First trimester predictors of diet and birth outcomes in low-income pregnant women

Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation

BACKGROUND

Two randomized trials found women with low blood docosahexaenoic acid (DHA; an omega 3 fatty acid) had fewer early preterm births (<34 weeks gestation) if they were assigned to high dose DHA supplementation, however, there is currently no capacity for clinicians who care for pregnancies to obtain a blood assessment of DHA. Determining a way to identify women with low DHA intake whose risk could be lowered by high dose DHA supplementation is desired.

OBJECTIVE

To determine if assessing DHA intake can identify pregnancies that benefit from high dose DHA supplementation.

STUDY DESIGN

This secondary analysis used birth data from 1310 pregnant women who completed a 7-question food frequency questionnaire (DHA-FFQ) at 16.8 ± 2.5 weeks gestation that is validated to assess DHA status. They were then randomly assigned to a standard (200 mg/day) or high dose (800 or 1000 mg/day) DHA supplement for the remainder of pregnancy. Bayesian logistic regressions were fitted for early preterm birth and preterm birth as a function of DHA intake and assigned DHA dose.

RESULTS

Participants who consumed less than 150 mg/day DHA prior to 20 weeks' gestation (n = 810/1310, 58.1%) had a lower Bayesian posterior probability (pp) of early preterm birth if they were assigned to high dose DHA supplementation (1.4% vs 3.9%, pp = 0.99). The effect on preterm birth (<37 weeks) was also significant (11.3% vs 14.8%, pp = 0.97).

CONCLUSION

The DHA-FFQ can identify pregnancies that will benefit most from high dose DHA supplementation and reduce the risk of preterm birth. The DHA-FFQ is low burden to providers and patients and could be easily implemented in obstetrical practice.

Maternal Nutrition Status Associated with Pregnancy-Related Adverse Outcomes

Although maternal nutrition has an impact on fetal development and gestational outcome, tracking maternal nutrition in outpatient practice is still complex and involves proper technical capacitation in this area. Nevertheless, the association between nutritional variables may broaden the ability to predict the occurrence of gestational disorders and prevention management. We aimed to identify factors that could indicate the probability of adverse outcomes in mid-pregnancy. From a cohort of 1165 nulliparous pregnant women without any previous disease, the nutritional status was assessed by body mass index (BMI) and mid-upper arm circumference (MUAC), associated with dietary patterns and sociodemographic characteristics. Two predictive models with nutritional status for screening the occurrence of adverse outcomes of preterm birth, gestational diabetes mellitus, small-for-gestational-age newborns and preeclampsia were developed. The odds of adverse outcomes were higher in non-white (p < 0.05) obese women and with high protein consumption. There was no significant difference between the models, with an overall accuracy of 63% for both models and a probability of success in predicting adverse outcomes (BMI = 61%, MUAC = 52%). This study of Brazilian pregnant nulliparous women offers two possible options for early tracking of adverse gestational outcomes that should be further externally validated.

Maternal dietary diversity and pattern during pregnancy is associated with low infant birth weight in the Cape Coast metropolitan hospital, Ghana: A hospital based cross-sectional study

BACKGROUND

This study investigated the associations between mother's dietary diversity score and dietary patterns during pregnancy and the odds of low birth weight at the Cape Coast Metropolitan Hospital in Ghana.

METHODS

Mothers attending the postnatal clinic from January to August 2016 at the Cape Coast Metropolitan Hospital were included. Dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the women's dietary diversity score, women were categorized into low, medium or high dietary diversity score groups. The primary outcome was low birth weight and was defined as weight <2500 g at birth. Factor analysis was conducted to identify maternal dietary patterns and a multivariable logistic regression analysis was used to determine the associations between dietary diversity score and dietary patterns with low birth weight.

RESULTS

The prevalence of low birth weight in infants was 43.8% (95% CI = 39%-49%). After adjusting for covariates, the odds of low birth weight was four times higher in the low dietary diversity score group compared to the high dietary diversity score group (odds ratio [OR] = 4.29, 95% confidence interval [CI], 1.24-6.48). Three dietary patterns namely "Western", "Traditional" and "Healthy", which explained 58.23% of the total variance in food intake were identified. The subjects in the highest quartiles of "healthy" and "traditional" dietary pattern scores had significantly lower odds of low birth weight (healthy: OR = 0.23, 95% CI, 0.19-0.39, P trend <0.0001; traditional: OR = 0.14, 95% CI, 0.06-0.35, P trend <0.0001, respectively) compared to those in the lowest quartiles of dietary pattern score.

CONCLUSION

Low dietary diversity score during pregnancy was associated with higher odds of infant low birth weight whereas dietary patterns considered as "healthy" and "traditional" during pregnancy were associated with lower odds of infant low birth weight. Findings of this study suggests that higher dietary diversity and "healthy" and "traditional" dietary patterns during pregnancy may be protective of LBW in the study area.

Extending the developmental origins of disease model: Impact of preconception stress exposure on offspring neurodevelopment

The concept of the developmental origins of health and disease via prenatal programming has informed many etiologic models of health and development. Extensive experimental research in non-human animal models has revealed the impact of in utero exposure to stress on fetal development and neurodevelopment later in life. Stress exposure, however, is unlikely to occur de novo following conception, and pregnancy health is not independent of the health of the system prior to conception. For these reasons, the preconception period is emerging as an important new focus for research on adverse birth outcomes and offspring neurodevelopment. In this review, we summarize the existing evidence for the role of preconception stress exposure on pregnancy health and offspring neurodevelopment across species and discuss the implications of this model for addressing health disparities in obstetrics and offspring outcomes.

Consumption of key food groups during the postpartum period in low-income, non-Hispanic black mothers

The postpartum period can impact diet quality and subsequently place women at greater risk for overweight or obesity. This study examined consumption of key food groups during the first 2 years postpartum among low income, non-Hispanic black, first-time mothers. Data were from the Infant Care, Feeding and Risk of Obesity Study, a cohort of 217 mother-infant dyads, followed from 3 to 18 months postpartum, collected from 2003 to 2007. At each study visit (3, 6, 9, 12, and 18 months) 24-h dietary recalls were collected. Consumption levels were compared to those recommended from the 2010 Dietary Guidelines for Americans (DGAs) for each of the following food groups: fruits, vegetables, grains, whole grains, protein foods and dairy, as well as an estimated upper limit for sugar-sweetened beverage (SSB) consumption. At each time point, mothers met recommended intake levels for grains and protein foods only. In random-intercept logistic regression models, no demographic or household characteristics were associated with a likelihood of consuming recommended levels for any of the food groups according to the DGAs. Given the low intake of fruits, vegetables, whole grains and lean protein foods and high intake of SSBs and refined grains, interventions targeting women's diet during the postpartum period are warranted.

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

OBJECTIVE

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

DESIGN

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

SETTING

High- and upper-middle-income countries.

SUBJECTS

Pregnant or postpartum women reporting their dietary intake during pregnancy.

RESULTS

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

CONCLUSIONS

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

The effect of prenatal docosahexaenoic acid supplementation on infant outcomes in African American women living in low-income environments: A randomized, controlled trial

IMPORTANCE

African American women living in urban, low-income environments are at high risk for poor nutrition during pregnancy and birth complications.

OBJECTIVE

To test the effectiveness of prenatal docosahexaenoic acid (DHA) supplementation on birth outcomes and infant development in a sample of African American women with Medicaid insurance and living in the city of Pittsburgh.

DESIGN

The Nutrition and Pregnancy Study (NAPS) is a double-blind, randomized controlled trial of prenatal DHA supplementation conducted between 2012 and 2014.

SETTING

Participants were recruited from obstetric clinics at the University of Pittsburgh Medical Center.

PARTICIPANTS

Sixty-four pregnant, African American women were enrolled at 16-21 weeks of gestation and randomized to either 450mg/day of DHA (22:6n-3)(n=43) or a soybean placebo (n=21). Four women (6.3%) withdrew from the study: two participants from each study arm; complete data were obtained for 49 infants (76.5%) at the 3-month assessment.

INTERVENTIONS

Supplementation with DHA or placebo continued from the beginning of enrollment through delivery.

MAIN OUTCOME AND MEASURES

Data on birth outcomes were collected from medical records. At approximately 3 months post-partum, mothers brought their infants to the laboratory where the Bayley Scales of Infant Development (BSID-III) were administered and cortisol response to the Face-to-Face Still-Face (FFSF) paradigm was assessed.

RESULTS

Infants of mothers who received DHA supplementation had higher birth weight (3.174g versus 2.890g) than infants of mothers receiving placebo (F [2.40]=6.09, p=0.018, eta=0.36), and were more likely to have a 1-min Apgar score greater than 8 (OR=5.99 [95% CI=1.25-28.75], p=0.025). Infants of mothers who received DHA compared with infants of mothers receiving placebo had lower levels of cortisol in response to the FFSF paradigm (F [1.32]=5.36, p=0.018, eta=0.36). None of the scores on the BSID-III differed as a function of active supplement versus placebo.

CONCLUSIONS

Infants of women living in urban, low-income environments who received DHA supplementation had more optimal birth outcomes and more modulated cortisol response to a stressor. DHA supplementation may be effective in attenuating the negative effects of prenatal stress on offspring development.

Modulation of prenatal stress via docosahexaenoic acid supplementation: implications for child mental health

Pregnant women living in poverty experience chronic and acute stressors that may lead to alterations in circulating glucocorticoids. Experimental evidence from animal models and correlational studies in humans support the hypothesis that prenatal exposure to high levels of glucocorticoids can negatively affect the developing fetus and later emotional and behavioral regulation in the offspring. In this integrative review, recent findings from research in psychiatry, obstetrics, and animal and human experimental studies on the role of docosahexaenoic acid in modulation of the stress response and brain development are discussed. The potential for an emerging field of nutritionally based perinatal preventive interventions for improving offspring mental health is described. Prenatal nutritional interventions may prove to be effective approaches to reducing common childhood mental disorders.

Quality of pregnant women's diet in Poland - macro-elements

INTRODUCTION

The objective was to assess the quality of pregnant women's diet in Poland concerning macro-elements and to analyze reasons for low or high quality diets.

MATERIAL AND METHODS

Five hundred and twelve pregnant women in their 20(th) to 30(th) week of pregnancy took part in the research conducted by means of a 7-day observation of diet. Consumed products were analyzed by means of DIETETYK software developed by the Polish National Food and Nutrition Institute. Obtained macro values were averaged. The results were compared with the recommendations from the World Health Organization, European Union and Polish National Food and Nutrition Institute and analyzed statistically (χ(2) test).

RESULTS

The pregnant women consumed an average of 1898 ±380 kcal daily. Average value of macro components supplied with the diet did not deviate from EU and NFNI nutrition recommendations: protein - 72.1 g/person daily, fats overall - 72.8 g, polyunsaturated fatty acids - 10.93 g, cholesterol - 283 mg, carbohydrates - 257 g. The study proved a significant relation between a higher quality diet of pregnant women and tertiary or secondary education (p = 0.05) as well as urban residence (p = 0.01).

CONCLUSIONS

Pregnant women's diet in Poland is not significantly different from diet quality of pregnant women from other countries. A lower quality diet was observed among women who smoked during pregnancy and lived in rural areas.

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

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

Stress, depression, social support, and eating habits reduce diet quality in the first trimester in low-income women: a pilot study

Maternal diet quality influences birth outcomes. Yet, little research exists that assesses women's diet quality during the first trimester of pregnancy, a crucial time of placental and fetal development. This cross-sectional study, describing diet quality and its relationship with stress, depression, social support, and eating habits in the first trimester, may identify low-income women needing intensive dietary intervention. Seventy-one low-income women completed validated instruments measuring stress, depression, social support, and eating habits; had their height and weight measured; received training on portion-size estimation; and completed three 24-hour dietary recalls (1 weekend day and 2 nonconsecutive weekdays) from July 2009 to February 2010. Comparative and correlational analyses were done. Women with diet quality scores below the median (n=35) had more depression (9.6±5.1 vs 6.7±5.1) and stress (22.1±5.4 vs 19.3±4.8) and less control over meal preparation (5.0±1.5 vs 4.2±1.5) and support from others (52.0±12.0 vs 57.4±7.2) than did women with high diet quality scores (n=36). Diet quality was negatively related to depression (r=-0.41), stress (r=-0.35), skipping meals (r=-0.41), and control over meal preparation (r=-0.33), and positively related to support from others (r=0.38). Low-income women experiencing life stressors represent an at-risk group for low diet quality and may need intensive dietary intervention before and during pregnancy. More research designed to improve diet quality in low-income pregnant women is needed.

Predictors of dietary quality in low-income pregnant women: a path analysis

BACKGROUND

Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester.

OBJECTIVE

The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women.

METHOD

A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy.

RESULTS

The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (β = .36) and a direct (β = -.23) and indirect effect on dietary quality (β = -.30). Poor eating habits had a direct effect on dietary quality (β = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (β = .39) and nutritional knowledge (β = .18) and an indirect effect on dietary quality (total effect, β = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables.

DISCUSSION

Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

Eating at fast-food restaurants and dietary quality in low-income pregnant women

Little is known about how fast-food consumption affects dietary quality in women during the first trimester of pregnancy, which may adversely affect pregnancy outcomes. An observational design compared high versus low frequency of fast-food consumption in low-income pregnant women (N = 50) during the first trimester. Although high-frequency fast-food consumers ate significantly more vegetables, they also consumed more gravies, less fruit, and more daily calories, with a higher percentage of total calories from fats. Those with high-frequency fast-food consumption were more likely to be obese, depressed, and stressed and they skipped more meals. In addition, the combination of depression, stress, and emotional eating depression and anxiety subscale scores explained 45% of the variance in dietary quality. High frequency of fast-food consumption contributed to poor dietary quality and excessive caloric intake, which may lead to excessive gestational weight gain.

Birth outcomes associated with prenatal participation in a government support programme for mothers with low incomes

BACKGROUND

Women with low incomes are at higher risk to have low-birthweight (LBW) babies and less likely to participate in prenatal support programmes than women with higher incomes. This study examined birth outcomes among participants in the Newfoundland and Labrador Mother-Baby Nutrition Supplement (MBNS), a prenatal programme for women with low incomes that provides a monthly financial supplement and printed information on infant health and development, along with a referral to public health nursing services.

METHODS

Application data (e.g. mother's age, education) for those who applied between August 2002 and December 2004 were obtained from the Provincial Government. Birth outcomes (e.g. birthweight, weeks of gestation) were available for 1599 women. Of these, 862 were parity zero and subsequently delivered full-term infants. Comparisons were made on demographics, timeliness of enrolment and rates of full-term LBW.

RESULTS

Participants were more often single, younger and less educated than the average woman who gave birth in the Province or Canada in 2004. Women enrolled early were less likely to have a full-term LBW baby than those enrolled late (chi(2)((1)) = 4.03, P = 0.045). Mothers enrolled late had a higher rate of full-term LBW than was the case in the Province [risk ratio (RR) = 2.76, 95% confidence interval (CI) = 1.61-4.74] and Canada (RR = 2.53, 95% CI = 1.55-4.21) whereas those enrolled earlier, despite increased risk due to low income, age and education, single status and zero parity, had rates of full-term LBW on par with the Province (RR = 1.29, 95% CI = 0.71-2.32) and Canada (RR = 1.19, 95% CI = 0.68-2.08).

CONCLUSION

The MBNS is an effective intervention for improving birth outcomes in women considered at risk. The challenge is to enrol pregnant women as early as possible. Future research will examine what programme component or combination of components (e.g. financial, information, referral) affects birth outcomes.

Correlates of dietary quality and weight retention in postpartum women

The purpose of this study(1) was to identify correlates of dietary quality and postpartum weight retention in women and to examine the association of dietary quality and weight retention. A secondary analysis was conducted of data from 100 women who delivered singleton babies and were over 18 years of age. In sum, 44 women had adequate dietary quality. Most women had adequate intake of meat (79%), milk (66%), and fruit (51%) but not bread (14%) or vegetables (24%). Dietary quality was significantly associated with breast-feeding (rs = .378, p < .000). Dietary quality was not associated with postpartum weight retention. In all, 43% of the variance in postpartum retained weight was explained by weight gained during pregnancy and weight-related distress. A gap exists in the nutrition education and weight management of women after childbirth that allows for a reversal of the healthy eating patterns adopted during pregnancy and throughout the ensuing postpartum life transition.