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

Are first-trimester pregnant women consuming adequate and diverse diet? A hospital-based cross-sectional study in Karachi, Pakistan

BACKGROUND

Maintaining a healthy and diverse diet during pregnancy is crucial for maternal well-being and fetal development. The first trimester marks the beginning of vital developmental processes influenced by maternal nutritional status. Therefore, we aimed to determine dietary adequacy and diversity among first-trimester pregnant women.

METHODS

In this cross-sectional study, we recruited 306 first-trimester pregnant women from the antenatal clinics of Aga Khan University Hospital, Karachi (January 2020 to September 2021). Eligible women possessed smartphones (for the mHealth intervention trial) and reported no major comorbidities or medication use. Data about socio-demographic, obstetric, and dietary history were collected through interviews using a structured questionnaire. Booking weight, height, blood pressure, and haemoglobin levels were extracted from medical records. An aggregate dietary risk score (DRS) was calculated separately for quantity and quality by summing the DRS for each of the six major food groups. A score of 0 was assigned to adequate, 1.5 to intermediate, and 3 to inadequate quantity or quality categories. Data were analysed using STATA 14.0.

RESULTS

The mean ± SD for DRS quantity and quality were 10.6 ± 2.4 and 7.5 ± 2.5, respectively. Adequate dietary quantity and quality per week for starch-based food were reported by 14.4% and 21.2%, for vegetables by 0.3% and 49%, for fruits by 41.2% and 88.6%, for animal and plant protein by 19% and 0%, for milk and milk products by 1% and 37.6% and for oils and fats by 90.5% and 8.8%, respectively. Sweet and savoury snacks were eaten by 74.8% and 53.9%, respectively. Ready-made meals, carbonated beverages, packaged juices, and additional salt were consumed by 55.2%, 46.4%, 34.3%, and 7.5%, respectively. The median (IQR) water intake was 6 (4-8) glasses/day.

CONCLUSIONS

During the early stages of pregnancy, women enrolled for antenatal care at an urban private tertiary care hospital report inadequate dietary intake for various food groups, except for the quantity of oils/fats and the quality of fruit consumption. Poor dietary practices underscore the need for focused and impactful dietary counselling during the initial stages of pregnancy.

Assessing the reproducibility and validity of a food frequency questionnaire for pregnant women from the Chinese Miao ethnic group

Background

Currently, no food frequency questionnaire is available to be administered exclusively to ethnic minorities in China. This study aimed to evaluate the reproducibility and validity of a culturally tailored semi-quantitative food frequency questionnaire (FFQ) designed for pregnant women belonging to the Miao ethnic group in China.

Methods

A total of 74 questions in the FFQ were administered to collect dietary information from Miao women in China during their pregnancy. This study included 153 and 127 pregnant women, respectively, for testing the validity and reproducibility of the results. Baseline FFQ data (FFQ1) were collected initially, followed by the administration of a repeated FFQ 4-6 weeks later (FFQ2). Two 24-h recalls (24HR) were used as references to compare food groups and nutrient intake. Pearson/Spearman's coefficients were used to measure the validity and reproducibility of the FFQ. Quartile cross-classification, weighted kappa coefficients, and Bland-Altman plots were employed to assess the agreement.

Results

Most food groups and nutrient intake estimated by the FFQ were higher than those estimated by the 24HR. Food groups and nutrients' correlations for FFQ vs. 24HR after being energy-adjusted and de-attenuated, respectively, were 0.10 (vegetables) to 0.45 (grains/tubers) and 0.15 (iron) to 0.52 (riboflavin). Comparatively, correlation coefficients for FFQ1 vs. FFQ2 ranged from 0.41 (fruit) to 0.71 (vegetables) and from 0.45 (energy) to 0.64 (calcium). The percentage of pregnant women classified in the same or adjacent quartiles ranged from 64.08% (vegetables) to 95.29% (sour soup) and from 68.88% (vitamin E) to 78.81% (energy). Weighted kappa coefficients exceeded 0.2 for food groups and most nutrients, and Bland-Altman plots demonstrated acceptable agreement between the two tools.

Conclusions

This study provides novel information on the validation of FFQ. It demonstrates that the FFQ exhibits ideal reproducibility and acceptable validity in estimating and ranking the intake of food groups and most nutrients among pregnant women belonging to the Chinese Miao ethnic group.

Food Insecurity Is Associated with Diet Quality in Pregnancy: A Cross-Sectional Study

Household food insecurity (HFI) and poorer prenatal diet quality are both associated with adverse perinatal outcomes. However, research assessing the relationship between HFI and diet quality in pregnancy is limited. A cross-sectional online survey was conducted to examine the relationship between HFI and diet quality among 1540 pregnant women in Australia. Multiple linear regression models were used to examine the associations between HFI severity (marginal, low, and very low food security compared to high food security) and diet quality and variety, adjusting for age, education, equivalised household income, and relationship status. Logistic regression models were used to assess the associations between HFI and the odds of meeting fruit and vegetable recommendations, adjusting for education. Marginal, low, and very low food security were associated with poorer prenatal diet quality (adj β = -1.9, -3.6, and -5.3, respectively; p < 0.05), and very low food security was associated with a lower dietary variety (adj β = -0.5, p < 0.001). An association was also observed between HFI and lower odds of meeting fruit (adjusted odds ratio [AOR]: 0.61, 95% CI: 0.49-0.76, p < 0.001) and vegetable (AOR: 0.40, 95% CI: 0.19-0.84, p = 0.016) recommendations. Future research should seek to understand what policy and service system changes are required to reduce diet-related disparities in pregnancy.

Development and short evaluation of the Dutch healthy diet index for pregnant women; DHD-P

Introduction

Diet quality indices provide a quick indicator of overall diet and are commonly used in research and surveillance. We developed a Dutch Healthy Diet for pregnant women (DHD-P) index, comprising 22 components aligned with the 2021 Dutch food-based dietary guidelines for pregnant women. Our evaluation focused on assessing its performance and sensitivity to change.

Methods

The DHD-P index was quantified by using a validated Food Frequency Questionnaire (FFQ) and two 24-h recalls at 12 and 24 weeks gestation completed by 24-to-41 year old pregnant women participating in the GLIMP-II study. Strength and direction of associations were evaluated based on de-attenuated correlation coefficients between FFQ and 24-h recall data at 24 weeks gestation (n = 47). Sensitivity to change was evaluated by comparing DHD-P index data assessed by both FFQ and recalls at 12 and 24 weeks gestation using paired t-tests or Wilcoxon Signed Rank Test (n = 27).

Results

De-attenuated correlation coefficients between FFQ and 24-recall data showed a good correlation for the total DHD-P score (rho = 0.57) and moderate to good correlations for component scores. FFQ as well as recall data showed comparable dietary intake at 12 and 24 weeks, suggesting minimal changes during pregnancy. Correlations over time were moderate-to-good for scores based on FFQ and low to moderate for scores based on 24hRs, indicating better reproducibility of scores based on FFQ data.

Conclusion

Considering the moderate to good correlations, the DHD-P index appears to be an appropriate index to assess diet quality among pregnant women, and could serve as a foundation to provide dietary feedback toward healthier food choices. Studies including dietary data for all relevant food groups and nutrients are needed to substantiate our findings and further explore the DHD-P sensitivity to change.

Exploring the relationships between pre-pregnancy BMI, gestational weight gain, and nutritional intake: a real-world investigation in Shandong, China

This study investigated the associations between gestational weight gain (GWG), pre-pregnancy body mass index (BMI), and prenatal diet quality in pregnant women from Shandong, China. We analyzed a sample of 532 early-stage pregnant women registered at an outpatient clinic. Diet quality was evaluated using the Chinese Healthy Dietary Index for Pregnancy (CHDI-P), encompassing three dimensions: diversity, adequacy, and limitation, with an overall score out of 100. Dietary intake was documented via 24-h dietary recalls spanning three consecutive days and subsequently translated to a CHDI-P score. At the time of enrollment, BMI was measured on-site and classified as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Pregnant women were also categorized into inadequate, adequate, and excessive weight gain groups based on their GWG. We employed a Tukey-adjusted generalized linear model to compare the CHDI-P scores between the pre-pregnancy BMI groups and GWG groups. The results revealed that the underweight group had significantly higher total scores and limitation total scores on the CHDI-P (p < 0.001). Conversely, the overweight and obese groups were more susceptible to suboptimal dietary quality. Notably, the inadequate weight gain group displayed significantly elevated food adequacy scores compared to the other two groups (p < 0.05). This indicates that greater GWGs do not necessarily align with principles of adequate nutrition.

Dietary Patterns and Factors Associated with Food Affinity in Pregnant Women from Quito, Ecuador

Nutrition during pregnancy influences perinatal outcomes and predispositions to chronic diseases. A prospective cohort study was carried out with the objectives of describing the dietary patterns in the pregnant population in the city of Quito, Ecuador and analysing the sociodemographic and lifestyle factors that influence the adherence to each dietary pattern. The body mass index was calculated for each patient, and the patients were classified according to the Atalah criteria. The Global Physical Activity Questionnaire was also applied. The dietary patterns were assessed using a dietary survey with a 24 h recall on two occasions. A total of 535 pregnant women were included. A positive association was found between the pattern "dairy, salads and sweet snacks/dressings" and foreign nationality (β = 0.82 (0.43;1.21)). The "refined carbohydrates" pattern was negatively associated with education equal to or less than 7 years and an income of up to one basic salary (β = -0.59 (-1.05; -0.14)). The "traditional Ecuadorian" pattern showed a positive association with being born in the coastal region of Ecuador (β = 0.62 (0.22; 1.01)). This study identified three dietary patterns in pregnant women and their possible associations with certain sociodemographic factors. More studies are needed to better understand these patterns as well as to analyse their nutritional and caloric properties.

Exploring preliminary dietary intake results using a novel dietary assessment tool with pregnant participants enrolled in a birth cohort

OBJECTIVE

We aimed to describe preliminary dietary intake results using DietID™ for dietary assessment during pregnancy. A sub-sample of participants in the Research Enterprise to Advance Children's Health (REACH) prospective birth cohort from Detroit, MI received a unique web link to complete the DietID™ assessment multiple times during pregnancy. We present results for the first dietary assessment completed during pregnancy by each participant. DietID™ uses an image-based algorithm to estimate nutrient intake, dietary patterns, and diet quality and provides immediate results to participants. Descriptive statistics were used to summarize participant characteristics, nutrient intakes, dietary patterns, diet quality, and participant-rated accuracy of individual dietary assessment results. Differences in diet parameters were assessed by participant race with an independent t-test.

RESULTS

Participants (n = 84) identified as majority Black (n = 47; 56%), reflective of the source population. Mean (SD) maternal age and gestational age at dietary assessment were 32 (5.6) years and 14.3 (4.8) weeks, respectively. Mean dietary quality, as reported in the DietID™ data output as the Healthy Eating Index (HEI), was 68 (range 12-98; higher scores indicate higher diet quality) and varied significantly between Black (mean [SD] 61 [23]) and White (mean [SD] 81 [19]) race (p < 0.01). Mean participant-rated accuracy of individual dietary assessment results was high at 87% on a scale of 0-100% ("not quite right" to "perfect"; range 47-100%).

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial

Background

Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM.

Aims

This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care.

Methods

Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval.

Discussion

This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM.

Clinical trial registration

https://clinicaltrials.gov/study/NCT05299502, NCT05299502.

Diet quality indexes for use during pregnancy: a scoping review

AIMS

High diet quality is related to better health outcomes in general. During pregnancy, a high-quality diet is of paramount importance to promote optimal maternal and neonatal outcomes. This is a scoping review of research available on diet quality indexes (DQIs) for use during pregnancy that summarizes the DQIs in terms of development, country of origin, population used, components, scoring and weighting of components, and evaluation. Furthermore, the DQIs are discussed narratively to inform and direct the development of improved and country-specific DQIs for pregnancy.

METHODS

The EBSCOhost database was used to identify English-language, peer-reviewed articles published between 2000 and 2023, from which 11 publications were identified that describe the development of pregnancy-specific DQIs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews model.

RESULTS

Almost all DQIs (n = 9 of 11) were developed in high-income countries, using dietary intake data from food frequency questionnaires. Several DQIs (n = 5 of 11) used the US Healthy Eating Index as basis and modified it in various ways. Almost all DQIs included both foods and nutrients as components (n = 9 of 11), with vegetables being the most commonly included component alone (n = 8 of 11) or combined with fruit (n = 2 of 11).

CONCLUSION

Because most DQIs were developed using dietary guidelines, recommendations, and dietary intake data from high-income countries, it is recommended that pregnancy-specific DQIs be developed and validated to reflect the nutrition guidelines for lower-income and culturally diverse countries.

Assessing Repeated Urinary Proline Betaine Measures as a Biomarker of Usual Citrus Intake during Pregnancy: Sources of Within-Person Variation and Correlation with Reported Intake

Proline betaine (Pro-B) has been identified as a biomarker of dietary citrus intake, yet gaps remain in its validation as a quantitative predictor of intake during various physiological states. This study quantified sources of within-individual variation (WIV) in urinary Pro-B concentration during pregnancy and assessed its correlation with the reported usual intake of citrus fruit and juice. Pro-B concentrations were determined by 1H-NMR spectroscopy in spot and 24-h urine specimens (n = 255) collected throughout pregnancy from women participating in the MARBLES cohort study. Adjusted linear or log mixed effects models quantified WIV and tested potential temporal predictors of continuous or elevated Pro-B concentration. Pearson or Spearman correlations assessed the relationship between averaged repeated biomarker measures and usual citrus intake reported by food frequency questionnaires. The proportion of variance in urinary Pro-B attributable to WIV ranged from 0.69 to 0.74 in unadjusted and adjusted models. Citrus season was a significant predictor of Pro-B in most analyses (e.g., adjusted β [95% CI]: 0.52 [0.16, 0.88] for non-normalized Pro-B), while gestational age predicted only non-normalized Pro-B (adjusted β [95% CI]: -0.093 [-0.18, -0.0038]). Moderate correlations (rs of 0.40 to 0.42) were found between reported usual citrus intake and averaged repeated biomarker measurements, which were stronger compared to using a single measurement. Given the high degree of WIV observed in urinary Pro-B, multiple samples per participant are likely needed to assess associations between citrus consumption and health outcomes.

Ultra-Processed Foods and Schooling Are Independently Associated with Lower Iron and Folate Consumption by Pregnant Women Followed in Primary Health Care

Combined deficiencies of nutrients such as iron and folic acid intake during pregnancy are related to nutritional deficiencies risk, such as anemia. The objective of this study was to analyze the association between risk factors (sociodemographic, dietary and lifestyle) and the intake of iron and folate by pregnant women followed up in Primary Health Care (PHC) in the Federal District, Brazil. A cross-sectional observational study was carried out with adult pregnant women of different gestational ages. A semi-structured questionnaire was applied by researchers trained to collect sociodemographic, economic, environmental, and health data. Two nonconsecutive 24-hour recalls (24hr) were carried out to collect data about food consumption. Multivariate linear regression models were used to analyze the association between sociodemographic and dietary risk factors and the consumption of iron and folate. The mean daily energy intake was 1726 kcal (95% CI 1641-1811), with 22.4% (95% CI 20.09-24.66) derived from ultra-processed foods (UPFs). The mean iron and folate intake were 5.28 mg (95% CI 5.09-5.48) and 193.42 µg (95% CI 182.22-204.61), respectively. According to the multivariate model, the highest quintile of ultra-processed foods intake was associated with lower iron (β = -1.15; IC 95%: -1.74; 0.55; p < 0.001) and folate intake (β = -63.23; IC 95%: -98.32; -28.15; p < 0.001). Pregnant women with high school degree presented higher iron intake (β = 0.74; IC 95%: 0.20; 1.28; p = 0.007) and folate intake (β = 38.95; IC 95%: 6.96; 70.95; p = 0.017) compared to pregnant women with elementary school degree. Folate consumption was also associated with the second gestational period (β = 39.44; IC 95%: 5.58; 73.30; p = 0.023) and pregnancy planning (β = 26.88; IC 95%: 3.58; 50.18; p = 0.024). Further research is warranted to enhance evidence on the relationship between the role of processed foods and micronutrients intake to strengthen the nutritional quality of diet of pregnant women attended in Primary Health Care.

Dietary intake, physical activity and sedentary behavior and association with BMI during the transition to parenthood: a prospective dyadic study

Introduction

Little is known on how diet, physical activity (PA) and sedentary behavior (SB) changes during pregnancy and after childbirth in primiparous couples. Moreover, it is unclear how potential behavioral changes are associated with changes in BMI. This study examined changes in diet, PA and SB, and their association with changes in BMI in couples transitioning to parenthood.

Methods

Dietary intake (FFQ), PA, SB (both Actigraph GT3X accelerometers) and BMI of women and men were assessed at 12 weeks of gestation, 6 weeks and 6 months postpartum. Data were analyzed using dyadic longitudinal data analyses techniques.

Results

In women, a decrease in fruit intake, an increase in alcohol intake, an increase of light-intensity PA, and a decrease in SB were observed from the beginning of pregnancy up to 6 months postpartum. Decreases in fruit intake between 6 weeks and 6 months postpartum was associated with increases in BMI. Men did not show significant dietary changes, while an increase in light-intensity PA and a decrease in moderate-to-vigorous PA (MVPA) was observed at 6 months postpartum when compared to 12 weeks of gestation. Paternal increases in "avoidance food group" intake were associated with increases in BMI between baseline and 6 weeks postpartum. No associations of changes in BMI and changes in PA and SB were found.

Discussion

Not only mothers but also fathers experienced unfavorable changes in lifestyle during the transition to parenthood, with impact on BMI changes. This highlights the need to monitor unhealthy changes in lifestyle and body weight in both parents when expecting a child and after childbirth.

Clinical trial registration

Clinicaltrials.gov, NCT03454958.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Diet quality during pregnancy and its association with social factors: 3D Cohort Study (Design, Develop, Discover)

Good diet quality during pregnancy provides adequate nutrition to support both the mothers and the fetus. The objective of this study is to describe the distribution of diet quality during pregnancy and to study the association between social factors and diet quality during pregnancy in a Canadian population. This study was based on 1535 pregnant women who provided dietary information in the 3D Cohort Study in Quebec, Canada. A 3‐day food record was used to collect dietary intake in the second trimester of pregnancy. A Canadian adaption of the Healthy Eating Index (HEI‐C) 2010 was used to quantify diet quality. Univariate and multiple linear regression models were used to calculate unadjusted and adjusted effect estimates and confidence intervals for the association between social factors and HEI‐C. The mean HEI‐C 2010 score in this study was 62.9 (SD: 11.2). Only 4.5% and 8.3% of the pregnant women consumed the recommended amounts of whole grains and ‘greens and beans’, respectively. Diet quality was lower in some subgroups of pregnant women. After multivariable adjustment, lower diet quality was observed in participants who were less educated, younger, overweight or obese before pregnancy, or parous. There was an interaction between ethnicity and immigration status on diet quality in pregnancy. These findings could be useful for health practitioners and policymakers in developing strategies to improve the diet quality of pregnant women.

The diet of the women in Canada still needs improvement, especially regarding whole grains and ‘greens and beans’, where the majority of the women did not meet the recommendations.

Pregnant women who were less educated, younger, overweight or obese before pregnancy, or parous should be targeted for improving diet quality in Canada.

There was an interaction between ethnicity and immigration status on diet quality during 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.

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.

Ultra-Processed Food Consumption during Pregnancy and Its Association with Maternal Oxidative Stress Markers

Ultra-processed food (UPF) consumption during gestation may lead to increased oxidative stress (OS) and could affect pregnancy outcomes. This study aims to evaluate the association of UPF consumption during pregnancy with circulating levels of OS markers. Diet was assessed (average of three assessments) in 119 pregnant women enrolled in the OBESO perinatal cohort (Mexico), obtaining quantitative data and the percentage of energy that UPFs (NOVA) contributed to the total diet. Sociodemographic, clinical (pregestational body-mass index and gestational weight gain) and lifestyle data were collected. Maternal circulating levels of OS markers (malondialdehyde (MDA), protein carbonylation (PC), and total antioxidant capacity (TAC)) were determined at the third trimester of pregnancy. Adjusted linear regression models were performed to analyze the association between UPFs and OS markers. UPFs represented 27.99% of the total energy intake. Women with a lower UPF consumption (<75 percentile°) presented a higher intake of fiber, ω-3, ω-6, and a lower ω-6/3 ratio. Linear regression models showed that UPFs were inversely associated with TAC and MDA. Fiber intake was associated with PC. UPF intake during pregnancy may result in an increase in oxidative stress. When providing nutrition care, limiting or avoiding UPFs may be an intervention strategy that could promote a better antioxidant capacity in the body.

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.

Associations between Sociodemographic Factors, Lifestyle Behaviors, Pregnancy-Related Determinants, and Mediterranean Diet Adherence among Pregnant Women: The GESTAFIT Project

We examined sociodemographic factors, lifestyle behaviors, and pregnancy-related determinants associated with adherence to the Mediterranean diet (MD) during pregnancy. A total of 152 Caucasian pregnant women were included in this cross-sectional study. Dietary habits and MD adherence were assessed with a food frequency questionnaire. Physical activity (PA) levels and physical fitness (PF) components (cardiorespiratory fitness, relative muscle strength, and flexibility) were objectively measured. A clustered overall PF index was calculated. Participants with a high MD adherence were older, had a lower body mass index (BMI), spent more time in moderate−vigorous PA, had a greater overall PF, cardiorespiratory fitness, and relative muscle strength compared to participants with low MD adherence (all, p < 0.05). When we explored factors associated with improved MD adherence with logistic regression analysis, we found that the following factors: lower pre-pregnancy BMI (OR = 2.337; p = 0.026), meeting PA recommendations (OR = 2.377; p = 0.045), higher relative muscle strength (OR = 2.265; p = 0.016), and higher overall PF (OR = 5.202; p = 0.004) increased the chances to adhere to the MD. Older age, lower BMI, greater PF, and meeting PA recommendations were associated with higher MD adherence. These factors should be considered for a better design of educational programs and guidelines focused on improving materno−fetal health status during pregnancy.

Eating Patterns during Pregnancy and Postpartum and Their Association with Diet Quality and Energy Intake

This study investigates the relationship between meal-specific eating patterns during pregnancy and postpartum with maternal diet quality and energy intake. Participants in a prospective cohort study completed 24-h dietary recalls three times throughout both pregnancy and 1 year postpartum (n = 420). Linear regressions estimated the associations of eating frequency (number of daily main meals and eating occasions), meal and energy regularity (meal skipping and variation of daily energy intake), and intake timing patterns (distribution of energy intake throughout the day, derived using principal component analysis) with daily energy intake and diet quality (Healthy Eating Index-2015, calculated daily and overall, across both pregnancy and postpartum). Eating frequency was positively associated with energy intake and daily diet quality. Irregular meals were associated with lower energy intake in pregnancy but not postpartum and with lower pregnancy and postpartum diet quality. Energy irregularity was not associated with energy intake or diet quality. Higher postpartum diet quality was associated with a morning energy intake pattern (versus late morning/early afternoon or evening). Differences in these associations between pregnancy and postpartum suggest that efforts to support optimal energy intake and diet quality by modifying eating patterns may require specific strategies for pregnancy and postpartum.

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.

Changes in diet from pregnancy to one year after birth: a longitudinal study

Background

Pregnancy and the first year after giving birth are marked by physiological and psychological changes. While it is well known that energy requirements change during this time, the question of how a woman’s diet actually changes from pregnancy until 1 year postpartum has been left virtually unexplored. The present study employs a longitudinal design to investigate these changes.

Methods

Data were collected within the framework of the LIFE Child study (Leipzig, Germany). The diet composition and culture of eating of 110 women were assessed at 3 time points: in the 24th week of pregnancy, 3 months after giving birth (breastfeeding period), and 12 months after giving birth (after weaning). We assessed differences in nutritional health (Nutritional Health Score, NHS) and the consumption of different food items at each of these time points. We also investigated associations between nutritional health and age, socio-economic status (SES), BMI before pregnancy, and previous births at all three time points.

Results

The analyses revealed high correlations in the NHS values between the three time points (rho_t0/t1 = .55, rho_t0/t2 = .60). On average, nutritional health was lower in the breastfeeding period than during pregnancy. In more detail, women reported less healthy levels of treats and white bread consumption and a higher frequency of snacking in the breastfeeding period than during pregnancy. In contrast, overall nutritional health did not differ significantly between pregnancy and the time after weaning. Increased age was associated with a healthier diet during pregnancy, and a high SES was associated with healthier diet after weaning. Furthermore, the increase in nutritional health from the breastfeeding period to the time after weaning was significantly stronger in women with a higher BMI. We observed no significant associations between dietary nutritional health and previous births.

Conclusions

The present findings suggest that higher energy requirements in the breastfeeding period are met by consuming high-calorie and unhealthy food products rather than healthy and nutrient-rich food. Young mothers should be supported in taking care of their own nutritional health during the challenging time of breastfeeding and caring for a newborn child.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04038-3.

Healthy dietary patterns and common pregnancy complications: a prospective and longitudinal study

BACKGROUND

Adherence to alternate Healthy Eating Index (AHEI), alternate Mediterranean diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) has been linked to lower risks of chronic diseases. However, their associations with common pregnancy complications are unclear.

OBJECTIVES

This study investigates the associations of AHEI, AMED, and DASH during periconception and pregnancy with common pregnancy complication risks.

METHODS

The study included 1887 pregnant women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons. Women responded to an FFQ at 8-13 gestational weeks, and they performed a 24-h dietary recall at 16-22 and 24-29 wk. Gestational diabetes (GDM), gestational hypertension, preeclampsia, and preterm delivery were ascertained using medical records.

RESULTS

Healthier diet indicated by higher AHEI, AMED, and DASH scores was generally related to lower risks of pregnancy complications. Significant inverse associations were observed between AHEI score reported at 16-22 wk and GDM risk [adjusted RR (95% CI), highest (Q4) vs. lowest quartile (Q1): 0.32 (0.16, 0.66), P-trend = 0.002]; DASH score reported at both 8-13 [adjusted RR (95% CI), Q4 vs. Q1: 0.45 (0.17, 1.17), P-trend = 0.04] and 16-22 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.19 (0.05, 0.65), P-trend = 0.01] and gestational hypertension risk; AHEI score reported at 24-29 wk and preeclampsia risk [adjusted RR (95% CI), Q4 vs. Q1: 0.31 (0.11, 0.87), P-trend = 0.03]; AMED score reported at 8-13 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50 (0.25, 1.01), P-trend = 0.03] and DASH score reported at 24-29 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50, (0.26, 0.96), P-trend = 0.03] and preterm delivery risk.

CONCLUSIONS

Adherence to AHEI, AMED, or DASH during periconception and pregnancy was related to lower risks of GDM, gestational hypertension, preeclampsia, and preterm delivery.This study was registered at ClinicalTrials.gov as NCT00912132.

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.

Healthy for My Baby Research Protocol- a Randomized Controlled Trial Assessing a Preconception Intervention to Improve the Lifestyle of Overweight Women and Their Partners

Background: Preconception lifestyle interventions appear promising to reduce pregnancy complications, prevent adult cardiometabolic diseases, and prevent childhood obesity. These interventions have almost exclusively been studied in populations of obese infertile women. The development of preconception lifestyle interventions targeting a broader population of overweight and obese women without a history infertility and their partners is needed.

Methods: This study is a multicenter open label parallel group randomized controlled trial. Sixty-eight non-infertile women with overweight or obesity in the preconception period and their partners will be recruited from the Sherbrooke and Quebec City regions. The couples will be randomized in a 1:1 ratio to receive the Healthy for my Baby intervention or standard care in the preconception period and pregnancy. Women and their partners will be invited to take part in this lifestyle intervention which includes motivational interviews and daily self-monitoring of lifestyle goals through a mobile phone application. The primary endpoint of this study is the diet quality of women during the preconception period, which will be evaluated using the C-HEI 2007 score at baseline, 2, 4- and 6-months following study enrolment. Women's dietary quality will also be evaluated through the measure of urinary biomarkers of habitual dietary intake at baseline and 2 months in preconception, and 24–26 weeks in pregnancy. Additional indicators of women's lifestyle as well as anthropometric measures will be documented in preconception and pregnancy. For the pregnancy period, the main secondary endpoint is the pattern of gestational weight gain. Pregnancy and neonatal complications will also be evaluated. For partners, diet quality, other lifestyle habits, and anthropometric measures will be documented in the preconception and pregnancy periods.

Discussion: This study will evaluate the effectiveness of a low-cost intervention designed to improve diet and other lifestyle characteristics of women in the preconception period who are overweight or obese. If the Healthy for my Baby intervention is efficacious regarding dietary measures, larger trials will be needed to evaluate the impact of this intervention on the rates of pregnancy complications, childhood obesity, and adult cardiometabolic disease.

Clinical Trial Registration:clinicaltrials.gov (NCT04242069).

Using food network analysis to understand meal patterns in pregnant women with high and low diet quality

BACKGROUND

Little is known about how meal-specific food intake contributes to overall diet quality during pregnancy, which is related to numerous maternal and child health outcomes. Food networks are probabilistic graphs using partial correlations to identify relationships among food groups in dietary intake data, and can be analyzed at the meal level. This study investigated food networks across meals in pregnant women and explored differences by overall diet quality classification.

METHODS

Women were asked to complete three 24-h dietary recalls throughout pregnancy (n = 365) within a prospective cohort study in the US. Pregnancy diet quality was evaluated using the Healthy Eating Index-2015 (HEI, range 0-100), calculated across pregnancy. Networks from 40 food groups were derived for women in the highest and lowest HEI tertiles at each participant-labeled meal (i.e., breakfast, lunch, dinner, snacks) using Gaussian graphical models. Network composition was qualitatively compared across meals and between HEI tertiles.

RESULTS

In both HEI tertiles, breakfast food combinations comprised ready-to-eat cereals with milk, quick breads with sweets (e.g., pancakes with syrup), and bread with cheese and meat. Vegetables were consumed at breakfast among women in the high HEI tertile only. Combinations at lunch and dinner were more varied, including vegetables with oils (e.g., salads) in the high tertile and sugary foods with nuts, fruits, and milk in the low tertile at lunch; and cooked grains with fats (e.g., pasta with oil) in the high tertile and potatoes with vegetables and meat in the low tertile at dinner. Fried potatoes, sugar-sweetened beverages, and sandwiches were consumed together at all main meals in the low tertile only. Foods were consumed individually at snacks in both tertiles; the most commonly consumed food were fruits in the high HEI tertile and cakes & cookies in the low tertile.

CONCLUSIONS

In this cohort of pregnant women, food network analysis indicated that food combinations differed by meal and between HEI tertiles. Meal-specific patterns that differed between diet quality tertiles suggest potential targets to improve food choices at meals; the impact of meal-based dietary modifications on intake of correlated foods and on overall diet quality should be investigated in simulations and intervention studies.

TRIAL REGISTRATION

PEAS was registered with number NCT02217462 in Clinicaltrials.gov on August 13, 2014.

Snacking patterns throughout the life span: potential implications on health

Eating outside the three main meals - in other words, snacking - is a part of the dietary pattern of individuals in all stages of life. The quality and pattern of snacking have an impact on health during the life span. Thus, the aim of this review was to evaluate various patterns and health outcomes of the snacking habits of different demographical groups, from children to the elderly, throughout their life span. We discuss the snacking pattern among children and adolescents, which is characterized by consuming high energy foods with low nutrient value, and which is associated with increased risk of obesity. During university years, study stress and lack of time were obstacles to a healthy dietary pattern involving nutritious snacks, although awareness of the importance of healthy snacks was higher in this group than among younger age groups. Employment status and skipping regular meals were important factors affecting snacking quality and patterns in adulthood. Unhealthy snacks, high in energy, sugar, and salt and low in nutrients, were demonstrated to have a negative impact on individuals' health, such as oral health, blood pressure, obesity, and diabetes. In conclusion, encouraging individuals to consume healthy snacks that are high in nutrients through education to help them plan for their snacks is important to enhance health and reduce disease risk.

Diet Quality and Its Effect on Weight Gain Prevention in Young Adults: A Narrative Review

Global environmental and societal changes have resulted in an increased consumption of energy-dense foods contributing to escalating obesity prevalence, with most rapid weight gain occurring in young adults. Diet is one major modifiable factor contributing to escalating obesity prevalence. Understanding overall diet quality of populations at high risk for weight gain and obesity development, including young adults, provides evidence of dietary intakes, dietary patterns, and associated behaviors, to inform the development of targeted interventions aimed at the prevention of weight gain. This narrative review synthesizes the current evidence of the association between diet quality and weight gain in young adults. Overall, there is a consistent direction of association between improved diet quality and reduced weight gain in adults. This demonstrates the potential of small improvements in diet quality over time as a probable contributor to minimizing weight gain in young adults. Future research evaluating environmental nutrition policies with associated change in diet quality and prospective weight change in population-based studies is warranted to determine their longer-term impact in improving overall diet quality as one strategy to halt escalating obesity prevalence rates.

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.

Pregnancy persistently reduces alcohol purchases: Causal evidence from scanner data

We analyze household-level changes in alcohol consumption in response to pregnancy. Using scanner data, we identify households with a pregnant household member. Within an event study and a dynamic difference-in-differences estimation, we find that during a first pregnancy, households reduce their alcohol purchases by 36%. After pregnancy, purchases of alcohol are 34% lower than before pregnancy. We do not find any effect during the second pregnancy. One possible explanation for our result is that lower consumption during pregnancy changes habits and reduces consumption in the long term. We discuss other explanations and comment on policy implications.

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

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

The accelerator, the brake, and the terrain: associations of reward-related eating, self-regulation, and the home food environment with diet quality during pregnancy and postpartum in the pregnancy eating attributes study (PEAS) cohort

Background

Neurobehavioral factors, including reward-related eating and self-regulation, in conjunction with the food environment, may influence dietary behaviors. However, these constructs have not been examined in pregnancy and postpartum, a time of changing appetite and eating behaviors, and when dietary intake has implications for maternal and child health. This study examined associations of reward-related eating, self-regulation, and the home food environment with pregnancy and postpartum diet quality.

Methods

Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks gestation and followed through one-year postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI-total), and adequacy and moderation scores, respectively, were calculated by pooling 24-h diet recalls administered each trimester and during 2, 6, and 12 months postpartum. Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale (mYFAS), Power of Food Scale (PFS), Multiple Choice Procedure (MCP), and Reinforcing Value of Food Questionnaire (RVFQ); two measures of self-regulation – Barratt Impulsiveness Scale (BIS) and Delay of Gratification Inventory (DGI); and a Home Food Inventory (HFI), yielding obesogenic (OBES) and fruit/vegetables (FV) scores. Linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with diet quality during pregnancy and postpartum, adjusting for sociodemographic characteristics.

Results

Pregnancy HEI-total was inversely associated with PFS (β = − 0.14 ± 0.05, p = 0.009), mYFAS(β = − 0.14 ± 0.06, p = 0.02), 2 of the 5 RVFQ indices, MCP (β = − 0.14 ± 0.05, p = 0.01), and DGI food subscale (β = 0.23 ± 0.05, p < 0.001), but associations of postpartum HEI-total with reward-related eating measures and self-regulation were small and not statistically significant. Pregnancy and postpartum HEI-total were associated inversely with HFI-OBES (β = − 0.17 ± 0.06, p = 0.004 and β = − 0.19 ± 0.07, p = 0.006, respectively), and positively with HFI-FV (β = 0.21 ± 0.05, p < 0.001 and β = 0.17 ± 0.06, p = 0.009, respectively).

Conclusions

Associations of poorer diet quality with greater reward-related eating during pregnancy but not postpartum suggests the need to better understand differences in the determinants of eating behaviors and approaches to circumvent or moderate reward-related eating to facilitate more optimal diet quality across this critical period.

Trial registration

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

Eating in the Absence of Hunger Is Related to Worse Diet Quality throughout Pregnancy

BACKGROUND

Scant research has examined whether laboratory assessments of eating in the absence of hunger (EAH) relates to long-term diet quality.

OBJECTIVE

This study investigates the association of EAH with diet quality during pregnancy.

DESIGN

Pregnancy diet quality was assessed using 24-hour diet recalls collected in each pregnancy trimester. EAH was assessed in a counterbalanced, crossover laboratory feeding substudy in which participants completed two free access eating occasions following a standardized meal during their second pregnancy trimester.

PARTICIPANTS/SETTING

Data were collected from March 2015 to December 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks' gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina.

INTERVENTION

Participants were presented with highly processed (HP) and minimally processed (MP) foods in two separate assessments.

MAIN OUTCOME MEASURES

Scores for total Healthy Eating Index-2015 (HEI-2015) and adherence to adequacy and moderation components were calculated from the diet recalls. Higher scores reflect better diet quality.

STATISTICAL ANALYSES PERFORMED

Linear regressions estimated associations of pregnancy diet quality with EAH (energy, EAH-kcal; and percent offered, EAH-%) in each condition for all foods, and separately for sweet and savory foods.

RESULTS

Lower pregnancy diet quality (all indicators) was associated with greater EAH (EAH-kcal and EAH-%) of all foods and sweet foods in the HP condition. Each 100-kcal increase in EAH of HP foods was associated with a 2- to 3-point decrease (standard error = 0.7 to 0.8) in HEI-2015 (P < 0.01); each 10% increase in EAH of HP foods was associated with a 5- to 7-point decrease (standard error = 2.0) in HEI-2015 (P < 0.01). Greater EAH (energy and percent offered) of savory food intake in the HP condition was associated with a lower HEI-2015 adequacy component score, but was not associated with the HEI-2015 or HEI-2015 moderation component scores. EAH in the MP condition was not associated with pregnancy diet quality.

CONCLUSIONS

Greater EAH of HP, especially sweet, foods was related to worse pregnancy diet quality. Consuming HP sweets after meal termination may reflect a tendency for eating beyond satiation and may be a useful intervention target for improving maternal diet quality.

Dietary intake profile in high-risk pregnant women according to the degree of food processing

BACKGROUND/OBJECTIVE

Studies that address dietary intake theme during pregnancy are generally centered on specific nutrients or on dietary patterns. However, the maternal dietary profile according to the degree of food processing is poorly understood. The purpose of the present study was to describe the dietary profile of high-risk pregnant women according to the degree of food processing.

MATERIALS AND METHODS

A prospective cohort study was conducted at Prof. Dr. Jose Aristodemo Pinotti Women's Hospital (CAISM), University of Campinas, Brazil, with high-risk pregnant women in the third trimester of gestation.

RESULTS

Data from 125 high-risk pregnant women were collected between September 2017 and April 2019. The mean total energy intake (EI) was 1778.3 ± 495.79 kcal/day and the majority of the calories was from unprocessed foods (52.42%), followed by ultra-processed foods (25.46%). The consumption of free sugar and sodium exceeded recommendations, while the consumption of fiber, calcium, folate and iron was below recommendations. The ultra-processed foods intake affects dietary patterns negatively.

CONCLUSION

More than 50% of the EI of high-risk pregnant women is from unprocessed or minimally processed foods, but it is insufficient for meeting dairy fiber, iron, folate and calcium recommendations.

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.

Nutrient Intake during Pregnancy and Post-Partum: ECLIPSES Study

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

Maternal Lutein and Zeaxanthin Concentrations in Relation to Offspring Visual Acuity at 3 Years of Age: The GUSTO Study

Lutein and zeaxanthin play important roles in visual functions, but their influence on early visual development is unclear. We related maternal lutein and zeaxanthin concentrations during pregnancy to offspring visual acuity (VA) in 471 mother–child pairs from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal concentrations of plasma lutein and zeaxanthin were determined at delivery. We measured uncorrected distance of VA in 3-year old children using a LEA Symbols chart; readings were converted to the logarithm of Minimum Angle of Resolution (logMAR), with >0.3 logMAR indicating poor VA. Associations were examined using linear or Poisson regression adjusted for confounders. The median (inter-quartile range) of maternal lutein and zeaxanthin concentrations were 0.13 (0.09, 0.18) and 0.09 (0.07, 0.12) µmol/L, respectively. A total of 126 children had poor VA. The highest tertile of maternal zeaxanthin concentration was associated with 38% lower likelihood of poor VA in children (95% CI: 0.42, 0.93, p-Trends = 0.02). Higher maternal lutein concentrations were associated with a lower likelihood of poor VA in children (RR 0.60 (95% CI: 0.40, 0.88) for middle tertile; RR 0.78 (95% CI: 0.51, 1.19) for highest tertile (p-Quadratic = 0.02)). In conclusion, lutein and zeaxanthin status during pregnancy may influence offspring early visual development; but the results require confirmation with further studies, including more comprehensive measurements of macular functions.

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.