Adherence to the Mediterranean Diet and Determinants Among Pregnant Women: The NELA Cohort

Nutrition education in the midwife consultation room. A cross sectional survey in Spain

BACKGROUND

Diet during pregnancy is a key factor in the success of pregnancy. However, several studies have found pregnant women have low adherence to dietary recommendations. The midwife is a key health professional to provide nutrition education for pregnant women. Thus, it is important to know in detail her role in this respect.

AIM

To explore how Spanish midwives undertake nutrition education in order to assess the need for specific interventions aimed at improving the health of pregnant women.

METHODS

A cross-sectional descriptive observational study was undertaken using an online questionnaire (466 responses).

FINDINGS

Spanish midwives recognise the importance of nutrition in pregnancy and that advising pregnant women in this regard is part of their role. In fact, all community midwives discuss nutrition to pregnant women, although they recognise that they do not feel particularly comfortable in dealing with certain topics, which could be related to a lack of mastery of the subjects. Midwives (56.5 %) rated the nutrition training their received as poor.

CONCLUSION

In order to guarantee the quality in the nutrition education provided by Spanish midwives to promote the health of pregnant women, our results demonstrate the importance of strengthening both the nutrition content of midwives' training programmes and the ongoing support they receive throughout their professional life.

Dietary patterns during pregnancy in relation to maternal dietary intake: The Mutaba'ah Study

AIM

To relate adherence to healthy dietary patterns, evaluated by different dietary indices, to the intake of nutrients and food groups among pregnant women in the United Arab Emirates.

METHODS

The analyses included 1122 pregnant women from the Mutaba'ah Study. Dietary intake was assessed using a semi-quantitative Food Frequency Questionnaire. Adherence to three dietary pattern indices was assessed; Alternate Healthy Eating Index for Pregnancy (AHEI-P), Alternate Mediterranean Diet (aMED) and Dietary Approaches to Stop Hypertension (DASH). Associations between adherence (score >median) to the three dietary indices and intake of nutrients and food groups were analyzed using logistic regression analysis.

RESULTS

Women with higher intake of polyunsaturated fatty acids, fiber, vegetables, fruits, legumes, and nuts and lower intake of saturated fatty acids, red meat, and sweetened beverages had significantly higher odds of adherence to all three dietary patterns (p<0.05). Associations between intakes of nutrients and food groups with odds of adherence to the dietary patterns differed for total fat (only with AHEI-P, [odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98]) and monounsaturated fatty acids (only with aMED, [OR: 1.06; 95% CI: 1.02-1.10]), dairy (with AHEI-P [OR: 0.89; 95% CI: 0.84-0.95] and aMED [OR: 0.86; 95% CI: 0.81-0.91], and with DASH [OR: 1.10; 95% CI: 1.04-1.17]), whole grain (only with aMED [OR: 2.19; 95% CI: 1.61-2.99] and DASH [OR: 4.27; 95% CI: 3.04-5.99]) and fish (with AHEI-P [OR: 1.36; 95% CI: 1.02-1.80] and aMED [OR: 1.79; 95% CI: 1.35-2.38], and with DASH [OR: 0.67; 95% CI: 0.52-0.86]).

CONCLUSION

Adherence to the three dietary pattern indices was generally associated with a favorable intake of nutrients and food groups. However, the indices captured slightly different aspects of dietary intake. These results show that dietary indices that assess adherence to healthy dietary patterns cannot be used interchangeably.

What are the changes in mothers' diets after the birth of a child: results from the NutriNet-Santé cohort

Childbirth is a major life-changing event, this period is an opportunity to improve eating habits. The aim of this longitudinal study was to identify and characterise dietary changes in women according to their parity status. Dietary intake data from 4194 women of childbearing age included in the NutriNet-Santé cohort were derived using a FFQ, administered in 2014 and 2018, distinguishing between organic and conventional food consumption. Women were classified into four groups: ‘previous children’, ‘multiparous’, ‘primiparous’ and ‘nulliparous’. Multi-adjusted ANCOVA models were used to estimate the changes according to the parity group. Changes in food consumption towards a more plant-based, healthier and organic diet were observed in all four groups of women, although to various degrees. In multivariable models, ‘Nulliparous’ women showed a greater improvement in terms of ‘sustainable’ food consumption than ‘previous children’ women. ‘Primiparous’ women significantly increased their energy intake (+349 (269–429) kcal/d) and their consumption of dairy products (+30 (3–56) g/d), and they significantly decreased their consumption of alcohol (–23 (–32–15) g/d), coffee and tea (–107 (–155–60) g/d). Regarding organic food, ‘nulliparous’ women increased their consumption more than ‘previous children’ and ‘primiparous’ women were those who were most frequently in the top quintile of organic food increase. Although there were dietary changes in all groups of women according to their parity, childless women have a shift moving towards a more sustainable diet. Women who had a first child reduced their alcohol and caffeine consumption.

Dietary Habits and Nutritional Knowledge of Pregnant Women: The Importance of Nutrition Education

A good diet during pregnancy is associated with improvements to maternal and fetal health. Nevertheless, excessive weight gain during pregnancy has been reported in several studies. The aim of this review is to determine the dietary habits of pregnant women (measured according to their degree of adherence to the Mediterranean diet, a reference in dietary quality), their knowledge of food and nutrition, and their perceptions of the nutritional education received during their pregnancy, in order to detect intervention needs within that group. The bibliographic search was conducted on three databases (Medline, PubMed central, and Web of Science), using the keywords "pregnancy", "Mediterranean diet", "nutrition knowledge", "nutritional education", and some synonyms. The final selection included 68 original articles. The available evidence indicated that, although pregnant women were aware of the importance of nutrition during pregnancy, their habits showed some room for improvement in terms of diet and physical exercise. Lack of adequate advice was the main barrier to the practice of healthy habits that pregnant women encountered; they considered that the information they received during pregnancy follow-up visits was inadequate. However, the success of interventions within different countries is a source of hope for well-structured nutrition education throughout pregnancy. The lack of nutrition-related knowledge among pregnant women could be originally related to poorly planned nutrition education from healthcare providers. Research focused on the consultations with these healthcare providers could be of help when proposing strategies to improve the content, the depth, and the duration of nutrition education sessions. It should, in any case, be noted that the available evidence in this field is limited to certain geographical origins. Therefore, research that uncovers evidence in different countries will be useful for learning about the factors that condition the habits of pregnant women and, in that way, guide strategies for the improvement of the health of expectant mothers during that stage in their lives.

Associations between diet quality and dietary patterns and gestational diabetes mellitus in a low-risk cohort of pregnant women in Australia: a cross-sectional study

INTRODUCTION

Evidence of associations between the Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) score and gestational diabetes mellitus (GDM) in pregnant women is limited. This study examined changes in MDS and DASH and dietary patterns in Australian pregnant women between early and late pregnancy and their associations with GDM.

METHODS

The data from n = 284 participants were analysed. Diet quality indices and empirical dietary patterns were determined in early (15 ± 3 weeks gestation) and late pregnancy (35 ± 2 weeks gestation). Paired t-tests were used to examine changes in scores for diet quality indices and dietary patterns from early to late pregnancy. Logistic regression analysis was used to examine associations between GDM, diet quality indices and dietary patterns.

RESULTS

Three major dietary patterns were identified at early pregnancy. The first and second dietary patterns included unhealthier and healthier food groups, respectively, and the third comprised mixed food groups. Although diet quality scores did not change over time, consumption of the first dietary pattern increased (p = 0.01), and consumption of the second dietary pattern decreased by late pregnancy in women without GDM (p < 0.001).

CONCLUSION

No associations between DASH score, MDS and GDM were found; however an inverse association was observed between the first dietary pattern and GDM in late pregnancy (p = 0.023). Longitudinal studies are needed to examine diet quality and dietary patterns at early and late pregnancy to inform the development of tailored dietary advice for GDM.

Associations of adherence to the DASH diet and Mediterranean diet with maternal c-reactive protein levels during pregnancy

BACKGROUND AND AIMS

Elevated C-reactive protein (CRP) during pregnancy, a marker of inflammation, is associated with adverse outcomes. Better understanding the relationship between CRP and modifiable factors, including diet, is essential to assist early pregnancy lifestyle interventions. The aim of this study was to assess the relationship between adherence to the Dietary Approaches to Stop Hypertension diet (DASH-diet) and the Mediterranean diet (MED-diet) during pregnancy with maternal plasma CRP in early and late pregnancy.

METHODS AND RESULTS

Secondary analysis of the Creatine and Pregnancy Outcomes (CPO) study was undertaken. Women (n = 215) attending antenatal clinics through Monash Health, Melbourne were recruited at 10-20 weeks gestation. Medical history and blood samples were collected at 5 antenatal visits. Adapted DASH-diet and MED-diet scores were calculated from Food Frequency Questionnaires completed at early ([mean ± SD]) (15 ± 3 weeks) and late (36 ± 1 week) pregnancy. CRP was measured in maternal plasma samples collected at the same time points. Adjusted linear regression models assessed associations of early-pregnancy DASH and MED-diet scores with early and late pregnancy plasma CRP. There were no statistically significant changes in DASH-diet score from early (23.5 ± 4.8) to late (23.5 ± 5.2) pregnancy (p = 0.97) or MED-diet score from early (3.99 ± 1.6) to late pregnancy (4.08 ± 1.8) (p = 0.41). At early-pregnancy, there was an inverse relationship between DASH-diet scores and MED-diet scores with plasma CRP; (β = -0.04 [95%CI = -0.07, -0.00], p = 0.044), (β = -0.12 [95%CI = -0.21, -0.02], p = 0.023).

CONCLUSION

Adherence to the DASH-diet and MED-diet during early pregnancy may be beneficial in reducing inflammation. Assessment of maternal dietary patterns may assist development of preventive strategies, including dietary modification, to optimise maternal cardiometabolic health in pregnancy.

Serum Vitamins A and E at Mid-Pregnancy and Their Relationships with Both Maternal and Cord Blood Antioxidant Status and Perinatal Conditions: The NELA Cohort

INTRODUCTION

Most of the pregnant women do not achieve the recommended dietary intake of vitamins A and E. These vitamins may counteract oxidative stress involved in some adverse perinatal outcomes. We aimed to assess the associations between maternal vitamin A and E at mid-pregnancy with both maternal and fetal outcomes and to identify possible early biomarkers during pregnancy to predict and prevent oxidative stress in the offspring.

METHODS

Data on dietary and serum levels of vitamins A and E were collected from 544 pregnant women from the Nutrition in Early Life and Asthma (NELA) study, a prospective mother-child cohort set up in Spain.

RESULTS

There were large discrepancies between low dietary vitamin E intake (78% of the mothers) and low serum vitamin E levels (3%) at 24 weeks of gestation. Maternal serum vitamins A and E at mid-pregnancy were associated with higher antioxidant status not only in the mother at this time point (lower hydroperoxides and higher total antioxidant activity [TAA]) but also with the newborn at birth (higher TAA). Gestational diabetes mellitus (GDM) was negatively associated with maternal serum vitamin A (OR: 0.95 CI: 0.91-0.99, p = 0.009) at mid-pregnancy. Nevertheless, we could not detect any association between GDM and oxidative stress parameters.

CONCLUSIONS

In conclusion, maternal vitamin A and E serum levels may be used as an early potential biomarker of antioxidant status of the neonate at birth. Control of these vitamins during pregnancy could help avoid morbid conditions in the newborn caused by oxidative stress in GDM pregnancies.

The Nutrition in Early Life and Asthma (NELA) birth cohort study: Rationale, design, and methods

BACKGROUND

Primary prevention strategies for asthma are lacking. Its inception probably starts in utero and/or during the early postnatal period as the developmental origins of health and disease (DOHaD) paradigm suggests.

OBJECTIVES

The main objective of Nutrition in Early Life and Asthma (NELA) cohort study is to unravel whether the following factors contribute causally to the developmental origins of asthma: (1) maternal obesity/adiposity and foetal growth; (2) maternal and child nutrition; (3) outdoor air pollution; (4) endocrine disruptors; and (5) maternal psychological stress. Maternal and offspring biological samples are used to assess changes in offspring microbiome, immune system, epigenome and volatilome as potential mechanisms influencing disease susceptibility.

POPULATION

Randomly selected pregnant women from three health areas of Murcia, a south-eastern Mediterranean region of Spain, who fulfilled the inclusion criteria were invited to participate at the time of the follow-up visit for routine foetal anatomy scan at 19-22 weeks of gestation, at the Maternal-Fetal Medicine Unit of the "Virgen de la Arrixaca" University Clinical Hospital over a 36-month period, from March 2015 to April 2018.

DESIGN

Prospective, population-based, maternal-child, birth cohort study.

METHODS

Questionnaires on exposures and outcome variables were administered to mothers at 20-24 gestation week; 32-36 gestation week; and delivery. Children were surveyed at birth, 3 and 18 months of age and currently at 5 years. Furthermore, physical examinations were performed; and different measurements and biological samples were obtained at these time points.

PRELIMINARY RESULTS

Among the 1350 women invited to participate, 738 (54%) were finally enrolled in the study and 720 of their children were eligible at birth. The adherence was high with 612 children (83%) attending the 3 months' visit and 532 children (72%) attending the 18 months' visit.

CONCLUSION

The NELA cohort will add original and unique knowledge to the developmental origins of asthma.