Reward-related eating, self-regulation, and weight change in pregnancy and postpartum: the Pregnancy Eating Attributes Study (PEAS)

Relationships of pregnancy and postpartum diet quality with offspring birth weight and weight status through 12 months

OBJECTIVE

This study examined relationships of maternal pregnancy and postpartum diet quality with infant birth size and weight status indicators through 12 months and tested whether breastfeeding duration modifies these associations.

METHODS

In the Pregnancy Eating Attributes Study (PEAS), dietary intake was assessed six times in 458 mothers who were followed from early pregnancy through 12 months postpartum (2014-2018). Logistic and linear mixed models estimated relationships of pregnancy and postpartum diet quality (Healthy Eating Index [HEI]) with offspring who were large-for-gestational-age (LGA) at birth, as well as BMI z score (BMIz) and weight-for-length z score (WFLz) at birth, 6 weeks, 6 months, and 12 months.

RESULTS

Pregnancy HEI was inversely related to LGA (odds ratio [OR] = 0.95, 95% CI: 0.92 to 0.98); HEI was also inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.002) and BMIz (β = -0.009, 95% CI: -0.02 to -0.0009) from birth through 12 months. Postpartum HEI was inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.0009) and BMIz (β = -0.008, 95% CI: -0.02 to 0.0007) in infants who were breastfed for at least 6 months, but not in those who were breastfed for a shorter duration.

CONCLUSIONS

Maternal diet quality during pregnancy (and during postpartum in mothers who breastfed for a longer duration) was inversely related to LGA and weight status indicators from birth through 12 months. Increasing maternal diet quality may have use for promoting healthy infant weight development.

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

Associations of parent feeding behaviors and early life food exposures with early childhood appetitive traits in an observational cohort study

PURPOSE

Child appetitive traits, eating styles that reflect responsiveness to external influences and internal hunger and satiety signals, are associated with eating behaviors and susceptibility to excess weight gain. However, relatively little is known about early life influences on child appetitive traits. This study investigated relations of early life maternal feeding behaviors and food exposures with appetitive traits at age 3.5 years.

METHODS

Participants of the Pregnancy Eating Attributes Study (PEAS) and follow-up study were enrolled in early pregnancy and followed prospectively. This analysis included data collected from baseline through child aged 3.5-years (n = 160). Child appetitive traits at age 3.5 years were measured using the Child Eating Behavior Questionnaire. Age at introduction to fruit, vegetables, discretionary sweets, and discretionary savory foods was assessed, along with intake frequency at infant ages 6, 9, and 12 months, and 2 years. Maternal feeding to soothe was assessed at child aged 3, 6, and 12 months. Maternal permissive feeding was assessed at child aged 2 years. Multiple linear regressions estimated relations of maternal feeding behaviors and infant food exposures with child appetitive traits at age 3.5 years, controlling for sociodemographics and breastfeeding duration.

RESULTS

Maternal feeding to soothe at 6 (r = 0.39, p < 0.001) and 12 months (r = 0.39, p < 0.001) was positively associated with permissive feeding at 2 years. Maternal feeding to soothe at 12 months and permissive feeding at 2 years were associated with greater child emotional overeating, emotional undereating, and desire to drink. Older age at introduction to fruit (β = 0.20±0.08, p = 0.01) and younger age at introduction to discretionary sweet foods (β = -0.07±0.04, p = 0.06) were associated with greater emotional overeating. Older age at introduction to vegetables (β = 0.22±0.11, p = 0.04) and less frequent feeding of fruit (β = -0.20±0.08, p = 0.01) were associated with greater food fussiness.

CONCLUSIONS

Associations of emotional eating with parent feeding behaviors and early life food exposures suggest the potential for interventions targeting early life feeding to have long-term impact on child appetitive traits and diet quality.

Longitudinal study of energy, neurosensory and eating responses durinG pregnancY (ENERGY cohort): A study protocol

BACKGROUND AND AIMS

Physiological changes that occur during pregnancy can have long-term impacts on metabolism and neurosensory responses to food, which can impact nutrition and health outcomes. The ENERGY cohort is a longitudinal study that aims to capitalizes on pregnancy as a natural model of metabolic reprogramming in order to understand the neurosensory mechanisms underpinning links between metabolism and dietary behaviour. The study objectives are to test for multi-sensory shifts during pregnancy, and the effect of sensory changes on dietary choices and bodyweights, and to identify neurosensory mechanisms that determine macronutrient selection before and after pregnancy.

METHODS

A longitudinal cohort study involving 130 pregravid women planning to conceive with the next 12-months and 65 pregravid women with no short-term plans to conceive. Participants will be recruited from Dunedin and Auckland, New Zealand. The study will test for changes in diet, neurosensory outcomes, and metabolism across the reproductive cycle, from pre-pregnancy to 1-year post-pregnancy. Data will be collected at six timepoint throughout the pregnancy which will occur approximately every 3 months. The primary response variables will be changes in supra-threshold sensitivity across modalities, dietary intake, and metabolism between pre-pregnancy and post-pregnancy. Longitudinal data analysis will use linear mixed models to assess changes in the response outcomes over time adjusted for age, ethnicity, and socioeconomic status.

DISCUSSION

Understanding the relationship between metabolism, sensory processing, and macronutrient preferences will provide crucial insights into diet-related health issues, including obesity. This study will lead to the formation of a prospective research cohort that is unique to Aotearoa New Zealand, and will develop multidisciplinary skills that are increasingly necessary to addressing the obesity epidemic.

Potential mechanisms and modulators of food intake during pregnancy

Dietary choice during pregnancy is crucial not only for fetal development, but also for long-term health outcomes of both mother and child. During pregnancy, dramatic changes in endocrine, cognitive, and reward systems have been shown to take place. Interestingly, in different contexts, many of these mechanisms play a key role in guiding food intake. Here, we review how food intake may be impacted as a function of pregnancy-induced changes across species. We first summarize changes in endocrine and metabolic signaling in the course of pregnancy. Then, we show how these may be related to cognitive function and reward processing in humans. Finally, we link these to potential drivers of change in eating behavior throughout the course of pregnancy.

Prospective relations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits

Background

Infant appetitive traits including eating rate, satiety responsiveness, food responsiveness, and enjoyment of food predict weight gain in infancy and early childhood. Although studies show a strong genetic influence on infant appetitive traits, the association of parent and infant appetite is understudied. Furthermore, little research examines the influence of maternal pregnancy dietary intake, weight indicators, and feeding mode on infant appetite. The present study investigated relations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits.

Methods

Mothers in the Pregnancy Eating Attributes Study (458 mothers enrolled, 367 retained through delivery) completed self-report measures of reward-related eating, and principal component analysis yielded two components: (1) food preoccupation and responsiveness and (2) reinforcing value of food. Mothers completed 24-h dietary recalls across pregnancy, and the standardized NOVA (not an acronym) system categorized recalled foods based on processing level. Maternal anthropometrics were measured across pregnancy. At infant age 6 months, mothers reported on feeding mode and infant appetitive traits. Linear regressions were conducted predicting infant appetitive traits from household income-poverty ratio (step 1); maternal reward-related eating components (step 2); pregnancy ultra-processed food intake (% of energy intake), early pregnancy body mass index, and gestational weight gain (step 3); and exclusive breastfeeding duration (step 4).

Results

A 1-SD greater maternal food preoccupation and responsiveness was associated with 0.20-SD greater infant satiety responsiveness (p = .005). A 1-SD greater % energy intake from ultra-processed foods during pregnancy was associated with 0.16-SD lower infant satiety responsiveness (p = .031). A 1-SD longer exclusive breastfeeding duration was associated with 0.18-SD less infant food responsiveness (p = .014). Other associations of maternal reward-related eating, pregnancy ultra-processed food intake and weight indicators, and feeding mode with infant appetitive traits were non-significant.

Conclusions

Proximal early-life environmental factors including maternal pregnancy dietary intake and feeding mode may facilitate or protect against obesogenic infant appetitive traits, whereas infant appetite may not parallel maternal reward-related eating. Further investigation into the etiology of appetitive traits early in development, particularly during solid food introduction, may elucidate additional modifiable risk factors for child obesity.

Trial registration

Clinicaltrials.gov. Registration ID – NCT02217462. Date of registration – August 13, 2014.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01334-9.

Associations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth

BACKGROUND

Excessive intake of ultra-processed foods, formulated from substances extracted from foods or derived from food constituents, may be a modifiable behavioral risk factor for adverse maternal and infant health outcomes. Prior work has predominately examined health correlates of maternal ultra-processed food intake in populations with substantially lower ultra-processed food intake compared to the US population. This longitudinal study investigated relations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth in a US cohort.

METHODS

Mothers in the Pregnancy Eating Attributes Study were enrolled at ≤12 weeks gestation and completed multiple 24-Hour Dietary Recalls within six visit windows through one-year postpartum (458 mothers enrolled, 321 retained at one-year postpartum). The NOVA (not an acronym) system categorized food and underlying ingredient codes based on processing level. Maternal anthropometrics were measured throughout pregnancy and postpartum, and infant anthropometrics were measured at birth and ages 2 months, 6 months, and 1 year. Maternal cardiometabolic markers were analyzed from blood samples obtained during the second and third trimesters.

RESULTS

Holding covariates and total energy intake constant, a 1-SD greater percent energy intake from ultra-processed foods during pregnancy was associated with 31% higher odds of excessive gestational weight gain (p = .045, 95% CI [1.01, 1.70]), 0.68±0.29 mg/L higher c-reactive protein during pregnancy (p = .021, 95% CI [0.10, 1.26]), 6.7±3.4% greater gestational weight gain retained (p = .049, 95% CI [0.03, 13.30]), and 1.09±0.36 kg greater postpartum weight retention (p = .003, 95% CI [0.38, 1.80]). No other significant associations emerged.

CONCLUSIONS

Ultra-processed food intake during pregnancy may be a modifiable behavioral risk factor for adverse maternal weight outcomes and inflammation. Randomized controlled trials are needed to test whether targeting ultra-processed food intake during pregnancy may support optimal maternal health.

TRIAL REGISTRATION

Clinicaltrials.gov. Registration ID - NCT02217462 . Date of registration - August 13, 2014.