregnancy: is poor diet quality contributing to future cardiometabolic disease risk?

BACKGROUND

Hypertensive pregnancy is associated with increased long-term cardiometabolic disease risk. Assessing dietary intake patterns after hypertensive (HP) versus normotensive pregnancy (NP) may provide insights into the mechanism of this risk.

METHODS

This study was a prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatrics) cohort. Women were studied six months after NP versus HP (preeclampsia or gestational hypertension). Dietary energy, macronutrient and micronutrient intake were measured using a three-day food diary (FoodWorks™) and assessed against Australian and New Zealand Nutrient Reference Values to determine nutritional adequacy. Comparisons between breastfeeding and non-breastfeeding women were assessed, and linear regression modelling (using hypertensive status, breastfeeding status, and demographic/pregnancy variables) performed to assess predictors of energy intake.

RESULTS

Seventy-four women (60 NP, 14 HP) were included. HP women had higher mean body mass index (p = 0.02) and lower breastfeeding rates (29% HP versus 83% NP, p < 0.001) compared to NP women. Twenty-four-hour energy intake and total fat intake were 17% and 20% lower after HP respectively. Nutrient deficiencies were prevalent across all participants, however more HP women had inadequate magnesium, calcium and phosphorus intake. Breastfeeding women had significantly increased energy (17%), carbohydrate (15%) and total fat intake (21%), and increased vitamin A, vitamin E, riboflavin, magnesium and iron intake compared to non-breastfeeding women. HP and breastfeeding status were independent predictors of energy intake.

CONCLUSIONS

HP women had lower micronutrient intake and greater prevalence of nutritional inadequacy compared to NP women, reflecting poorer diet quality and potentially contributing to future increased cardiometabolic disease risk.

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.

Maternal dietary patterns are associated with susceptibility to a depressive-like phenotype in rat offspring

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Modified maternal diet influences offspring behavior and the brain transcriptome.

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Maternal HFD provokes depressive-like behavior in male and female offspring.

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In utero exposure to HFD leads to transcriptomics alterations within the offspring’s frontal cortex.

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Maternal HFD changes expression of markers specific to excitatory and inhibitory cortical neurons.

Environmental factors such as maternal diet, determine the pathologies that appear early in life and can persist in adulthood. Maternally modified diets provided through pregnancy and lactation increase the predisposition of offspring to the development of many diseases, including obesity, diabetes, and neurodevelopmental and mental disorders such as depression. Fetal and early postnatal development are sensitive periods in the offspring’s life in which maternal nutrition influences epigenetic modifications, which results in changes in gene expression and affects molecular phenotype. This study aimed to evaluate the impact of maternal modified types of diet, including a high-fat diet (HFD), high-carbohydrate diet (HCD) and mixed diet (MD) during pregnancy and lactation on phenotypic changes in rat offspring with respect to anhedonia, depressive- and anxiety-like behavior, memory impairment, and gene expression profile in the frontal cortex. Behavioral results indicate that maternal HFD provokes depressive-like behavior and molecular findings showed that HFD leads to persistent transcriptomics alterations. Moreover, a HFD significantly influences the expression of neuronal markers specific to excitatory and inhibitory cortical neurons. Collectively, these experiments highlight the complexity of the impact of maternal modified diet during fetal programming. Undoubtedly, maternal HFD affects brain development and our findings suggest that nutrition exerts significant changes in brain function that may be associated with depression.

Are antenatal interventions effective in improving multiple health behaviours among pregnant women? A systematic review protocol

BACKGROUND

Maternal behaviours in pregnancy associated with adverse pregnancy, birth and health outcomes include tobacco smoking, poor nutrition, alcohol consumption and low physical activity, collectively referred to as the SNAP risk factors. Due to the high prevalence, co-occurrence and possible interactive health effects of such health behaviours in pregnancy, antenatal interventions that support pregnant women to improve multiple SNAP behaviours have a greater potential impact on the health outcomes of women and their children than interventions addressing single behaviours. The objective of this review is to determine the effectiveness of interventions delivered as part of antenatal care that aim to improve multiple SNAP behaviours among pregnant women.

METHODS

Seven electronic databases will be searched for potentially eligible studies. Eligible studies will include those where pregnant women are attending antenatal care. Studies that examine the effect of an intervention that addresses multiple SNAP behaviours (≥ 2 behaviours) during pregnancy and are delivered or instigated through antenatal care in a healthcare service will be included. Systematic reviews of randomised controlled trials (RCTs), RCTs, cluster RCTs, stepped-wedge RCTs and non-randomised control trials will be eligible. Studies that include a no-intervention control, wait-list control group, standard/usual care, or another active single behavioural intervention (e.g. addressing one behaviour only) will be considered. Two independent reviewers will conduct study screening, data extraction and risk of bias assessment. Discrepancies will be resolved by consensus or a third reviewer if required. A random effects model will be used to synthesise the results. Alternative synthesis methods will be investigated in instances where a meta-analysis is not appropriate, such as summarising effect estimates, combining P values, vote counting based on direction of effect, or synthesis in narrative form.

DISCUSSION

The review will synthesise the evidence on the effect of interventions that address multiple SNAP behaviours in antenatal care and will help researchers, policy-makers and health services to develop and deliver best practice integrated models of antenatal care that have the potential to impact on both the short- and long-term health outcomes for women and their children.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018095315.

Tracking of Maternal Diet from Pregnancy to Postpregnancy: A Systematic Review of Observational Studies

We systematically reviewed studies to examine changes in women's diets from pregnancy to the postpregnancy period and sought to understand the characteristics of women making these changes. From a search of 4 databases and up to November 2019, 17 studies met our inclusion criteria. They reported changes in various dietary aspects. Mixed findings were reported for changes in energy and micronutrient intakes. Most studies reported significant decreases in fruit and vegetable consumption, diet quality, and adherence to a healthier dietary pattern during the transition from pregnancy to postpregnancy, whereas increases in discretionary food and fat intakes were observed. Women with lower education level, lower income, and/or who worked full-time tended to have poorer dietary behaviors postpregnancy. Further research, with better aligned dietary measurement time points during pregnancy and postpartum and standardization of dietary assessment tools, is needed for future studies to be comparable. The systematic review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews as CRD42020158033.

The UK Pregnancies Better Eating and Activity Trial (UPBEAT); Pregnancy Outcomes and Health Behaviours by Obesity Class

The effectiveness of antenatal intervention in women with increasing obesity is unknown. This study investigated whether there was a differential effect of antenatal intervention on diet, physical activity and pregnancy outcomes in women stratified by obesity class using data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) (n = 1555). The stratification was by World Health Organization classifications: Class I, II and III (30–34.9 kg/m², 35–39.9 kg/m² and ≥40 kg/m²). Using linear and logistic regression, adjusted for confounders, outcomes were assessed post-intervention (27⁺⁰–28⁺⁶ weeks’ gestation) and in late pregnancy (34⁺⁰–36⁺⁰ weeks’ gestation). Interactions between obesity class and the intervention were explored. Compared to the standard care arm, class III intervention women had lower gestational weight gain (GWG) (−1.87 kg; 95% CI −3.29 to −0.47, p = 0.009), and the effect of the intervention was greater in class III compared to class I, by −2.01 kg (95% CI −3.45 to −0.57, p = 0.006). Class I and II intervention women reported significantly lower dietary glycaemic load and saturated fat intake across their pregnancy. This differential effect of the intervention suggests antenatal interventions for women with obesity should stratify outcomes by obesity severity. This would inform evidence-based antenatal strategies for high-risk groups, including women with a BMI ≥ 40 kg/m².

The effect of high dietary fiber intake on gestational weight gain, fat accrual, and postpartum weight retention: a randomized clinical trial

BACKGROUND

Interventions to prevent excessive gestational weight gain (GWG) have had limited success This pilot study examined the effectiveness of a single goal (SG) high dietary fiber intervention to prevent excessive GWG.

METHODS

Twelve weekly lessons focused on consuming a high fiber diet (≥30 g/day). Snacks containing 10-12 g of dietary fiber were given for the first 6 weeks only. Body composition was measured at baseline and at the end of the intervention. At one-year postpartum, body weight retention and dietary practices were assessed. A p-value is reported for the primary analysis only. For all other comparisons, Cohen's d is reported to indicate effect size.

RESULTS

The SG group increased fiber intake during the study (32 g/day at 6 weeks, 27 g/day at 12 weeks), whereas the UC group did not (~ 17 g/day). No differences were found for the proportion of women classified as excessive gainers (p = 0.13). During the intervention, the SG group gained less body weight (- 4.1 kg) and less fat mass (- 2.8 kg) (d = 1.3). At 1 year postpartum, the SG group retained less weight (0.35 vs. 4.4 kg, respectively, d = 1.8), and reported trying to currently eat high fiber foods.

CONCLUSION

The SG intervention resulted in less weight gain, fat accrual, and weight retention at 1 year postpartum. A residual intervention effect was detected postpartum with the participants reporting continued efforts to consume a high fiber diet.

TRIAL REGISTRATION

NCT03984630; Trial registered June 13, 2019 (retrospectively registered).

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications

In this article, we describe the process of establishing agreed international pregnancy research priorities to address the global issues of unhealthy lifestyles and rising maternal obesity. We focus specifically on the prevention of maternal obesity to improve related clinical pregnancy and long-term complications. A team of multidisciplinary, international experts in preconception and pregnancy health, including consumers, were invited to form the Health in Preconception, Pregnancy and Postpartum (HiPPP) Global Alliance. As an initial activity, a priority setting process was completed to generate pregnancy research priorities in this field. Research, practice and policy gaps were identified and enhanced through expert and consumer consultation, followed by a modified Delphi process and Nominal Group Technique, including an international workshop. Research priorities identified included optimising: (1) healthy diet and nutrition; (2) gestational weight management; (3) screening for and managing pregnancy complications and pre-existing conditions; (4) physical activity; (5) mental health; and (6) postpartum (including intrapartum) care. Given extensive past research in many of these areas, research priorities here recognised the need to advance pregnancy research towards pragmatic implementation research. This work has set the agenda for large-scale, collaborative, multidisciplinary, implementation research to address the major public health and clinical issue of maternal obesity prevention.

Associations between prenatal diet quality and gestational weight gain

BACKGROUND

Improving prenatal diet quality may promote appropriate gestational weight gain (GWG).

AIM

To examine relationships between dietary quality in the second and third trimesters of pregnancy and GWG.

METHODS

Participants' (n = 41) dietary intake was assessed at 14-20 and 35 weeks gestation via the Automated Self-Administered 24-h recall (ASA-24). Kilocalories and Healthy Eating Index (HEI-2015) scores were calculated and associations with GWG were explored via linear regression.

RESULTS

Participants reported consuming 2139 ± 719 and 2085 ± 704 kilocalories at 18 and 35 weeks, respectively. HEI-2015 total scores at 18 (55.6 ±12.6) and 35 weeks gestation (56.6 ± 14.1) indicated a need for improvement. Greens and beans component score at 35 weeks was the only diet quality score associated with GWG.

CONCLUSIONS

GWG was not associated with most diet quality indices. However, vegetable intake may help to attenuate GWG. Future research should seek to elucidate relationships between GWG and dietary quality/intake to provide valuable insight for researchers and clinicians.

Postpartum Diet Quality: A Cross-Sectional Analysis from the Australian Longitudinal Study on Women's Health

Reproductive-aged women are at high risk of developing obesity, and diet quality is a potential modifiable risk factor. There is limited research exploring diet quality and its association with time since childbirth. Using data from the Australian Longitudinal Study on Women’s Health (ALSWH) survey 5 (2009) of women born between 1973–1978, who reported having previously given birth, we investigated the association between time since childbirth and diet quality, and differences in energy, macronutrients, micronutrient intake, and diet quality assessed by the dietary guideline index (DGI) in women stratified by time from last childbirth, early (0–6 months; n = 558) and late (7–12 months; n = 547), and all other women with children (>12 months post childbirth n = 3434). From this cohort, 8200 participants were eligible, of which 4539 participants completed a food frequency questionnaire (FFQ) and were included in this analysis. Overall, diet quality was higher in early and late postpartum women (mean DGI score 89.8 (SD 10.5) and mean DGI score 90.0 (SD 10.2), respectively) compared to all other women with children (>12 months post childbirth), mean DGI score 85.2 (SD 11.7), p < 0.001. Factors positively associated with diet quality included higher education, physical activity, health provider support, and vitamin and/or mineral supplement use. Conversely, increasing time from childbirth (>12 months), smoking compared with non-smoking and medium income level compared with no income was negatively associated with diet quality. A lower diet quality in women greater than 12 months post childbirth may be reflective of increased pressures, balancing childrearing and return to work responsibilities. This highlights the need to support women beyond the postpartum period to improve modifiable factors associated with weight gain, including diet quality, to optimize health and reduce chronic disease risk.

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

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

An observational analysis of meal patterns in overweight and obese pregnancy: exploring meal pattern behaviours and the association with maternal and fetal health measures

BACKGROUND

Nutrient intakes are known to be poorer among pregnant women with raised body mass index (BMI) than those with a healthy BMI. While meal patterns have the potential to influence obstetric, metabolic and anthropometric measures for mother and infant, limited data exists regarding meal patterns among pregnant women with raised BMI.

AIM

To identify categories of meal patterns among pregnant women with overweight and obesity and determine whether patterns change with advancing gestation. To determine if maternal meal patterns are associated with dietary intakes and pregnancy outcomes.

METHODS

Prospective, observational analysis of pregnant women (n = 143) (BMI 25-39.9 kg/m²). Meal pattern data were analysed from 3-day food diaries at 16 and 28 weeks' gestation. Outcomes include maternal blood glucose, insulin resistance, gestational diabetes, gestational weight gain and infant anthropometry.

RESULTS

Three meal pattern categories were identified: 'main meal dominant' (3 main eating occasions + 0-3 snacks), 'large meal dominant' (≤ 2 main eating occasions + < 2 snacks), and 'snack dominant' (3 main eating occasions + > 3 snacks and ≤ 2 main + ≥ 2 snacks). A main meal-dominant pattern prevailed at 16 weeks' (85.3%) and a snack-dominant pattern at 28 weeks' (68.5%). Dietary glycaemic index was lower among the main meal versus large meal-dominant pattern at 28 weeks (P = 0.018). Infant birth weight (kg) and macrosomia were highest among participants with a large meal-dominant pattern at 28 weeks (P = 0.030 and P = 0.008, respectively).

CONCLUSION

Women with raised BMI changed eating patterns as pregnancy progressed, moving from main meal-dominant to snack-dominant patterns. Large meal-dominant meal patterns in later pregnancy were associated with higher glycaemic index and greater prevalence of macrosomia.

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

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

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.

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.

The effect of a diabetes prevention program on dietary quality in women with previous gestational diabetes

Background

Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year.

Methods

Women were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure).

Results

Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen’s D = − 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with − 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen’s D = 0.14)).

Conclusions

Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement.

Trial registration

Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066, April 2010.

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.

Global inequities in dietary calcium intake during pregnancy: a systematic review and meta-analysis

BACKGROUND

Evidence shows that adequate calcium intake during pregnancy reduces the risk of hypertensive disorders of pregnancy. In most low- and middle-income countries (LMICs) the daily calcium intake is well below recommendations. Mapping calcium intake during pregnancy worldwide and identifying populations with low calcium intake will provide the evidence base for more targeted actions to improve calcium intake.

OBJECTIVE

To assess dietary calcium intake during pregnancy worldwide.

SEARCH STRATEGY

MEDLINE and EMBASE (from July 2004 to November 2017).

SELECTION CRITERIA

Cross-sectional, cohort, and intervention studies reporting calcium intake during pregnancy.

DATA COLLECTION AND ANALYSIS

Five reviewers working in pairs independently performed screening, extraction, and quality assessment. We reported summary measures of calcium intake and calculated the weighted arithmetic mean for high-income countries (HICs) and LMICs independently, and for geographic regions, among studies reporting country of recruitment, mean intake, and total number of participants. When available, inadequate intakes were reported.

MAIN RESULTS

From 1880 citations 105 works met the inclusion criteria, providing data for 73 958 women in 37 countries. The mean calcium intake was 948.3 mg/day (95% CI 872.1-1024.4 mg/day) for HICs and 647.6 mg/day (95% CI 568.7-726.5 mg/day) for LMICs. Calcium intakes below 800 mg/day were reported in five (29%) countries from HICs and in 14 (82%) countries from LMICs.

CONCLUSION

These results are consistent with a lack of improvement in calcium dietary intake during pregnancy and confirm the gap between HICs and LMICs, with alarmingly low intakes recorded for pregnant women in LMICs. From the public health perspective, in the absence of specific local data, calcium supplementation of pregnant women in these countries should be universal.

TWEETABLE ABSTRACT

Despite dietary recommendations, women in LMICs face pregnancy with diets low in calcium.