Healthy eating index for pregnancy: adaptation for use in pregnant women in Brazil

Development and Validation of the South African Diet Quality Index for Pregnancy: The NuEMI Study

BACKGROUND

Diet quality indexes (DQIs) consist of combinations of foods and/or nutrient components that represent adherence to dietary guidelines. A high-quality diet during pregnancy contributes to optimal birth outcomes.

OBJECTIVE

We developed and validated the first DQI for pregnancy for South African women.

METHODS

The South African Food Based Dietary Guidelines and pregnancy dietary guidelines were used as theoretical basis for the a priori development of the South African Diet Quality Index for Pregnancy (SA-DQI-P). To validate the SA-DQI-P, we applied it to data collected for the Nutritional status of Expectant Mothers and their newborn Infants (NuEMI) study (N = 682). We determined the associations between SA-DQI-P scores in tertiles with nutrient intakes, sociodemographic factors, household food security level, and biochemical values.

RESULTS

A lower household density ratio, household access to a toilet, refrigerator, and microwave, a higher educational level, being employed and being food secure were significantly associated with a higher score. After correcting for energy intake, higher scores were significantly associated with higher intakes of protein, total fat, saturated fat, cholesterol, calcium, vitamin A, vitamin E, folic acid, vitamin B12, and vitamin C. Significantly more participants who were vitamin A deficient scored in the lowest tertile than those in higher tertiles.

CONCLUSION

The SA-DQI-P is the first DQI developed for a South African population and has proven to be valid in ranking diet quality in pregnant women in our sample. Information regarding diet quality of this vulnerable group can assist with planning nutrition intervention programs to improve nutritional status.

Diet quality indexes for use during pregnancy: a scoping review

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Quality of the diet of pregnant women in the scope of Primary Health Care

ABSTRACT Objective To evaluate the quality of the diet of the pregnant women monitored by the Family Health Strategy teams and associated factors. Methods This is a population-based cross-sectional study, carried out with 1244 pregnant women between 2018 and 2019. The Diet Quality Index Adapted for Pregnant Women was used to measure the quality of the diet and associate it with risk factors (sociodemographic, obstetric, clinical, behavioral, nutritional status) during the pregnancy. A hierarchical model composed of three blocks was used. A multinomial logistic regression was applied. Results The general average of this Diet Quality Index was 72.75 points, the average of the 1st tercile was 56.06 points, the average of the 2nd tercile was 73.71 points and the average of the 3rd was 88.51 points. The worst diet quality was related to pregnant women with lower education (OR=2.36; 95% CI=1.39-4.01), sedentary women (OR=1.37; 95% CI=1.17-2, 61), those who had a negative self-perception of food (OR=2.00; 95% CI=1.45-2.76) and who had 3 to 5 meals a day (OR=1.83; 95% CI=1.26-2.77), and less than 3 (OR=2.64; 95% CI=1.13-6.18). Conclusion The present study identified that pregnant women with less education, sedentary, and with inadequate nutritional characteristics presented worse diet qualities.

Is chronotype associated with dietary intake and weight gain during pregnancy? A prospective and longitudinal study

OBJECTIVES

The effects of chronotype on dietary intake and weight gain during pregnancy have not been addressed in the literature. The aim of this study was to analyze the effect of chronotype on eating patterns, energy, and macronutrient intake and distribution, as well as weight gain during pregnancy.

METHODS

This was a prospective cohort study carried out with 100 pregnant women in the first, second, and third gestational trimesters. Dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine recalls. Energy and macronutrient intake and distribution were evaluated at meals throughout the day. Chronotype was derived from midsleep time on free days, and the scores obtained were categorized into tertiles. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of chronotype and gestational trimester on eating patterns, daily energy, macronutrient distribution, and weight gain.

RESULTS

Pregnant women with values for midsleep time on free days indicative of eveningness have breakfast later and also have higher energy and carbohydrate intake at dinner than "morning" women. Pregnant "morning" women showed better diet quality in terms of milk and dairy and saturated fat. Also, despite the tendency for all tertiles to gain excess weight during pregnancy, we found that pregnant women with a tendency to eveningness had worse adequacy of gestational weight gain in the third trimester than "morning" women (2.24 ± 0.25 versus 1.22 ± 0.14, P < 0.001).

CONCLUSION

Pregnant women with a tendency to eveningness consume breakfast later in the day and exhibit greater consumption of energy and carbohydrates in the evening, as well as a worse standard of gestational weight gain in the third trimester. Our results emphasize the importance of considering chrononutrition variables in prenatal nutritional guidelines to promote maternal and fetal health.

Diet Quality Is Associated with a High Newborn Size and Reduction in the Risk of Low Birth Weight and Small for Gestational Age in a Group of Mexican Pregnant Women: An Observational Study

A high-quality diet during pregnancy may have positive effects on fetal growth and nutritional status at birth, and it may modify the risk of developing chronic diseases later in life. The aim of this study was to evaluate the association between diet quality and newborn nutritional status in a group of pregnant Mexican women. As part of the ongoing Mexican prospective cohort study, OBESO, we studied 226 healthy pregnant women. We adapted the Alternated Healthy Eating Index-2010 for pregnancy (AHEI-10P). The association between maternal diet and newborn nutritional status was investigated by multiple linear regression and logistic regression models. We applied three 24-h recalls during the second half of gestation. As the AHEI-10P score improved by 5 units, the birth weight and length increased (β = 74.8 ± 35.0 g and β = 0.3 ± 0.4 cm, respectively, p < 0.05). Similarly, the risk of low birth weight (LBW) and small for gestational age (SGA) decreased (OR: 0.47, 95%CI: 0.27–0.82 and OR: 0.55, 95%CI: 0.36–0.85, respectively). In women without preeclampsia and/or GDM, the risk of stunting decreased as the diet quality score increased (+5 units) (OR: 0.62, 95%IC: 0.40–0.96). A high-quality diet during pregnancy was associated with a higher newborn size and a reduced risk of LBW and SGA in this group of pregnant Mexican women.

Associations between diet quality, blood pressure, and glucose levels among pregnant women in the Asian megacity of Jakarta

BACKGROUND

The prevalence of gestational hypertension and diabetes in pregnancy is increasing worldwide. Diet is a modifiable factor that may influence these conditions, but few studies have examined the association between diet quality and blood pressure and glucose profiles among pregnant women. Data are especially scarce for women in low- and middle-income countries (LMICs), where 90% of global pregnancies occur, and in urban settings. We, therefore, assessed these associations among 174 pregnant women in the Asian megacity of Jakarta in a cross-sectional study of the Brain Probiotic and LC-PUFA Intervention for Optimum Early Life (BRAVE) project.

METHODS

Trained field-enumerators collected socio-demographic characteristics, measured Mid-Upper Arm Circumference (MUAC), and assessed diet by two 24-hour recalls, which were used to calculate the Alternate Healthy Eating Index for Pregnancy (AHEI-P). Blood pressure was measured by automated sphygmomanometer, and fasting blood glucose by capillary glucometer. General linear models were used to identify associations.

RESULTS

The median AHEI-P score was 47.4 (IQR 19.1-76.6). The middle tertile of the AHEI-P score (39.59-56.58) was associated with a 0.4 SD (standardized effect size, 95% CI -0.7 to -0.06; p = 0.02) lower diastolic blood pressure compared with the lowest tertile (<39.59), after adjustment for level of education, smoking status, MUAC, gestational age, history of hypertension, and family history of hypertension. However, no associations were found between the AHEI-P score and systolic blood pressure and blood glucose.

CONCLUSION

Higher diet quality was associated with lower diastolic blood pressure among pregnant women in an urban LMIC community, but not with systolic blood pressure and blood glucose. A behavioral change intervention trial would be warranted to confirm the influence of diet quality on blood pressure and glucose levels and among pregnant women, and even before pregnancy.

Epidemiology of artherial hypertension in pregnants

OBJECTIVE

To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events.

METHODS

Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used.

RESULTS

Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed).

CONCLUSION

After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.

Hábitos alimentares das gestantes brasileiras:revisão integrativa da literatura

Resumo Os hábitos alimentares das mulheres grávidas são influenciados por diversos fatores, sendo essencial conhecê-los para poder realizar intervenções nutricionais na atenção pré-natal. O objetivo desta revisão integrativa foi analisar a produção bibliográfica sobre hábitos alimentares de gestantes brasileiras. Foram buscados artigos na Biblioteca Virtual em Saúde (BVS), PubMed, Scopus, Web of Science e na Scientific Eletronic Library Online (SciELO) utilizando os seguintes descritores: “Gestantes” OR “Grávidas” AND “Hábitos Alimentares” e os termos “Pregnant women” AND “Food habits” AND “Brazil” para busca em inglês. Após a adoção dos critérios de inclusão e exclusão foram analisados 18 estudos. Alguns estudos contemplaram populações específicas como adolescentes ou gestantes não obesas. O instrumento mais utilizado para investigação do consumo alimentar de gestantes foi o Questionário de Frequência Alimentar. A maioria mostrou que a dieta das gestantes precisa de melhorias, especialmente pelo baixo consumo de frutas, verduras e hortaliças, elevado consumo de açúcares, doces e gorduras. A maioria dos estudos concluiu e reforçou a importância e a necessidade da educação nutricional pelos profissionais atuantes no pré-natal. Mais estudos são necessários para compreensão mais acurada destes hábitos alimentares.

Relationship between pregestational nutritional status and type of processing of foods consumed by high-risk pregnant women

Abstract Objectives: to relate pregestational nutritional status, maternal age and number of pregnancies to the distribution of macronutrients and micronutrients according to the type of processing offoods consumed by high-risk pregnant women. Methods: a retrospective cross-sectional study was carried out with data from medical records of 200 pregnant women served by a public outpatient clinic in Rio Grande do Sul from 2014 to 2016. Results: the mean percentages of lipids, monounsaturated fatty acids, polyunsaturated fatty acids and sodium intake were higher among ultra-processed foods. There was a significant inverse correlation between maternal age and total calorie intake (p=0.003) and percentage of carbohydrates (p=0.005) and proteins (p=0.037) from ultra-processed foods. There was also a significant association between pregestational nutritional status and total calorie intake (p=0.018) and percentage of carbohydrates (p=0.048) from ultra-processed foods. Conclusions: the mean percentages of lipids, monounsaturated fatty acids, polyunsaturated fatty acids and sodium intake were higher among ultra-processed foods. It was observed that the older the maternal age of high-risk pregnant women, the lower the intake of total calories and percentages of carbohydrates and proteins from ultra-processed foods. It was also observed that pregestational nutritional status was significantly associated with the intake of total calories and percentage of carbohydrates from ultra-processed foods.

Development of a Diet Quality Index Adapted for Pregnant Women

OBJECTIVE:

To develop a Diet Quality Index Adapted for Pregnant Women (IQDAG) and to evaluate its relation with the characteristics of women treated at the Brazilian Unified Health System.

METHODS:

The data on food intake come from a cross-sectional study carried out with 785 adult pregnant women in the city of Ribeirão Preto, state of São Paulo, Brazil, between 2011 and 2012. The index was based on the recommendations of the Brazilian Ministry of Health, previous national dietary indexes, and the new Dietary Guidelines for the Brazilian Population. We used the ANOVA, Kruskal-Wallis, and chi-square tests to describe the quality of the diet according to the characteristics of the mother.

RESULTS:

The IQDAG has nine components, and it is represented by three food groups (in servings/1,000 kcal), five nutrients, and a moderator component. A high proportion of pregnant women reached the maximum score for the components of legumes and vegetables. However, few women reached the maximum score for consumption of fresh fruits, fiber, omega-3, calcium, folate, iron, and ultra-processed foods. We verified a better quality of diet among older and eutrophic pregnant women who reported practicing more physical activity and taking dietary supplements. We also observed the highest index score among women with higher intake of carbohydrates, proteins, vitamins C, E, and A, and minerals calcium, folate, and iron, as well as among those with lower intake of total fats and saturated fats.

CONCLUSIONS:

This dietary index is unprecedented in incorporating the recommendation of the new Dietary Guidelines for the Brazilian Population regarding the moderation of the consumption of ultra-processed foods. It was useful in evaluating the quality of the diet of pregnant women and we verified a higher score among older and eutrophic women who reported a healthy lifestyle. Strategies are needed to promote a higher consumption of fresh fruits, foods high in fiber, omega-3, calcium, folate, iron, and minimally processed foods in pregnant women.

Different Dietary Patterns and New-Onset Diabetes Mellitus After Kidney Transplantation: A Cross-Sectional Study

OBJECTIVE

To verify the association of dietary patterns and dietary components with new-onset diabetes mellitus after transplantation (NODAT).

DESIGN

Cross-sectional study.

SUBJECTS

Adult kidney transplant recipients, without history of diabetes before transplantation, who received a kidney transplant and were followed up for at least 1 year. One hundred and sixteen subjects recruited between January 2013 and August 2014. Diagnosis of NODAT was established according to the American Diabetes Association criteria for type 2 diabetes.

METHODS

Demographic, clinical, and anthropometric data were collected. Dietary intake was assessed by food frequency questionnaire, administered by a registered dietitian. Dietary patterns were identified by cluster analysis. Chi-square test was used to verify the association between dietary patterns and NODAT. Total energy, fiber, and cholesterol intake were calculated. Consumption of macronutrients, carbohydrates, proteins, and fats (total fats and saturated, monounsaturated, polyunsaturated and trans fatty acids), were expressed in percentage of total energy intake.

RESULTS

Twenty-eight patients developed NODAT in the follow-up period. They presented higher body mass index and body fat percentage, as well as higher levels of triglycerides and urinary protein/creatinine ratio than the non-NODAT group. Two dietary patterns, I and II, were identified. Pattern II was characterized by higher intake of total, saturated, monounsaturated, and trans fats than pattern I. No association between the dietary patterns and NODAT was identified (P = .905), and there was no difference in the distribution of macronutrients, dietary fiber, and dietary cholesterol between the groups with and without NODAT.

CONCLUSION

Posttransplant dietary patterns were not different between patients with and without NODAT. Further larger and prospective studies are needed to evaluate a possible relationship between dietary components and NODAT incidence in kidney transplant recipients.

[Critical analysis of the diet quality of the Brazilian population according to the Healthy Eating Index: a systematic review]

In light of the importance of studying instruments that assess the food quality of the population, this study sought to conduct a systematic review of the quality of the diet of the Brazilian population using the Healthy Eating Index (HEI) and duly analyzing its methodology and results. The major electronic databases were used for the selection of studies. After the searches with the key words, 32 articles were included in this review. The growing interest of the scientific community in addressing this issue was observed, with recent studies using this instrument in Brazil. Methodological issues of articles were evaluated and discussed taking into consideration the revised versions and adaptations of the HEI. Some common results were highlighted among the studies such as low consumption of fruit, vegetables and/or dairy products, and the wider consumption of meat and eggs, cholesterol, total fat and saturated fat. Among the articles that address the HEI and socioeconomic aspects it was seen that quality of diet improves both in accordance with the increasing level of education of parents and with the family income in the population studied. The HEI can be used to monitor changes in dietary patterns and also as a nutrition education and health promotion tool.

Association between dietary patterns and mental disorders in pregnant women in Southern Brazil

Objective:

To evaluate the association between dietary patterns and mental disorders among pregnant women in southern Brazil.

Methods:

Cross-sectional study with 712 pregnant women recruited from the Study of Food Intake and Eating Behaviors in Pregnancy (ECCAGe). Food intake assessment was performed using the Food Frequency Questionnaire. Dietary patterns were identified by cluster analysis. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to evaluate participants’ mental health. Poisson regression models with robust variance were fitted to estimate prevalence ratios (PR).

Results:

In the adjusted models, there was a high prevalence of major depressive disorder among women with low fruit intake (43%, PR 1.43, 95%CI 1.04-1.95) and high sweets and sugars intake (91%, PR 1.91, 95%CI 1.19-3.07). Women with a common-Brazilian dietary pattern had higher prevalence of major depressive disorder compared to those with a varied consumption pattern (PR 1.43, 95%CI 1.01-2.02). Low intake of beans was significantly associated with generalized anxiety disorder (PR 1.40, 95%CI 1.01-1.93).

Conclusions:

Low consumption of fruits and beans and intake of the common-Brazilian dietary pattern during pregnancy were associated with higher prevalence of mental disorders. These results reinforce the importance of an adequate dietary intake to ensure better mental health in pregnancy.

CONSUMO DE POLIFENÓIS E SUA ASSOCIAÇÃO COM CONHECIMENTO NUTRICIONAL E ATIVIDADE FÍSICA

RESUMO Introdução: Os benefícios que a atividade física pode agregar à saúde de seus praticantes são expressivos, principalmente quando associada à dieta orientada e à prevenção de possíveis danos ocasionados pela prática. Nesse contexto, os efeitos benéficos de compostos bioativos e nutracêuticos, como os polifenóis, têm mobilizado diversos estudos. Objetivo: Avaliar o consumo de polifenóis na dieta de praticantes de atividade física, associando-o ao conhecimento nutricional e ao tempo despendido nessa prática. Métodos: Este é um estudo quantitativo de caráter transversal. A amostra foi composta por 35 homens com média de idade de 27,9 anos, praticantes de atividade física em uma academia situada na cidade de São Leopoldo, RS, Brasil. Para a obtenção e análise dos dados foi realizado inquérito alimentar, questionário sociodemográfico e uma escala de conhecimento nutricional. Os polifenóis ingeridos na dieta foram quantificados utilizando-se o banco de dados Phenol-Explorer. As médias de polifenóis entre os grupos foram comparadas utilizando-se o teste t para amostras independentes. A normalidade dos dados referentes ao consumo de polifenóis foi testada pelo teste de Kolmogorov-Smirnov. Resultados: A média de tempo semanal despendido pelos indivíduos da amostra para a prática de atividade física foi de 291,7 ± 117,5 minutos, sendo aqueles que praticam por um período maior os que consomem mais polifenóis na dieta. Conclusão: Ao se analisar o consumo de polifenóis, observou-se que todos os participantes têm ingestão regular, porém em proporções inferiores à sugerida por alguns estudos. Quando avaliada a qualidade da dieta, verificou-se que a maioria consumiu frutas e vegetais, ainda que divergindo da falta de conhecimento adequado sobre a relevância nutricional desses alimentos.

Maternal diet quality and nutrient intake in the gestational period: results from the delta healthy sprouts comparative impact trial

BACKGROUND

A woman's diet while pregnant can play an important role in her reproductive health as well as the health of her unborn child. Diet quality and nutrient intake amongst pregnant women residing in the rural Lower Mississippi Delta (LMD) region of the United States is inadequate. The Delta Healthy Sprouts Project was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of women and their infants residing in the LMD region. This paper reports results pertaining to maternal diet quality and nutrient intake in the gestational period.

METHODS

The experimental arm (PATE) received monthly home visits beginning in the second trimester using the Parents as Teachers curriculum enhanced with a nutrition and lifestyle behavior curriculum. The control arm (PAT) received monthly home visits using the Parents as Teachers curriculum only. Maternal diet was assessed via 24-h dietary recall at gestational months (GM) 4 (baseline), 6, and 8. Diet quality was computed using the Healthy Eating Index-2010 (HEI-2010).

RESULTS

Gestational period retention rates for PAT and PATE arms were 77 % (33/43) and 67 % (26/39), respectively. Significant effects were not found for time, treatment, or time by treatment for the HEI-2010 total or component scores, macro- or micronutrient intake or percentage of women meeting recommended nutrient intakes.

CONCLUSIONS

Perhaps due to low participant enrollment and higher than expected rates of drop out and noncompliance, we were not able to demonstrate that the enhanced nutrition and lifestyle curriculum (PATE) intervention had a significant effect on diet quality or nutrient intake during pregnancy in this cohort of rural, Southern, primarily African American women.

TRIAL REGISTRATION

clinicaltrials.gov, NCT01746394. Registered 5 December 2012.

Diet, Pre-pregnancy BMI, and Gestational Weight Gain in Puerto Rican Women

OBJECTIVES

To describe the dietary patterns in pregnant woman and determine the association between diet factors, pre-pregnancy Body Mass Index (BMI) and socio-demographic characteristics with gestational weight gain (GWG).

METHODS

This is a secondary analysis of a longitudinal cohort study of pregnant women exploring the risk factors for preterm birth, the Puerto Rico Testsite for Exploring Contamination Threats program. Recruitment was conducted during 2011-2014. Data was collected from multiple sources. GWG was calculated using maternal weight recorded in the medical records at the first and last prenatal visits and classified according to the Institute of Medicine guidelines. Sociodemographic characteristics were obtained at baseline using an interviewed-based questionnaire. Participants completed a self-administered food frequency questionnaire at 20-28 weeks to assess dietary patterns. Analysis of associations between variables was conducted using Chi Square tests.

RESULTS

A total of 160 women with term pregnancies were included in this analysis. Mean pre-pregnancy BMI was 25.4 ± 5.48 kg/m(2), with 44.4 % classified as overweight/obese. Excessive GWG was observed in 24.4 % of the participants. Socio-demographic characteristics were not associated with GWG. Being overweight/obese at the start of pregnancy was significantly associated with excessive GWG (p < 0.05). In addition, women consuming one or more fruit drinks per day were more likely to have an excessive GWG while those consuming less than one fruit drink per day were more likely to have an adequate GWG (p < 0.05).

CONCLUSIONS FOR PRACTICE

Being obese before pregnancy and frequently consuming fruit drinks were important determinants of excessive GWG in this group.

Use of a web-based dietary assessment tool in early pregnancy

BACKGROUND

Maternal diet is critical to fetal development and lifelong health outcomes. In this context, dietary quality indices in pregnancy should be explicitly underpinned by data correlating food intake patterns with nutrient intakes known to be important for gestation.

AIMS

Our aim was to assess the correlation between dietary quality scores derived from a novel online dietary assessment tool (DAT) and nutrient intake data derived from the previously validated Willett Food Frequency Questionnaire (WFFQ).

METHODS

524 women completed the validated semi-quantitive WFFQ and online DAT questionnaire in their first trimester. Spearman correlation and Kruskal-Wallis tests were used to test associations between energy-adjusted and energy-unadjusted nutrient intakes derived from the WFFQ, and diet and nutrition scores obtained from the DAT.

RESULTS

Positive correlations were observed between respondents' diet and nutrition scores derived from the online DAT, and their folate, vitamin B12, iron, calcium, zinc and iodine intakes/MJ of energy consumed derived from the WFFQ (all P < 0.001). Negative correlations were observed between participants' diet and nutrition scores and their total energy intake (P = 0.02), and their percentage energy from fat, saturated fat, and non-milk extrinsic sugars (NMES) (all P ≤ 0.001). Median dietary fibre, beta carotene, folate, vitamin C and vitamin D intakes derived from the WFFQ, generally increased across quartiles of diet and nutrition score (all P < 0.001).

CONCLUSIONS

Scores generated by this web-based DAT correlate with important nutrient intakes in pregnancy, supporting its use in estimating overall dietary quality among obstetric populations.

Pregnancy Requires Major Changes in the Quality of the Diet for Nutritional Adequacy: Simulations in the French and the United States Populations

BACKGROUND

Maternal nutrition is critical to the health of both mother and offspring, but there is a paucity of data on the nutritional adequacy of diets during pregnancy.

OBJECTIVE

Our objective was to identify to what extent pregnancy reduces the nutritional adequacy of the expecting mother's diet and if this nutritional gap can be resolved by simple quantitative or qualitative changes in the diet.

MATERIALS AND METHODS

We evaluated the observed overall nutritional adequacy of diets of French and American women of childbearing age participating in ENNS (n = 344) and NHANES (n = 563) using the probabilistic approach of the PANDiet system, resulting in a 100-point score. Then, we simulated the changes in the PANDiet scores of women of childbearing age who would remain on their diet during pregnancy. Finally, by either increasing the quantity of consumed foods or using eleven snacks recommended during pregnancy, we simulated the effect of a 150-kcal increase in the energy intake of French women.

RESULTS

Observed PANDiet scores were equal to 59.3 ± 7.0 and 58.8 ± 9.3 points respectively in France and in the US. Simulation of pregnancy for women of childbearing age led to a decrease in nutritional adequacy for key nutrients during pregnancy and resulted in reducing PANDiet scores by 3.3 ± 0.1 and 3.7 ± 0.1 points in France and in the US. Simulated 150-kcal increases in energy intake proved to be only partially effective in filling the gap both when the quantity of food consumed was increased and when recommended snacks were used.

CONCLUSIONS

The decrease in nutritional adequacy induced by pregnancy cannot be addressed by simply following generic dietary guidelines.

Development and validation of an educational booklet for healthy eating during pregnancy

OBJECTIVE

to describe the validation process of an educational booklet for healthy eating in pregnancy using local and regional food.

METHODS

methodological study, developed in three steps: construction of the educational booklet, validation of the educational material by judges, and by pregnant women. The validation process was conducted by 22 judges and 20 pregnant women, by convenience selection. We considered a p-value<0.85 to validate the booklet compliance and relevance, according to the six items of the instrument. As for content validation, the item-level Content Validity Index (I-CVI) was considered when a minimum score of at least 0.80 was obtained.

RESULTS

five items were considered relevant by the judges. The mean I-CVI was 0.91. The pregnant women evaluated positively the booklet. The suggestions were accepted and included in the final version of the material.

CONCLUSION

the booklet was validated in terms of content and relevance, and should be used by nurses for advice on healthy eating during pregnancy.