Maternal dietary patterns in pregnancy and fetal growth in Japan: the Osaka Maternal and Child Health Study

Investigating the relationship between anthropometric indicators of the mother during pregnancy with the weight, height, and head circumference of the infant at birth: A mother-infant cohort study

BACKGROUND

The growth and development of the fetus inside the womb depends on several factors, including the weight gain of the mother during pregnancy. The aim of the current research is to determine the relationship between anthropometric indicators of the mother during pregnancy and the weight, height, and head circumference of the infant at birth.

MATERIALS AND METHODS

The present study is a Historical cohort study that was conducted on 1623 pregnant mothers from the beginning of pregnancy to delivery by census method in 4 reference and specialized gynecology and obstetrics hospitals affiliated to Shahid Sadougi University of Medical Sciences in Yazd from 2016 to 2021. The tools used were the questionnaires approved by the Ministry of Health and the Research Council of the University to conduct the mother-infant cohort. Data analysis was performed with SPSS Software Version 22 with analytical statistical tests.

RESULTS

The baby's weight had a significant negative relationship with the mother's weight and the mother's body mass index at the beginning of pregnancy. The baby's height had a significant positive difference with the body mass index at the beginning of pregnancy. The baby's head circumference had a positive and significant relationship with the mother's weight in the third trimester of pregnancy.

CONCLUSION

According to the results of the study and the importance of the health of the mother during pregnancy due to the effect on the health of the fetus, it is recommended to monitor the weight of mothers more sensitively from before pregnancy to the end of pregnancy.

Effects of prepregnancy dietary patterns on infant birth weight: a prospective cohort study

BACKGROUND

Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of prepregnancy dietary patterns.

OBJECTIVES

This study aimed to explore the effects between prepregnancy dietary patterns on birth weight.

METHODS

This study included 911 singleton live-born infants from the Taicang and Wuqiang Mother-Child Cohort Study (TAWS). Baseline information and prepregnancy diet data were collected during early pregnancy. Newborn birth information was obtained from the Wuqiang County Hospital. Macrosomia, defined as a birth weight of ≥4000 g, and large for gestational age (LGA), defined as a birth weight higher than the 90th percentile for the same sex and gestational age, were the outcomes of interest. The dietary patterns were extracted using principal component analysis. Logistic regression models were used to investigate the association between prepregnancy dietary patterns (in tertiles) and macrosomia and LGA, and subgroup analysis was further explored by pre-pregnancy body mass index (BMI).

RESULTS

Four dietary patterns were identified based on 15 food groups. These patterns were named as "cereals-vegetables-fruits," "vegetables-poultry-aquatic products," "milk-meat-eggs," and "nuts-aquatic products-snacks." After adjusting for sociodemographic characteristics, pregnancy complications, and other dietary patterns, greater adherence to the "cereals-vegetables-fruits" pattern before pregnancy was associated with a higher risk of macrosomia (adjusted OR = 2.220, 95% CI: 1.018, 4.843), while greater adherence to the "nuts-aquatic products-snacks" pattern was associated with a lower risk of macrosomia (adjusted OR = 0.357, 95% CI: 0.175, 0.725) compared to the lowest tertile. No significant association was observed between prepregnancy dietary patterns and LGA. However, after subgroup analysis of pre-pregnancy BMI, "cereals-vegetables-fruits" pattern was associated with an increased risk of LGA in overweight and obese mothers (adjusted OR = 2.353, 95% CI: 1.010, 5.480).

CONCLUSIONS

An unbalanced pre-pregnancy diet increases the risk of macrosomia and LGA, especially in overweight or obese women before pre-pregnancy.

Associations of dietary and sedentary behaviours of pregnant women with their children's birth weight: findings from the CHAT trial in Australia

OBJECTIVE

To examine the associations of pregnant women's dietary and sedentary behaviours with their children's birth weight.

DESIGN

Secondary data analysis was conducted using data from a randomised controlled trial, Communicating Healthy Beginnings Advice by Telephone, conducted in Australia. Information on mothers' socio-demographics, dietary and sedentary behaviours during pregnancy was collected by telephone survey at the third trimester. Birth weight data were extracted from the child's health record book. Multinomial logistic regression models were built to examine the associations of pregnant women's dietary and sedentary behaviours with children's birth weight.

SETTING

Participating families.

PARTICIPANTS

Pregnant women and their children.

RESULTS

A total of 1132 mother-child dyads were included in the analysis. The majority of infants (87 %, n 989) were of normal birth weight (2500 g to <4000 g), 4 % (n 50) had low birth weight (<2500 g) and 8 % (n 93) had macrosomia (≥4000 g). Mothers who ate processed meat during pregnancy were more likely to have macrosomia (adjusted risk ratio (ARR) 1·80, 95 % CI (1·12, 2·89)). The risk of macrosomia decreased as the number of dietary recommendations met by mothers increased (ARR 0·84, 95 % CI (0·71, 0·99)). Children's birth weight was not associated with mothers' sedentary time. Children's low birth weight was not associated with mothers' dietary and sedentary behaviours during pregnancy.

CONCLUSION

Maternal consumption of processed meat during pregnancy was associated with an increased risk of macrosomia. Increasing number of dietary recommendations met by mothers was associated with a lower risk of macrosomia. The findings suggested encouraging pregnancy women to meet dietary recommendation will benefit children's birth weight.

Maternal Dietary Protein Patterns and Neonatal Anthropometrics: A Prospective Study with Insights from NMR Metabolomics in Amniotic Fluid

This study aimed to characterize dietary protein patterns (DPPs) in a sample pool of 298 well-nourished pregnant women and explore potential associations between DPPs and neonatal anthropometrics. Maternal dietary data were collected using a validated food frequency questionnaire. Neonatal anthropometrics were abstracted from health booklets. A hierarchical cluster analysis identified three DPPs: "Dairy-focused", "Med-fusion", and "Traditional-inspired". The "Dairy-focused" DPP exhibited the highest protein intake (p < 0.001), predominantly animal protein (p < 0.001), while the "Traditional-inspired" DPP presented higher plant protein (p < 0.001) and fiber intakes (p < 0.001), and, therefore, a reduced carbohydrate-to-fiber quotient (p < 0.001). The "Med-fusion" DPP had the lowest protein-to-fat ratio (p < 0.001). Infants of women following the "Dairy-focused" DPP had the highest birth height centiles (p = 0.007) and the lowest ponderal index (p = 0.003). The NMR-metabolomics approach was implemented on a subset of women that provided amniotic fluid (AF) specimens (n = 62) to elucidate distinct metabolic signatures associated with DPPs. PCA and OPLS-DA models verified the adherence to three DPPs, revealing that the levels of several amino acids (AAs) were the highest in "Dairy-focused", reflecting its protein-rich nature. The "Traditional-inspired" DPP showed decreased AAs and glucose levels. This knowledge may contribute to optimizing maternal dietary recommendations. Further research is needed to validate these findings and better understand the relationships between maternal diet, AF metabolic signature, and neonatal anthropometrics.

Detrimental actions of obesity-associated advanced glycation end-products on endometrial epithelial cell proliferation are alleviated by antioxidants

RESEARCH QUESTION

Advanced glycation end-products (AGE) are elevated in the uterine environment of obese infertile women. Can the detrimental effects of AGE on endometrial epithelial cells be mitigated with therapeutics, and recapitulated in a more physiologically relevant primary model (organoids)?

DESIGN

Human endometrial epithelial cells (ECC-1) were exposed to AGE at concentrations physiologically representative of uterine fluid in lean or obese individuals, and three potential therapeutics: 25 nmol/l receptor for AGE (RAGE) antagonist FPS-ZM1, 100 μmol/l metformin, or a combination of antioxidants (10 μmol/l N-acetyl-l-cysteine, 10 μmol/l N-acetyl-l-carnitine and 5 μmol/l α-lipoic acid). Real-time cell analysis (xCELLigence, ACEA Biosciences) determined the rate of adhesion and proliferation. The proliferation of organoid-derived cells and secretion of cytokines from organoids was characterized in the presence of AGE (n = 5). The uterine fluid of women undergoing assisted reproduction was profiled for AGE-associated inflammatory markers (n = 77).

RESULTS

ECC-1 proliferation was reduced by AGE from obese versus lean conditions and vehicle control (P = 0.04 and P < 0.001, respectively), and restored to a proliferation corresponding to lean conditions by antioxidants. AGE influenced organoid derived primary endometrial epithelial cell proliferation in a donor-dependent manner. AGE increased the organoid secretion of the proinflammatory cytokine CXCL16 (P = 0.006). Clinically, CXCL16 correlated positively to maternal body mass index (R = 0.264, P = 0.021) and intrauterine glucose concentration (R = 0.736, P < 0.0001).

CONCLUSIONS

Physiologically relevant concentrations of AGE alter endometrial epithelial cell function. Antioxidants restore the rate of proliferation of AGE-treated endometrial epithelial (ECC-1) cells. Primary endometrial epithelial cells, cultured as organoids, demonstrate altered proliferation and CXCL16 secretion in the presence of AGE equimolar with the uterine fluid from obese individuals.

Diet Quality and Its Relationship with Weight Characteristics in Pregnant Japanese Women: A Single-Center Birth Cohort Study

Maternal underweight and inadequate gestational weight gain (GWG) are problems in Japan. However, increases in food intake aimed at weight gain alone are not sufficient for mother-child health. This study assessed diet quality based on the 3-day dietary records of pregnant women in an urban area of Japan in order to show the importance of evaluating diet quality, using the Nutrient-Rich Food Index 9.3 (NRF9.3), which is one metric based on nutrition profiling, and the Japanese Food Guide Spinning Top (JFGST). After excluding misreporters of energy intake, we stratified women (n = 91) by pre-pregnancy body mass index (BMI) and determined energy intake, diet quality status, and their relationship with GWG. Intakes of carbohydrate-containing staple foods, vegetable dishes, and fruit were insufficient regardless of BMI. Most of the underweight women with inadequate GWG had insufficient energy intake but high diet quality, as assessed by NRF9.3. In contrast, most women who consumed energy within the recommended range had low diet quality and gained weight at inappropriate levels. These results highlight the importance for pregnant Japanese women to maintain diet quality through a nutrient-dense diet, while simultaneously increasing energy intake after evaluation of their individual diet quality.

Multi-Omics Analysis Reveals the Potential Effects of Maternal Dietary Restriction on Fetal Muscle Growth and Development

In terms of fetal muscle growth, development, and health, maternal nutrition is a crucial influence, although the exact biochemical mechanism by which this occurs is still not fully understood. To examine the potential impacts of maternal dietary restriction on fetal muscle development, the sheep maternal dietary restriction model was developed for this study. In our study, 12 pregnant ewes were evenly split into two experimental groups and fed either 75% or 100% of a maternal nutrient. In addition, a multi-omics analysis was used to study the embryonic longissimus dorsis on gestational days (GD) 85 and 135. The fetal weight at GD 135 was significantly below normal due to the maternal restricted diet (p < 0.01). When fetuses were exposed to the dietary deficit, 416 mRNAs and 40 proteins were significantly changed. At GD 85, the multi-omics analysis revealed that maternal dietary restriction led to a significant up-regulation of the cell cycle regulator CDK2 gene in the cellular senescence signaling pathway, and the results of the qRT-PCR were similar to the multi-omics analysis, which showed that SIX1, PAX7, the cell cycle factors CDK4 and CDK6, and the BCL-2 apoptosis factor were up-regulated and several skeletal muscle marker genes, such as MYF5 and MyoD were down-regulated. At GD 135, maternal dietary restriction blocks the muscle fiber differentiation and maturation. The multi-omics analysis revealed that the TEAD1 gene was in the Hippo signaling pathway, the muscle marker genes MYF5 and MyoG were significantly down-regulated, and the TEAD1 binding of the down-regulated VGLL3 gene might be potential mechanisms affecting myofiber differentiation and maturation. Knocking down the CDK2 gene could inhibit the proliferation of primary embryonic myoblasts, and the expression levels of cell cycle regulatory factors CDK4 and CDK6 were significantly changed. Under low nutrient culture conditions, the number of myoblasts decreased and the expression of CDK2, CDK6, MYF5, PAX7 and BCL-2 changed, which was in perfect agreement with the multi-omics analysis. All of the findings from our study helped to clarify the potential effects of maternal dietary restriction on fetal muscle growth and development. They also provided a molecular foundation for understanding the molecular regulatory mechanisms of maternal nutrition on fetal muscle growth and development, as well as for the development of new medications and the management of related metabolic diseases.

Dietary patterns and birth outcomes of healthy Lebanese pregnant women

Background

The aim of this study was to define the dietary patterns (DPs) of a sample of Lebanese pregnant women and to establish their correlation with maternal and neonatal outcomes.

Methods

A cross-sectional study was conducted among 358 Lebanese pregnant women. Maternal socio-demographic variables, anthropometric measurements, gestational weight gain and neonatal outcomes such as weight, length, head circumference and Apgar score were collected by qualified dietitians. Dietary intake was assessed by a validated food frequency questionnaire and three 24-h dietary recalls. DPs were determined, a posteriori, by a factor analysis to distinguish the inter-correlations between the food groups and a cluster analysis method to assemble the participants into groupings based on similarities in food consumption.

Results

The identified DPs were not exclusively composed of specific food groups, since some components were overlapping in the DPs. The first one was characterized by a high consumption of starchy vegetables, unsaturated fats and unhealthy foods, the second was rich in fruits and vegetables, seeds, rice and pasta, and in fried local meals and the third was mainly based on protein-rich foods like poultry, fish, eggs and dairy products. They were named respectively as “Westernized,” “Mixed” and “Neo-Mediterranean” by the research team. Women having the lowest pre-gestational body mass index (BMI) and higher gestational age followed mainly the “Neo-Mediterranean” eating pattern.

Conclusion

The three identified DPs among Lebanese pregnant women were correlated with the pre-gestational BMI, and some maternal variables. However, neither the maternal nor the neonatal outcomes were correlated with the DP adopted by the mothers.

Dietary patterns and associated factors among pregnant women in Ibadan, Nigeria: Evidence from Ibadan pregnancy cohort study

Background

Maternal nutrition is vital for an optimal intrauterine environment, foetal development, birth weight, pregnancy and neonatal outcomes. We assessed the maternal dietary patterns using a data-driven technique and the associated sociodemographic factors among pregnant women in Ibadan, Nigeria.

Methodology

Dietary assessment was performed during the enrolment of participants for the Ibadan Pregnancy Cohort Study, a prospective cohort study, conducted among 1745 pregnant women enrolled early in pregnancy (≤ 20 weeks) at four comprehensive obstetric facilities within the Ibadan metropolis. A qualitative food frequency questionnaire was used to assess the pregnant population’s intake of food and drinks three months prior to their enrollment. We determined dietary patterns by applying principal component analysis with a varimax rotation. Multivariate analysis was used to investigate the association between sociodemographic factors and dietary patterns at 5% statistical significance.

Results

Mean age and gestational age at enrolment were 29.8 (± 5.3) years and 16.4 (±4.2) weeks, respectively. White rice was the most frequently consumed meal [794 (45.5%) daily, 898 (51.4%)] weekly in our study population. Five major dietary patterns were identified, and they accounted for 28.8% of the total variation: "protein-rich diet with non-alcoholic beverages" (15.6%); "fruits" (4.1%); "typical diet with alcohol" (3.8%); "legumes" (2.8%), "refined grains" (2.6%). Maternal education and income were inversely associated with the consumption of a "protein-rich diet with non-alcoholic beverages", "typical diet with alcohol", and "legumes" in a dose-response fashion. Also, employed women had a higher mean intake of fruits [adjusted β: 0.33 (0.02; 0.65) p = 0.040] compared with women without employment.

Conclusions and recommendation

We described five dietary patterns of pregnant women using a data-driven technique, principal component analysis, in Nigeria. We also identified factors influencing maternal dietary patterns, which can inform public health interventions, especially behavioural change communication during antenatal care.

Prenatal exposure to tobacco and adverse birth outcomes: effect modification by folate intake during pregnancy

BACKGROUND

Fetal exposure to tobacco increases the risk for many adverse birth outcomes, but whether diet mitigates these risks has yet to be explored. Here, we examined whether maternal folate intake (from foods and supplements) during pregnancy modified the association between prenatal exposure to tobacco and with preterm delivery, small-for-gestational age (SGA) births, or neonatal adiposity.

METHODS

Mother-child pairs (n = 701) from Healthy Start were included in this analysis. Urinary cotinine was measured at ~ 27 weeks gestation. Diet was assessed using repeated 24-h dietary recalls. Neonatal adiposity (fat mass percentage) was measured via air displacement plethysmography. Interaction was assessed by including a product term between cotinine (< / ≥ limit of detection [LOD]) and folate (< / ≥ 25th percentile [1077 µg/day]) in separate logistic or linear regression models, adjusting for maternal age, race, ethnicity, education, pre-pregnancy body mass index, and infant sex.

RESULTS

Approximately 26% of women had detectable levels of cotinine. Folate intake was significantly lower among women with cotinine ≥ LOD as compared to those with cotinine < LOD (1293 µg/day vs. 1418 µg/day; p = 0.01). Folate modified the association between fetal exposure to tobacco with neonatal adiposity (p for interaction = 0.07) and SGA (p for interaction = 0.07). Among those with lower folate intake, fetal exposure to tobacco was associated with lower neonatal adiposity (mean difference: -2.09%; 95% CI: -3.44, -0.74) and increased SGA risk (OR: 4.99; 95% CI: 1.55, 16.14). Conversely, among those with higher folate intake, there was no difference in neonatal adiposity (mean difference: -0.17%; 95% CI: -1.13, 0.79) or SGA risk (OR: 1.15; 95% CI: 0.57, 2.31).

CONCLUSIONS

Increased folate intake during pregnancy (from foods and/or supplements) may mitigate the risk of fetal growth restriction among those who are unable to quit smoking or cannot avoid secondhand smoke during pregnancy.

Maternal Consumption of Ultra-Processed Foods-Rich Diet and Perinatal Outcomes: A Systematic Review and Meta-Analysis

The consumption of ultra-processed food (UPF)-rich diets represents a potential threat to human health. Considering maternal diet adequacy during pregnancy is a major determinant for perinatal health outcomes, this study aimed to systematically review and meta-analyze studies investigating the association between maternal consumption of a UPF-rich diet and perinatal outcomes. Conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and gray literature using Google Scholar and ProQuest Dissertations and Theses Global were searched up to 31 May 2022. No restrictions were applied on language and publication date. Two reviewers independently conducted the study selection and data extraction process. Meta-analysis was conducted according to the random-effects model. In total, 61 studies were included in the systematic review and the overall population comprised 698,803 women from all gestational trimesters. Meta-analysis of cohort studies showed that maternal consumption of UPF-rich diets was associated with an increased risk of gestational diabetes mellitus (odds ratio (OR): 1.48; 95% confidence interval (CI): 1.17, 1.87) and preeclampsia (OR: 1.28; 95% CI: 1.15, 1.42). Neonatal outcomes showed no association. The overall GRADE quality of the evidence for the associations was very low. The findings highlight the need to monitor and reduce UPF consumption, specifically during the gestational period, as a strategy to prevent adverse perinatal outcomes.

Association between maternal dietary intake classified according to its degree of processing and sex-specific birth weight for gestational age

ABSTRACT Objective To assess the association between the maternal diet, according to the degree of processing of food consumption, and birth weight for gestational age and sex. Methods A cross-sectional study with 300 women was conducted from February 2009 to 2011 from a maternity ward in Mesquita, Rio de Janeiro. The outcome was based on sex-specific birth weight for gestational age: small, adequate, or large. A validated food frequency questionnaire was used to estimate the food consumption during the 2nd and 3rd trimesters of pregnancy. The food intake was classified into three groups according to the degree of processing: 1) unprocessed or minimally processed foods and culinary ingredients (oil, fats, salt, and sugar), 2) processed foods, and 3) ultra-processed foods. Descriptive analyses were made to assess the tertiles of the percentage of energy intake of each food group on the outcome and on maternal and infant characteristics. Multinomial logistic regressions were used to test the association of the tertiles of food according to the degree of processing on the outcome (adequate, small, or large birth weight for gestational age and sex). Results The analysis of the food frequency questionnaire from the 300 women indicated that the mean percentage of kcal consumed from unprocessed and minimally processed food and culinary ingredients was 54.0%, while the percentages of energy from processed foods and ultra-processed foods were 2.0% and 44.0%, respectively. The highest tertile of consumption of unprocessed and minimally processed food and culinary ingredients had a protective effect on the prevalence of newborn large for gestational weight in relation to the lowest (OR: 0.13; 95% IC: 0.02 to 0.89; p=0.04). Conclusion High consumption of unprocessed and minimally processed food and culinary ingredients during the last six months of pregnancy might be a protective factor against having a newborn large for gestational weight when compared to mothers with the lowest consumption.

Dietary patterns and birth outcomes in the ELSPAC pregnancy cohort

OBJECTIVES

The aim of this study was to identify dietary patterns in a Czech pregnancy cohort established in the early postcommunist era and investigate associations between dietary patterns, maternal characteristics and birth outcomes.

METHODS

Pregnant women were recruited for the Czech part of the European Longitudinal Study of Pregnancy and Childhood. A self-reported questionnaire answered in late pregnancy was used to assess information about the weekly intake of 43 food items. Information about birth outcomes (birth weight, height, ponderal index, head circumference, cephalisation index, gestational length and Apgar score) was obtained from the National Registry of Newborns. Complete details on diet and birth outcomes were available for 4320 mother-infant pairs.

RESULTS AND CONCLUSION

The food items were aggregated into 28 variables and used for extraction of two dietary patterns by principal component factor analysis. The patterns were denoted 'unhealthy' and 'healthy/traditional' based on the food items with the highest factor loadings on each pattern. The 'unhealthy' pattern had high positive loadings on meat, processed food and confectionaries. In contrast, the 'healthy/traditional' pattern had high positive loadings on vegetables, dairy, fruits and wholemeal bread. Following adjustment for covariates, we found that high adherence to the unhealthy pattern (expressed as beta for 1 unit increase in pattern score), that is, the higher consumption of less healthy foods, was associated with lower birth weight: -23.8 g (95% CI -44.4 to -3.2) and length: -0.10 cm (95% CI -0.19 to -0.01) and increased cephalisation index: 0.91 μm/g (95% CI 0.23 to 1.60). The 'healthy/traditional' pattern was not associated with any birth outcomes. This study supports the recommendation to eat a healthy and balanced diet during pregnancy.

Associations between Maternal Dietary Patterns and Infant Birth Weight in the NISAMI Cohort: A Structural Equation Modeling Analysis

The mother’s diet during pregnancy is associated with maternal and child health. However, there are few studies with moderation analysis on maternal dietary patterns and infant birth weight. We aim to analyse the association between dietary patterns during pregnancy and birth weight. A prospective cohort study was performed with pregnant women registered with the prenatal service (Bahia, Brazil). A food frequency questionnaire was used to evaluate dietary intake. Birth weight was measured by a prenatal service team. Statistical analyses were performed using factor analysis with a principal component extraction technique and structural equation modelling. The mean age of the pregnant women was 27 years old (SD: 5.5) and the mean birth weight was 3341.18 g. It was observed that alcohol consumption (p = 0.05) and weight-gain during pregnancy (p = 0.05) were associated with birth weight. Four patterns of dietary consumption were identified for each trimester of the pregnancy evaluated. Adherence to the “Meat, Eggs, Fried Snacks and Processed foods” dietary pattern (pattern 1) and the “Sugars and Sweets” dietary pattern (pattern 4) in the third trimester directly reduced birth weight, by 98.42 g (Confidence interval (CI) 95%: 24.26, 172.59) and 92.03 g (CI 95%: 39.88, 165.30), respectively. It was also observed that insufficient dietary consumption in the third trimester increases maternal complications during pregnancy, indirectly reducing birth weight by 145 g (CI 95%: −21.39, −211.45). Inadequate dietary intake in the third trimester appears to have negative results on birth weight, directly and indirectly, but more studies are needed to clarify these causal paths, especially investigations of the influence of the maternal dietary pattern on the infant gut microbiota and the impacts on perinatal outcomes.

Pre-pregnancy dietary pattern is associated with newborn size: results from ProcriAr study

Babies born small-for-gestational age (SGA) have an increased risk of mortality, morbidity and adverse functional consequences. Studies suggest that pre-pregnancy maternal diet may influence newborns' size. This study aimed to determine whether maternal pre-pregnancy dietary patterns (DP) are associated with delivering SGA newborns in the ProcriAr Cohort Study, Sao Paulo-Brazil. Pre-pregnancy DP of 299 women were investigated using factor analysis with principal component's estimation, based on intake reported on a validated 110-item FFQ. Newborns were classified as SGA if their weight and/or length, adjusted by gestational age and sex, were below the 10th percentile of the INTERGROWTH-21st standards. Multivariate Poisson regression modelling with robust error variance was performed to examine associations between the different DP (in quintiles) and SGA. In a model adjusted by maternal sociodemographic and health behaviours, women who scored in the highest quintile of the DP 'Snacks, sandwiches, sweets and soft drinks' (in relation to the women who scored in the lowest quintile) were significantly more likely to deliver SGA babies (relative risk 1·92; 95 % CI 1·08, 3·39). This study verified that women's pre-pregnancy dietary behaviour characterised by an energy-dense nutrient-poor food intake was a risk factor for delivering SGA newborns. Investments in education and improved access to healthful food and nutritional information before pregnancy should be prioritised due to their potential positive impact on child health. However, further studies are warranted to identify specific metabolic pathways that may be underlying these associations.

Application of the Nutrient-Rich Food Index 9.3 and the Dietary Inflammatory Index for Assessing Maternal Dietary Quality in Japan: A Single-Center Birth Cohort Study

The maternal diet can potentially influence the life-course health of the child. A poor-quality maternal diet creates nutrient deficiencies and affects immune–metabolic regulation during pregnancy. The nutrient-based overall dietary quality can be assessed using the Nutrient-Rich Food Index 9.3 (NRF9.3), which measures adherence to the national reference daily values of nutrient intake. Pro- and anti-inflammatory nutrient intake can be assessed using the energy-adjusted dietary inflammatory index (E-DII), a comprehensive index of diet-derived inflammatory capacity. Using these indices, we assessed the overall dietary quality and inflammatory potential of pregnant women during mid-gestation in an urban area of Japan (n = 108) and found that there was a strong inverse correlation between the NRF9.3 and E-DII scores. Comparison of the scores among the tertiles of NRF9.3 or E-DII indicated that dietary fiber, vitamin C, vitamin A, and magnesium mainly contributed to the variability of both indices. Intake of vegetables and fruits was positively associated with high NRF9.3 scores and negatively associated with high E-DII scores, after adjustment for maternal age, pre-pregnancy body mass index, and educational level. Consistent with the previous studies that used dietary pattern analysis, this study also demonstrated that vegetables and fruits were the food groups chiefly associated with high dietary quality and low inflammatory potential among pregnant Japanese women.

Associations between Maternal Dietary Patterns and Perinatal Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies

The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as "healthy," "unhealthy," or "mixed." No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges' g: 0.15; P = 0.01), and birth weight (Hedges' g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and "prudent" dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.

Prenatal dietary diversity may influence underweight in infants in a Ugandan birth-cohort

Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed (NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD-W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0-4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.

Association of Dietary Change during Pregnancy with Large-for-Gestational Age Births: A Prospective Observational Study

Being born with large birthweight is considered as a risk of non-communicable diseases later in life. However, it is not fully understood what kind of maternal dietary intake during pregnancy affect large birthweight. Therefore, we examined the association of dietary intakes and its changes during pregnancy with large-for-gestational-age (LGA) births in Japanese pregnant women. In the prospective study, 245 pregnant women who visited Kyoto Medical Center were enrolled. Nutrition survey using brief-type self-administered diet history questionnaire (BDHQ) at all trimester was completed in 171 pregnant women. Based on birthweight and gestational age, participants were divided into three groups, such as small-for-gestational-age (<10th, SGA, n=17), appropriate-for-gestational-age (≥10th and <90th, AGA, n=144), and LGA (≥90th, n=10) groups. Compared with those without LGA births, mothers with LGA births showed: 1) greater weight gain during pregnancy (LGA: 14.0±3.2 kg, AGA: 9.9±3.9 kg, SGA: 8.4±3.1 kg, p<0.05); 2) higher energy intake throughout pregnancy (LGA: 310±368 kcal, AGA: 7±490 kcal, SGA: -97±293 kcal, p_trend<0.05); 3) larger changes in plant oil and sucrose consumptions from the 1st to 2nd trimester, probably due to the results of greater consumption of bread, Western confectionery, Japanese confectionery, and mayonnaise and dressing during the same period (p_trend<0.05, respectively). Our results suggest that higher energy intake throughout pregnancy, as well as greater consumption of plant oil and sucrose from the first to second trimester could be associated with LGA births.

Association between Chinese Dietary Guidelines Compliance Index for Pregnant Women and Risks of Pregnancy Complications in the Tongji Maternal and Child Health Cohort

BACKGROUND

Compliance with dietary guidelines among pregnant women can positively influence not only their own health but also the health of their babies. Measuring the compliance requires professional skills in nutrition and dietary counseling. In China, few simple and effective techniques assess dietary quality among pregnant women, especially in rural areas. We aimed to establish a new simple and effective assessment technique, the "Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW)" and assess the association between maternal dietary compliance and risks of pregnancy complications.

METHODS

The CDGCI-PW consists of 13 main components which were based on the 2016 edition of the Chinese dietary guidelines for pregnant women. Each component was assigned a different score range, and the overall score ranged from 0 to 100 points. The Tongji Maternal and Child Health Cohort study (from September 2013 to May 2016) was a prospective cohort study designed to examine maternal dietary and lifestyle effects on the health of pregnant women and their offspring. The maternal diet during the second trimester was compared with the corresponding recommended intake of the Chinese balanced dietary pagoda for pregnant women to verify their compliance with dietary guidelines. The association between maternal dietary quality and risks of pregnancy complications was estimated by regression analysis. Receiver operating characteristic (ROC) curves were constructed to identify the optimal cut-off values of CDGCI-PW for gestational hypertension and gestational diabetes mellitus (GDM).

RESULTS

Among the 2708 pregnant women, 1489 were eventually followed up. The mean CDGCI-PW score was 74.1 (standard deviation (SD) 7.5) in the second trimester. The majority of foods showed the following trend: the higher the CDGCI-PW score, the higher the proportion of pregnant women who reported food intake within the recommended range. Moreover, a higher maternal CDGCI-PW score was significantly associated with lower risks of gestational hypertension [odds ratio (OR) (95% confidence interval [(CI): 0.30 (0.20, 0.37)] and GDM [OR (95% CI): 0.38 (0.31, 0.48)]. The optimal CDGCI-PW cut-off value for gestational hypertension was ≥68.5 (sensitivity 82%; specificity: 61%; area under the ROC curve, AUC = 0.743), and the optimal CDGCI-PW cut-off score for GDM was ≥75.5 (sensitivity 43%; specificity: 81%; area under the ROC curve, AUC = 0.714).

CONCLUSIONS

The CDGCI-PW is a simple and useful technique that assesses maternal diet quality during pregnancy, while adherence to the CDGCI-PW is associated with a lower risk of gestational hypertension and GDM.

Maternal Dietary Selenium Intake during Pregnancy Is Associated with Higher Birth Weight and Lower Risk of Small for Gestational Age Births in the Norwegian Mother, Father and Child Cohort Study

Selenium is an essential trace element involved in the body’s redox reactions. Low selenium intake during pregnancy has been associated with low birth weight and an increased risk of children being born small for gestational age (SGA). Based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN), we studied the association of maternal selenium intake from diet and supplements during the first half of pregnancy (n = 71,728 women) and selenium status in mid-pregnancy (n = 2628 women) with birth weight and SGA status, according to population-based, ultrasound-based and customized growth standards. An increase of one standard deviation of maternal dietary selenium intake was associated with increased birth weight z-scores (ß = 0.027, 95% CI: 0.007, 0.041) and lower SGA risk (OR = 0.91, 95% CI 0.86, 0.97) after adjusting for confounders. Maternal organic and inorganic selenium intake from supplements as well as whole blood selenium concentration were not associated with birth weight or SGA. Our results suggest that a maternal diet rich in selenium during pregnancy may be beneficial for foetal growth. However, the effect estimates were small and further studies are needed to elucidate the potential impact of selenium on foetal growth.

Maternal total energy, macronutrient and vitamin intakes during pregnancy associated with the offspring's birth size in the Japan Environment and Children's Study

Maternal diet during pregnancy can influence fetal growth; however, the available evidence is controversial. We aimed to assess whether maternal diet of Japanese women in mid-pregnancy can affect their offspring's birth size via collection of questionnaire and medical record data. The studied sample was a large cohort of paired mothers and their singleton offspring (n 78 793) from fifteen areas all over Japan who participated in the Japan Environment and Children's Study. The mid-pregnancy intakes of total energy, macronutrients and vitamins were lower than the recommended intakes for pregnant Japanese women. Maternal total energy intake was positively associated with the offspring's birth weight; there was a 10-g mean difference in the offspring's birth weight of mothers in the lowest (3026 g) v. highest (3036 g) quartiles of energy intake. Carbohydrate intake was positively associated with the offspring's birth length (mean difference of 0·7 cm) and inversely associated with the ponderal index (mean difference of 0·8 g/cm3). Offspring of mothers in the highest v. lowest quartiles of total dietary fibre intake were on average 9 g heavier and had 0·3 cm longer birth length and 0·2 cm longer head circumference. The highest in reference to lowest intake quartile of vitamin C was associated with 13 g and 0·7 cm mean differences in the offspring's birth weight and length, respectively. Several other associations were evident for maternal intakes of vitamins and the offspring's birth size. In conclusion, maternal dietary intakes of energy, dietary fibre, carbohydrate and vitamins during pregnancy were associated with the offspring's birth size.

Dietary patterns and diet quality during pregnancy and low birthweight: The PRINCESA cohort

Although the isolated effects of several specific nutrients have been examined, little is known about the relationship between overall maternal diet during pregnancy and fetal development and growth. This study evaluates the association between maternal diet and low birthweight (LBW) in 660 pregnant women from the Pregnancy Research on Inflammation, Nutrition,& City Environment: Systematic Analyses (PRINCESA) cohort in Mexico City. Using prior day dietary intake reported at multiple prenatal visits, diet was assessed prospectively using a priori (Maternal Diet Quality Score [MDQS]) and a posteriori (dietary patterns extracted by factor analysis) approaches. The association between maternal diet and LBW was investigated by logistic regression, controlling for confounders. Adherence to recommended guidelines (higher MDQS) was associated with a reduced risk of LBW (OR, 0.22; 95% confidence interval [0.06, 0.75], P < .05, N = 49) compared with the lowest adherence category (reference group), controlling for maternal age, education, height, marital status, pre-pregnancy body mass index, parity, energy intake, gestational weight gain, and preterm versus term birth; a posteriori dietary patterns were not associated with LBW risk. Higher adherence to MDQS was associated with a lower risk of having an LBW baby in this sample. Our results support the role of advocating a healthy overall diet, versus individual foods or nutrients, in preventing LBW.

Women's Experience and Understanding of Food Cravings in Pregnancy: A Qualitative Study in Women Receiving Prenatal Care at the University of North Carolina-Chapel Hill

BACKGROUND

Although the occurrence of food cravings during pregnancy is well established, there is a paucity of qualitative data on pregnant women's perceptions of and responses to food cravings. This study sought to assess and describe pregnant women's experiences and behaviors pertaining to food cravings.

METHODS

Eight focus groups were conducted with 68 pregnant women in their second trimester from March 2015 to October 2016. Using a semistructured approach, the facilitator asked women open-ended questions regarding their experience of eating behaviors and food cravings. The content from the focus groups was analyzed using a bottom-up approach based on grounded theory and constant comparison analysis.

RESULTS

Participants described cravings as urgent, food-specific, and cognitively demanding occurrences that were differentiated from hunger. They described beliefs surrounding the physiological causes of cravings and rationales for satisfying their cravings. Strategies used to manage cravings included environmental modifications to limit proximity and availability of craved foods, cognitive and behavioral strategies like distraction, and acceptance through satisfying the craving. Participants described food cravings as a psychologically salient aspect of their pregnancy, reporting a variety of emotional precursors and reactions surrounding their cravings.

CONCLUSIONS

A better understanding of food cravings may assist with the development of interventions to improve eating behaviors and reduce eating-related distress during pregnancy. Acceptance regarding food cravings was indicated as a way to diffuse pregnancy-related stress. These findings contribute to our understanding of psychological influences on eating behaviors in pregnant women.

Effects of maternal diets on preterm birth and low birth weight: a systematic review

Current evidence indicates that maternal diets before and during pregnancy could influence rates of preterm birth, low birth weight (LBW) and small for gestational age (SGA) births. However, findings have been inconsistent. This review summarised evidence concerning the effects of maternal diets before and during pregnancy on preterm birth, LBW and SGA. Systematic electronic database searches were carried out using PubMed, Embase, Scopus and Cochrane library using the preferred reporting items for systematic reviews and meta-analyses guidelines. The review included forty eligible articles, comprising mostly of prospective cohort studies, with five randomised controlled trials. The dietary patterns during pregnancy associated with a lower risk of preterm birth were commonly characterised by high consumption of vegetables, fruits, whole grains, fish and dairy products. Those associated with a lower risk of SGA also had similar characteristics, including high consumption of vegetables, fruits, legumes, seafood/fish and milk products. Results from a limited number of studies suggested there was a beneficial effect on the risk of preterm birth of pre-pregnancy diet quality characterised by a high intake of fruits and proteins and less intake of added sugars, saturated fats and fast foods. The evidence was mixed for the relationship between maternal dietary patterns during pregnancy and LBW. These findings indicate that better maternal diet quality during pregnancy, characterised by a high intake of vegetables, fruits, whole grains, dairy products and protein diets, may have a synergistic effect on reducing the risk of preterm birth and SGA.

High starchy food intake may increase the risk of adverse pregnancy outcomes: a nested case-control study in the Shaanxi province of Northwestern China

BACKGROUND

There was a wider disparity in the diet characterization among most studies on diet and pregnancy outcomes in different countries, and the research in northern China is limited. Therefore, the purpose of the present study that was conducted in northwest China was to understand the dietary characteristics of periconceptional women and to explore the relationship between and specific dietary patterns with adverse pregnancy outcomes.

METHODS

A nested case-control study was conducted from October 2017 to November 2018 in Shaanxi, China. Based on a prospective cohort of 368 women who were pregnant or prepared for pregnancy, 63 participants who developed the outcomes of gestational hypertension, gestational diabetes, preterm birth, low birth weight, and birth defects were included in the case group. A total of 237 healthy pregnant women were included during the same period in the control group. Dietary intake was assessed using a validated food frequency questionnaire for the three months before pregnancy and the first trimester. Information on delivery details and antenatal pregnancy complications was obtained from the hospital maternity records. Dietary patterns were derived using factor analysis. Stratified analysis was performed on the overall, single and multiple adverse pregnancy outcomes categories. Adjustment was made for sociodemographic characteristics and nutritional supplement status.

RESULTS

Six major dietary patterns were identified. The 'starchy' dietary pattern, composed of high intake in noodle and flour products and/or rice and its products, was associated with the odds of developing of adverse pregnancy outcomes (OR: 2.324, 95% CI: 1.293-4.178). This risk remained significant following adjustment for potential confounders of maternal demographic characteristics and nutritional status (aOR: 2.337, 95% CI:1.253-4.331). Strong association were found during the first trimester of pregnancy, but showed no association during the three months before pregnancy (aOR:1.473, 95% CI: 0.682-3.234).

CONCLUSIONS

High starchy food intake was associated with adverse pregnancy outcomes, particularly during the first trimester of pregnancy. Health education focusing on periconceptional dietary patterns could be a practical strategy for preventing adverse pregnancy outcomes.

Associations between maternal dietary patterns and infant birth weight, small and large for gestational age in the Norwegian Mother and Child Cohort Study

BACKGROUND/OBJECTIVES

To assess whether quality of maternal diet affects birth weight and the risk of small for gestational age (SGA) and/or large for gestational age (LGA) babies.

SUBJECTS/METHODS

This study is based on the Norwegian Mother and Child Cohort Study (MoBa) and includes 65,904 pregnant women who answered a validated food frequency questionnaire at mid-pregnancy. Three maternal dietary patterns were extracted based on characteristics of food items in each pattern. From these we created four non-overlapping groups: "high prudent," "high Western," "high traditional," and "mixed". We obtained information about birth weight from the Norwegian Medical Birth Registry and calculated birth weight z-scores, SGA, and LGA according to an ultrasound-based, population-based, and a customized growth standards. Associations were studied by linear and multiple logistic regression.

RESULTS

Compared to the high Western group, the high prudent group was associated with lower birth weight (βultrasound z-scores -0.041 (95% confidence interval (CI): -0.068, -0.013)) and the high traditional group with higher birth weight (βultrasound 0.067 (95% CI: 0.040, 0.094)) for all three growth standards. The high prudent pattern was associated with increased SGA risk (SGAultrasound odds ratio (OR) 1.25 (95% CI: 1.02, 1.54)) and decreased LGA risk (LGApopulation OR 0.84 (95% CI: 0.75, 0.94)), while the high traditional group on the contrary was associated with decreased SGA (SGAcustomized OR 0.92 (95% CI: 0.84, 0.99)) and increased LGA risk (LGApopulation OR 1.12 (95% CI: 1.02, 1.24)).

CONCLUSIONS

Food quality was associated with birth weight in this well-nourished Norwegian population. Food quality may affect a woman's risk of giving birth to a SGA or LGA baby.

Maternal Dietary Patterns and Birth Outcomes: A Systematic Review and Meta-Analysis

Findings on the relations of maternal dietary patterns during pregnancy and risk of preterm birth and offspring birth size remain inconclusive. We aimed to systematically review and quantify these associations. We searched MEDLINE, Embase, CENTRAL, and CINAHL up to December 2017. Three authors independently conducted a literature search, study selection, data extraction, and quality assessment. Summary effect sizes were calculated with random effects models and studies were summarized narratively if results could not be pooled. We included 36 studies and pooled results from 25 observational studies (167,507 participants). Two common dietary patterns-"healthy" and "unhealthy"-were identified. Healthy dietary patterns-characterized by high intakes of vegetables, fruits, wholegrains, low-fat dairy, and lean protein foods-were associated with lower risk of preterm birth (OR for top compared with bottom tertile: 0.79; 95% CI: 0.68, 0.91; I2 = 32%) and a weak trend towards a lower risk of small-for-gestational-age (OR: 0.86; 95% CI: 0.73, 1.01; I2 = 34%). Only statistically data-driven healthy dietary patterns, and not dietary index-based patterns, were associated with higher birth weight (mean difference: 67 g; 95% CI: 37, 96 g; I2 = 75%). Unhealthy dietary patterns-characterized by high intakes of refined grains, processed meat, and foods high in saturated fat or sugar-were associated with lower birth weight (mean difference: -40 g; 95% CI: -61, -20 g; I2 = 0%) and a trend towards a higher risk of preterm birth (OR: 1.17; 95% CI: 0.99, 1.39; I2 = 76%). Data from observational studies indicate that greater adherence to healthy dietary patterns during pregnancy is significantly related to lower risk of preterm birth. No consistent associations with birth weight and small- or large-for-gestational-age were observed.

Systematic review of the association between dietary patterns and perinatal anxiety and depression

Background

Specific dietary factors contribute to greater risks of prenatal and postpartum anxiety and depression. This study aimed to systematically review and assess the evidence regarding the association between dietary patterns and perinatal anxiety and depression (PAAD).

Methods

A systematic search of the Latin American & Caribbean Health Sciences Literature (LILACS), PubMed, and Scopus databases for cross-sectional and cohort studies through April 2019 was conducted. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale (NOS) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence.

Results

Ten studies (six cohort and four cross-sectional) were included. All studies had good methodological quality. In these studies, the Western (n = 10), healthy (n = 9), and traditional (n = 7) dietary patterns were examined. The healthy pattern was inversely associated with prenatal and postpartum anxiety and prenatal depression. The traditional Japanese dietary pattern, the traditional Indian-confinement dietary pattern, the United Kingdom traditional dietary and the traditional Brazilian dietary pattern were associated with a lower risk of prenatal depression, postpartum depression, prenatal anxiety and postpartum anxiety, respectively. There was no significant association between a Western dietary pattern and PAAD. The GRADE assessment suggested that the quality of the evidence was very low to low across all outcomes owing to the design, risk of bias, and small sample size.

Conclusions

There is no definitive evidence about the relationship between Western dietary patterns and perinatal anxiety and depression. However, it found an inverse association among the healthy dietary pattern and PAAD. Future studies will be required to better evaluate associations between meal patterns and PAAD. Such studies may provide new insights and assist in the development of new prevention and treatment strategies.

Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference: A prospective cohort study

BACKGROUND/OBJECTIVES

Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics.

SUBJECTS AND METHODS

This prospective cohort study included 737 participants enrolled in Seremban Cohort Study between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs.

RESULTS

Three DPs were identified at each time point and designated DP 1–3 (pre-pregnancy), DP 4–6 (first trimester), DP 7–9 (second trimester) and DP 10–12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds & legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk & dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments & spices, sugar, spreads & creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils & fats, and DP 11 had additional tea & coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal & cereal products, rice, noodles & pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal & cereal products, rice, noodles & pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds & legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11.

CONCLUSIONS

DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.

How are maternal dietary patterns and maternal/fetal cytokines associated with birth weight? A path analysis

The aim of the study was to investigate how maternal dietary patterns and maternal/fetal cytokines are associated with birth weight and whether cytokines mediate the association. A total of 469 pregnant women and their children were recruited for this prospective study. Dietary patterns in pregnancy were identified using factor analysis of data from three consecutive 24 h dietary recalls. Maternal and umbilical blood serum cytokines (adiponectin (APN), IL-6 and interferon-γ) were measured via ELISA. Path analysis was used to explore the relationships between maternal diet, cytokines and birth weight. Four dietary patterns were identified: a mainly fruit, dairy products and poultry diet (FDP); a mainly vegetables, beans and pork diet (VBP); a mainly fish, shrimp and soup diet (FS) and a mainly tuber and egg diet (TE). Path analysis showed the order of effects of dietary patterns on birth weight was FS>FDP>TE>VBP (β=0·130, 0·109, –0·094 and 0·046, respectively). Only the TE pattern’s effect was negative. Maternal and fetal APN were positively associated with birth weight (β=0·045 and 0·226, respectively), and they mediated the association between the TE pattern and birth weight (indirect effect was 5·3 %). Maternal IL-6 was negatively associated with birth weight (β=–0·067) and mediated the association between maternal FDP and VBP patterns and birth weight (indirect effects were 10·1 and 100·0 %, respectively). All variables in the path explained 33·6 % of variation. These results suggested that maternal dietary patterns in pregnancy are associated with birth weight and mediated directly and indirectly through some maternal/fetal serum cytokines.

Dietary patterns before and during pregnancy and birth outcomes: a systematic review

BACKGROUND

Maternal diet before and during pregnancy could influence fetal growth and birth outcomes.

OBJECTIVE

Two systematic reviews aimed to assess the relationships between dietary patterns before and during pregnancy and 1) gestational age at birth and 2) gestational age- and sex-specific birth weight.

METHODS

Literature was searched from January, 1980 to January, 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using predetermined inclusion and exclusion criteria. Data were extracted from included articles and risk of bias was assessed. Data were synthesized qualitatively, a conclusion statement was drafted for each question, and evidence supporting each conclusion was graded.

RESULTS

Of the 9103 studies identified, 11 [representing 7 cohorts and 1 randomized controlled trial (RCT)] were included for gestational age and 21 (representing 19 cohorts and 2 RCTs) were included for birth weight. Limited but consistent evidence suggests that certain dietary patterns during pregnancy are associated with a lower risk of preterm birth and spontaneous preterm birth. These protective dietary patterns are higher in vegetables; fruits; whole grains; nuts, legumes, and seeds; and seafood (preterm birth, only), and lower in red and processed meats, and fried foods. Most of the research was conducted in healthy Caucasian women with access to health care. No conclusion can be drawn on the association between dietary patterns during pregnancy and birth weight outcomes. Although research is available, the ability to draw a conclusion is restricted by inconsistency in study findings, inadequate adjustment of birth weight for gestational age and sex, and variation in study design, dietary assessment methodology, and adjustment for key confounding factors. Insufficient evidence exists regarding dietary patterns before pregnancy for both outcomes.

CONCLUSIONS

Maternal dietary patterns may be associated with a lower preterm and spontaneous preterm birth risk. The association is unclear for birth weight outcomes.

Relationships between stress, demographics and dietary intake behaviours among low-income pregnant women with overweight or obesity

OBJECTIVE

To identify demographic risk factors associated with high stress and examine the relationships between levels of stress, demographics and dietary fat, fruit and vegetable intakes in low-income pregnant women with overweight or obesity.

DESIGN

A cross-sectional study.

SETTING

Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, USA.ParticipantsParticipants (n 353) were non-Hispanic Black (black) or White (white).

RESULTS

Women aged 35 years or older (OR=4·09; 95% CI 1·45, 11·51) and who had high school or less education (OR=1·88; 95% CI 1·22, 2·89) or were unemployed (OR=1·89; 95% CI 1·15, 3·12) were significantly more likely to report high stress than women who were younger, had at least some college education or were employed/homemakers. However, race and smoking status were not associated with level of stress. Women with high stress reported significantly lower fruit and vegetable intakes but not fat intake than women with low stress. Women aged 35 years or older reported significantly higher vegetable but not fat or fruit intake than women who were 18-24 years old. Black women reported significantly higher fat but not fruit or vegetable intake than white women. Education, employment and smoking status were not significantly associated with dietary intake of fat, fruits and vegetables.

CONCLUSIONS

Nutrition counselling on reducing fat and increasing fruit and vegetable intakes may consider targeting women who are black or younger or who report high stress, respectively.

Effect of Adherence to a Mediterranean Diet and Olive Oil Intake during Pregnancy on Risk of Small for Gestational Age Infants

To quantify the effect of a Mediterranean dietary pattern, as well as the consumption of olive oil (OO), on the risk of having a small for gestational age infants (SGA), a matched case-control study was conducted in Spain. Dietary intake during pregnancy was assessed using a validated food frequency questionnaire. Three indices were used to evaluate the adherence to Mediterranean diet (MD) (Predimed, Trichopoulou and Panagiotakos). Crude odds ratios (cOR) and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were estimated using conditional logistic regression models. Results were stratified by severity of SGA: moderate (percentiles 6–10), and severe (percentiles ≤5). For moderate, four or more points in the Predimed´s index was associated with a 41% reduction of having SGA compared with women with a score ≤3, aOR = 0.59 (95% CI 0.38–0.98); for severe, the reduction in risk was not statistically significant. Similar results were found when the other MD indexes were used. An intake of OO above 5 g/day was associated with a lower risk of SGA (aOR = 0.53, 95% CI 0.34–0.85); statistical significance was observed for moderate SGA (aOR = 0.53, 95% CI 0.30–0.96), but not for severe SGA (aOR = 0.51, 95% CI 0.24–1.07), although the magnitude of ORs were quite similar. Adherence to a MD and OO intake is associated with a reduced risk of SGA.

Maternal seafood intake and the risk of small for gestational age newborns: a case-control study in Spanish women

OBJECTIVE

To investigate the relationship between seafood consumption during pregnancy and the risk of delivering a small for gestational age (SGA) newborn.

DESIGN

This case-control study included women with SGA newborns and controls matched 1:1 for maternal age (±2 years) and hospital.

SETTING

Five hospitals in Eastern Andalusia, Spain.

PARTICIPANTS

518 pairs of pregnant Spanish women. The SGA group included women who delivered SGA newborns: SGA was defined as a birth weight below the 10th percentile of infants at a given gestational age. Controls were women who delivered newborns with adequate birth weights.

INTERVENTIONS

We collected data on demographic characteristics, socioeconomic status, toxic habits and diet. Midwives administered a 137-item Food Frequency Questionnaire.

OUTCOME MEASURES

We calculated quintiles of seafood intake and applied conditional logistic regression to estimate ORs and 95% CIs.

RESULTS

Shellfish intake more than once/week yielded a significant protective effect against an SGA newborn (OR 0.25, 95% CI 0.08 to 0.76, after adjusting for energy, educational level, smoking, prepregnancy body mass index, weight and a history of preterm or low birthweight newborn). The risk of an SGA newborn was lower among women who consumed >121 g/day fish compared with women who consumed ≤56 g (adjusted OR 0.63, 95% CI 0.41 to 0.98; p=0.025 for a trend). Similarly, the risk of an SGA newborn was lower among women who consumed >1 g/day of marine n-3 polyunsaturated fatty acids compared with those who consumed ≤0.4 g/day (adjusted OR 0.58, 95% CI 0.38 to 0.90; p=0.025 for a trend).

CONCLUSION

An average seafood intake of at least 121 g/day during pregnancy, equivalent to 3-4 servings/week, reduced the risk of an SGA newborn, compared with an average seafood intake of less than 56 g/day.

Major Maternal Dietary Patterns during Early Pregnancy and Their Association with Neonatal Anthropometric Measurement

Background

Anthropometric measurements of newborn infant are widely assessed as determinants of maternal nutrition. Although earlier studies have mostly examined the effects of particular nutrients or foods during gestational period on neonatal anthropometric measurements, there are few studies regarding the association of dietary patterns and mentioned measurements. So, the purpose of the current study was to investigate the association between major maternal dietary patterns and neonatal anthropometric measurements including body weight, head circumference, and height.

Methods

The current prospective observational study is based on the data collected from 812 pregnant women. Dietary data was collected using a validated semiquantitative food frequency questionnaire.

Results

Three identified major dietary patterns according to the results obtained from the factor loading matrix were (i) “western dietary pattern”; (ii) “traditional dietary pattern”; (iii) “healthy dietary pattern”. Overall, this study demonstrated a positive significant association between high adherences to western dietary pattern and chance of having low birth weight infant. However, such associations were not seen in women taking healthy and traditional dietary patterns.

Conclusion

We found that healthier maternal dietary patterns during early pregnancy might be associated with lower risk of low birth weight. Further studies are required to confirm these findings.

Association of maternal omega-6 fatty acid intake with infant birth outcomes: Korean Mothers and Children's Environmental Health (MOCEH)

Background

Maternal fatty acids (FAs) intake has an effect on birth weight, birth length, and gestational age, as fetal development is entirely dependent on the maternal essential FA supply. This study aimed to identify the association between the maternal intake of FAs and birth outcomes among pregnant women who participated in the Mothers and Children’s Environmental Health (MOCEH) prospective cohort study in South Korea.

Methods

A total of 1407 pregnant women, aged 30.2 ± 3.7 years, at 12 to 28 weeks’ gestation were recruited between August 2006 and December 2010. Their dietary intake during pregnancy was investigated by the 1-day 24-h dietary recall method. The pregnancy outcome data—namely infant’s gestational age, birth weight, and birth length—were analyzed for their associations with their mothers’ intake of FAs.

Results

When adjusted for confounding factors, multiple regression analysis revealed adverse effects on birth weight (P = 0.031) and birth length (P = 0.025) with high maternal intake of omega-6 FAs. In the multiple logistic regression analysis, the odds ratio (OR) for the risk of being below the 10th percentile for birth weight was higher in the highest quintile (Q5) compared to the lowest quintile (Q1) of omega-6 FA intake levels (OR = 2.444; 95% CI = 1.038–5.751; P for trend = 0.010). Also, the OR for being above the 90th percentile of birth length was lower in the highest quintile (Q5) compared to that in the lowest quintile (Q1) of omega-6 FA intake (OR = 0.432; 95% CI = 0.211–0.884; P for trend = 0.020). However, the maternal intake of omega-3 FAs was not related to gestational age, birth weight, or birth length.

Conclusions

A high maternal omega-6 FA intake was negatively associated with birth weight and birth length.

1H NMR-based metabolomics reveals the effect of maternal habitual dietary patterns on human amniotic fluid profile

Maternal diet may influence offspring’s health, even within well-nourished populations. Amniotic fluid (AF) provides a rational compartment for studies on fetal metabolism. Evidence in animal models indicates that maternal diet affects AF metabolic profile; however, data from human studies are scarce. Therefore, we have explored whether AF content may be influenced by maternal diet, using a validated food-frequency questionnaire and implementing NMR-based metabolomics. Sixty-five AF specimens, from women undergoing second-trimester amniocentesis for prenatal diagnosis, were analysed. Complementary, maternal serum and urine samples were profiled. Hierarchical cluster analysis identified 2 dietary patterns, cluster 1 (C1, n = 33) and cluster 2 (C2, n = 32). C1 was characterized by significantly higher percentages of energy derived from refined cereals, yellow cheese, red meat, poultry, and “ready-to-eat” foods, while C2 by higher (P < 0.05) whole cereals, vegetables, fruits, legumes, and nuts. ¹H NMR spectra allowed the identification of metabolites associated with these dietary patterns; glucose, alanine, tyrosine, valine, citrate, cis-acotinate, and formate were the key discriminatory metabolites elevated in C1 AF specimens. This is the first evidence to suggest that the composition of AF is influenced by maternal habitual dietary patterns. Our results highlight the need to broaden the knowledge on the importance of maternal nutrition during pregnancy.

Infant Adiposity is Independently Associated with a Maternal High Fat Diet but not Related to Niacin Intake: The Healthy Start Study

Objectives Over-nutrition during pregnancy resulting from maternal obesity or an unhealthy diet can lead to excess infant adiposity at birth. Specific dietary macro- and micronutrients have been shown to increase fat cell development in both in-vitro and in-vivo models and may therefore link maternal diet to increased infant adiposity. We hypothesized that high maternal dietary niacin intake during pregnancy, especially in combination with a high-fat diet (HFD) would increase infant adiposity. Methods We included 1040 participants from a pre-birth cohort of mother-infant pairs. Maternal diet was assessed using multiple 24-hour dietary recalls. HFD was defined as ≥30% of calories from fat and ≥12% of fat calories from saturated fat. Neonatal body composition (% fat mass [%FM], fat mass [FM], fat-free mass [FFM]) was measured by PEAPOD. We used multivariate regression to assess the joint effect of maternal dietary niacin and maternal HFD on neonatal body composition. Results Dietary niacin was not associated with neonatal body composition, and maternal HFD did not modify this finding. However, maternal HFD was independently associated with %FM (β = 0.8 [0.1, 1.4]%, p < 0.01] and FM (β = 32.4 [6.7, 58.0] g, p < 0.01). Conclusions for Practice Our results suggest that a HFD during pregnancy may increase infant adiposity, therefore supporting the need for improved diet counseling of pregnant women at both the clinical and community levels.

The relationship between a low grain intake dietary pattern and impulsive behaviors in middle-aged Japanese people

Several studies indicate that dietary habits are associated with mental health. We are interested in identifying not a specific single nutrient/food group but the population preferring specific food combinations that can be related to mental health. Very few studies have examined relationships between dietary patterns and multifaceted mental states using cluster analysis. The purpose of this study was to investigate population-level dietary patterns associated with mental state using cluster analysis. We focused on depressive state, sleep quality, subjective well-being, and impulsive behaviors using rating scales. Two hundred and seventy-nine Japanese middle-aged people participated in the present study. Dietary pattern was estimated using a brief self-administered diet-history questionnaire (the BDHQ). We conducted K-means cluster analysis using thirteen BDHQ food groups: milk, meat, fish, egg, pulses, potatoes, green and yellow vegetables, other vegetables, mushrooms, seaweed, sweets, fruits, and grain. We identified three clusters characterized as "vegetable and fruit dominant," "grain dominant," and "low grain tendency" subgroups. The vegetable and fruit dominant group showed increases in several aspects of subjective well-being demonstrated by the SF-8. Differences in mean subject characteristics across clusters were tested using ANOVA. The low frequency intake of grain group showed higher impulsive behavior, demonstrated by BIS-11 deliberation and sum scores. The present study demonstrated that traditional Japanese dietary patterns, such as eating rice, can help with beneficial changes in mental health.

Maternal Dietary Patterns during Pregnancy Are Associated with Newborn Body Composition

Background: Maternal dietary intake during pregnancy may influence offspring growth and adiposity. Specific dietary patterns associated with newborn adiposity have not been identified.Objective: We aimed to identify patterns of maternal dietary intake associated with gestational weight gain (GWG) and fasting glucose during pregnancy and to evaluate whether adherence to these patterns is associated with newborn adiposity.Methods: In the Healthy Start prospective cohort, dietary intake during pregnancy was assessed via 24-h recalls. Reduced-rank regression identified dietary patterns predictive of GWG and fasting glucose. Associations between dietary patterns and newborn fat mass, fat-free mass, and adiposity were estimated by using linear regression models among 764 ethnically diverse mother-infant pairs.Results: Two dietary patterns were identified. Pattern 1, correlated with greater GWG (r = 0.22, P < 0.01), was characterized by a higher consumption of poultry, nuts, cheese, fruits, whole grains, added sugars, and solid fats. Greater adherence to pattern 1 (upper compared with lower tertile) predicted a greater newborn fat-free mass (61 g; 95% CI: 12, 110 g) but no difference in fat mass or adiposity. Pattern 2, correlated with greater maternal fasting glucose (r = 0.16, P < 0.01), was characterized by a higher consumption of eggs, starchy vegetables, solid fats, fruits, and nonwhole grains and a lower consumption of dairy foods, dark-green vegetables, and whole grains. Greater adherence to pattern 2 was associated with a greater newborn birth weight (80 g; 95% CI: 15, 145 g), fat mass (33 g; 95% CI: 8, 59 g), and adiposity (0.9%; 95% CI: 0.3%, 1.6%).Conclusions: Among pregnant women, adherence to a dietary pattern characterized by an intake of poultry, nuts, cheese, and whole grains was associated with greater GWG but not maternal fasting glucose or newborn adiposity. Adherence to a pattern characterized by an intake of eggs, starchy vegetables, and nonwhole grains was associated with higher maternal fasting glucose and greater newborn adiposity. Maternal dietary patterns during pregnancy may influence newborn body composition.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Pre-Pregnancy Body Mass Index Is Associated with Dietary Inflammatory Index and C-Reactive Protein Concentrations during Pregnancy

There have been a limited number of studies examining the association between pre-pregnancy body mass index (BMI) and dietary inflammation during pregnancy. Our aim is to examine the association between pre-pregnancy BMI and the Dietary Inflammatory Index (DII)™ and C-reactive protein (CRP) concentrations during pregnancy. The study included 631 pregnant American women from the National Health and Nutrition Examination Survey (NHANES) cross-sectional examinations from 2003 to 2012. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. The cut-offs of <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight), and ≥30 kg/m² (obese) were used to categorize the weight status of pregnant women prior to pregnancy. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a one-day 24-h recall. Multivariable linear and logistic regressions were performed to estimate beta coefficients and the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) on the association of pre-pregnancy BMI categories with the DII and CRP concentrations during pregnancy. After controlling for variables including: race/ethnicity, family poverty income ratio, education, marital status, month in pregnancy, and smoking status during pregnancy; women who were obese before pregnancy (n = 136) had increased odds for being in the highest tertile of the DII and CRP concentrations compared to women with normal weight (AORs 2.40, 95% CIs 1.01-5.71; AORs 24.84, 95% CIs 6.19-99.67, respectively). These findings suggest that women with pre-pregnancy obesity had greater odds of reporting higher DII and having elevated CRP. In conclusion, high pre-pregnancy BMI was associated with increased odds of pro-inflammatory diet and elevated CRP levels during pregnancy in the USA.

Harmonization of Food-Frequency Questionnaires and Dietary Pattern Analysis in 4 Ethnically Diverse Birth Cohorts

BACKGROUND

Canada is an ethnically diverse nation, which introduces challenges for health care providers tasked with providing evidence-based dietary advice.

OBJECTIVES

We aimed to harmonize food-frequency questionnaires (FFQs) across 4 birth cohorts of ethnically diverse pregnant women to derive robust dietary patterns to investigate maternal and newborn outcomes.

METHODS

The NutriGen Alliance comprises 4 prospective birth cohorts and includes 4880 Canadian mother-infant pairs of predominantly white European [CHILD (Canadian Healthy Infant Longitudinal Development) and FAMILY (Family Atherosclerosis Monitoring In earLY life)], South Asian [START (SouTh Asian birth cohoRT)-Canada], or Aboriginal [ABC (Aboriginal Birth Cohort)] origins. CHILD used a multiethnic FFQ based on a previously validated instrument designed by the Fred Hutchinson Cancer Research Center, whereas FAMILY, START, and ABC used questionnaires specifically designed for use in white European, South Asian, and Aboriginal people, respectively. The serving sizes and consumption frequencies of individual food items within the 4 FFQs were harmonized and aggregated into 36 common food groups. Principal components analysis was used to identify dietary patterns that were internally validated against self-reported vegetarian status and externally validated against a modified Alternative Healthy Eating Index (mAHEI).

RESULTS

Three maternal dietary patterns were identified-"plant-based," "Western," and "health-conscious"-which collectively explained 29% of the total variability in eating habits observed in the NutriGen Alliance. These patterns were strongly associated with self-reported vegetarian status (OR: 3.85; 95% CI: 3.47, 4.29; r² = 0.30, P < 0.001; for a plant-based diet), and average adherence to the plant-based diet was higher in participants in the fourth quartile of the mAHEI than in the first quartile (mean difference: 46.1%; r² = 0.81, P < 0.001).

CONCLUSION

Dietary data collected by using FFQs from ethnically diverse pregnant women can be harmonized to identify common dietary patterns to investigate associations between maternal dietary intake and health outcomes.

Maternal Dietary Patterns during Pregnancy Are Associated with Child Growth in the First 3 Years of Life

BACKGROUND

Child obesity is a major problem in the United States. Identifying early-life risk factors is necessary for prevention. Maternal diet during pregnancy is a primary source of fetal energy and might influence risk of child obesity.

OBJECTIVE

We prospectively investigated the influence of maternal dietary patterns during pregnancy on child growth in the first 3 y of life in 389 mother-child pairs from the Pregnancy, Infection, and Nutrition study.

METHODS

Dietary patterns were derived with the use of latent class analysis (LCA) based on maternal diet, collected with the use of a food-frequency questionnaire at 26-29 wk gestation. Associations between maternal dietary patterns and child body mass index (BMI)-for-age z score and overweight or obesity were assessed with the use of linear regression and log-binomial regression, respectively. We used linear mixed models to estimate childhood growth patterns in relation to maternal dietary patterns.

RESULTS

Three patterns were identified from LCA: 1) fruits, vegetables, refined grains, red and processed meats, pizza, french fries, sweets, salty snacks, and soft drinks (latent class 1); 2) fruits, vegetables, baked chicken, whole-wheat bread, low-fat dairy, and water (latent class 2); and 3) white bread, red and processed meats, fried chicken, french fries, and vitamin C-rich drinks (latent class 3). In crude analyses, the latent class 3 diet was associated with a higher BMI-for-age z score at 1 and 3 y of age and a higher risk of overweight or obesity at 3 y of age than was the latent class 2 diet. These associations were not detectable after adjustment for confounding factors. We observed an inverse association between the latent class 3 diet and BMI-for-age z score at birth after adjustment for confounding factors that was not evident in the crude analysis (latent class 3 compared with latent class 2-β: -0.41; 95% CI: -0.79, -0.03).

CONCLUSION

In this prospective study, a less-healthy maternal dietary pattern was associated with early childhood weight patterns.

A vegetable, fruit, and white rice dietary pattern during pregnancy is associated with a lower risk of preterm birth and larger birth size in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study

BACKGROUND

Maternal dietary patterns during pregnancy have been shown to influence infant birth outcomes. However, to our knowledge, only a few studies have examined the associations in Asian populations.

OBJECTIVE

We characterized maternal dietary patterns in Asian pregnant women and examined their associations with the risk of preterm birth and offspring birth size.

DESIGN

At 26-28 wk of gestation, 24-h recalls and 3-d food diaries were collected from the women in the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort. Dietary patterns were derived from exploratory factor analysis. Gestational age was determined by a dating ultrasound scan in the first trimester, and infant birth anthropometric measurements were obtained from hospital records. Associations were assessed by logistic and linear regressions with adjustment for confounding factors.

RESULTS

Three maternal dietary patterns were identified: vegetable, fruit, and white rice (VFR); seafood and noodle (SfN); and pasta, cheese, and processed meat (PCP). Of 923 infants, 7.6% were born preterm, 13.4% were born small for gestational age, and 14.7% were born large for gestational age. A greater adherence to the VFR pattern (per SD increase in VFR score) was associated with a lower risk of preterm births (OR: 0.67; 95% CI: 0.50, 0.91), higher ponderal index (β: 0.26 kg/m³; 95% CI: 0.06, 0.45 kg/m³), and increased risk of a large-for-gestational-age birth (RR: 1.31; 95% CI: 1.06, 1.62). No associations were observed for the SfN and PCP patterns in relation to birth outcomes.

CONCLUSIONS

The VFR pattern is associated with a lower incidence of preterm birth and with larger birth size in an Asian population. The findings related to larger birth size warrant further confirmation in independent studies. This trial was registered at clinicaltrials.gov as NCT01174875.

Dietary patterns by cluster analysis in pregnant women: relationship with nutrient intakes and dietary patterns in 7-year-old offspring

Little is known about how dietary patterns of mothers and their children track over time. The objectives of this study are to obtain dietary patterns in pregnancy using cluster analysis, to examine women's mean nutrient intakes in each cluster and to compare the dietary patterns of mothers to those of their children. Pregnant women (n = 12 195) from the Avon Longitudinal Study of Parents and Children reported their frequency of consumption of 47 foods and food groups. These data were used to obtain dietary patterns during pregnancy by cluster analysis. The absolute and energy‐adjusted nutrient intakes were compared between clusters. Women's dietary patterns were compared with previously derived clusters of their children at 7 years of age. Multinomial logistic regression was performed to evaluate relationships comparing maternal and offspring clusters. Three maternal clusters were identified: ‘fruit and vegetables’, ‘meat and potatoes’ and ‘white bread and coffee’. After energy adjustment women in the ‘fruit and vegetables’ cluster had the highest mean nutrient intakes. Mothers in the ‘fruit and vegetables’ cluster were more likely than mothers in ‘meat and potatoes’ (adjusted odds ratio [OR]: 2.00; 95% Confidence Interval [CI]: 1.69–2.36) or ‘white bread and coffee’ (OR: 2.18; 95% CI: 1.87–2.53) clusters to have children in a ‘plant‐based’ cluster. However the majority of children were in clusters unrelated to their mother dietary pattern. Three distinct dietary patterns were obtained in pregnancy; the ‘fruit and vegetables’ pattern being the most nutrient dense. Mothers' dietary patterns were associated with but did not dominate offspring dietary patterns.

Differences in the anthropometry of Asian children and its role in metabolic health in later life: A narrative review

BACKGROUND

The increasing incidence of childhood obesity in Asia could be a reflection of early life programming in which environmental/nutritional challenges during pregnancy and first two years of life (the so-called first 1000 days) influence later health.

OBJECTIVE OF NARRATIVE REVIEW

To assess differences/similarities of anthropometric measures in early life and their influences on metabolic health risk in later life among children in Asia.

METHODS

Literature search for publication in English using selected key words from Medline (PubMed), Scopus, Science Direct and Google Scholar published from 1994 to October 2014. Some comparisons with Caucasian setting were made when relevant.

RESULTS

From 152 publications selected for this narrative review, differences in foetal growth and birth weight were deducted between Asian and Caucasian children. Infants in India and Hong Kong had increased fat mass at birth and early infancy as compared to those from other parts of the world. Pre- and during pregnancy conditions influenced birth weight; feeding practices and gender influenced post-natal growth and body composition development. High and low birth weights followed by rapid postnatal growth were linked to increased risks of obesity, insulin resistance and high blood pressure in later life.

CONCLUSION

Foetal and postnatal growth trajectories are different between countries within and outside Asia. Extremes in birth weight followed by rapid postnatal growth were linked to increased risks of metabolic health of children in this region. As there is limited evidence in Asia, it is important to conduct thorough investigations by using longitudinal studies on early life programming.

Maternal Dietary Patterns and Pregnancy Outcome

Maternal nutritional status during pregnancy will affect the outcomes for the mother and the baby. Many analyses of the relationship between diet and outcome are often based on a single or a few food items or nutrients. However, foods are not consumed in isolation and dietary patterns can be used to assess the whole diet consumed. The use of dietary pattern analysis to understand nutritional intake and pregnancy outcome is becoming more and more popular. Many published studies have showed the association between maternal dietary patterns and pregnancy outcome. This review examined articles about the relationship between maternal dietary patterns and pregnancy outcome. As a modifiable factor, dietary patterns may be more applicable to clinical and pregnant health interventions.