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

The Effect of Maternal Diet and Lifestyle on the Risk of Childhood Obesity

Background/Objectives: Childhood obesity is a global health problem that affects at least 41 million children under the age of five. Increased BMI in children is associated with serious long-term health consequences, such as type 2 diabetes, cardiovascular disease, and psychological problems, including depression and low self-esteem. Although the etiology of obesity is complex, research suggests that the diet and lifestyle of pregnant women play a key role in shaping metabolic and epigenetic changes that can increase the risk of obesity in their children. Excessive gestational weight gain, unhealthy dietary patterns (including the Western diet), and pregnancy complications (such as gestational diabetes) are some of the modifiable factors that contribute to childhood obesity. The purpose of this narrative review is to summarize the most important and recent information on the impact of the diet and lifestyle of pregnant women on the risk of childhood obesity. Methods: This article is a narrative review that aims to summarize the available literature on the impact of pregnant women's diet and lifestyle on the risk of obesity in their offspring, with a focus on metabolic and epigenetic mechanisms. Results/Conclusions: Current evidence suggests that a pregnant woman's lifestyle and diet can significantly contribute to lowering the risk of obesity in their offspring. However, further high-quality research is needed to understand better the metabolic and epigenetic relationships concerning maternal factors that predispose offspring to obesity.

The risk prediction of intergenerational transmission of overweight and obesity between mothers and infants during pregnancy

BACKGROUND

Overweight and obesity in mothers before pregnancy lead to overweight and obesity in their offspring, which is the main form of intergenerational transmission of overweight and obesity in early life. Many factors, especially non-genetic factors, may influence intergenerational transmission, but little prediction research has been conducted. Therefore, we analyzed the status of intergenerational transmission in maternal and infant overweight and obesity. Second, we explored the factors during the pregnancy that might affect the the intergenerational transmission; According to the two application scenarios of pregnancy screen and self-management, risk prediction models for pregnant women were carried out.

METHODS

Based on a prospective birth cohort, a total of 908 mothers and offspring were followed up during early life. Follow-up visits were performed at the first trimester, second trimester, third trimester, delivery, 42 days after delivery, and 6 months and 12 months of age. The investigation methods included questionnaire survey, physical examination, biological sample collection and clinical data collection. In terms of risk prediction, univariate analysis was used to screen candidate predictors. Second, multivariable Cox proportional hazard regression models were used to determine the final selected predictors. Third, the corresponding histogram models were drawn, and then the 10-fold cross-validation methods were used for internal verification.

RESULTS

Regarding intergenerational transmission of overweight and obesity between mothers and infants during pregnancy, the risk prediction model for pregnancy screen was constructed. The model established: h(t|X) = h0(t)exp.(- 0.95 × (Bachelor Degree or above) + 0.75 × (Fasting blood glucose in the second trimester) + 0.89 × (Blood pressure in the third trimester) + 0.80 × (Cholesterol in third trimester) + 0.55 × (Abdominal circumference in third trimester))., with good discrimination (AUC = 0.82) and calibration (Hosmer-Lemeshow2 = 4.17). The risk prediction model for self-management was constructed. The model established: h(t|X) = h0(t)exp. (0.98 × (Sedentary >18METs) + 0.88 × (Sleep index≥8) + 0.81 × (Unhealthy eating patterns Q3/Q4) + 0.90 × (Unhealthy eating patterns Q4/Q4) + 0.85 × (Depression)), with good discrimination (AUC = 0.75) and calibration (Hosmer-Lemeshow2 = 3.81).

CONCLUSIONS

The risk predictions of intergenerational transmission of overweight and obesity between mothers and infants were performed for two populations and two application scenarios (pregnancy screening and home self-management). Further research needs to focus on infants and long-term risk prediction models.

Parental adherence to healthy lifestyles in relation to the risk of obesity in offspring: A prospective cohort study in China

Background

While maternal adherence to a healthy lifestyle was shown to be associated with a lower risk of obesity in offspring, the potential role of overall parental lifestyles has not yet been explored. We aimed to address this gap by exploring whether parental adherence to an overall healthy lifestyle was associated with a lower risk of obesity in offspring.

Methods

We included 5881 children and adolescents aged 6-15 years at enrolment in the 2010, 2012, and 2014 waves of the China Family Panel Studies (CFPS) who were free of obesity and followed them until 2020. Parental healthy lifestyle score at study baseline was composed of five modifiable lifestyle factors (0-5; 1 for each): never smoking, non-habitual drinking, weekly exercise, modified dietary diversity score ≥5 points, and body mass index (BMI) of 18.5-23.9 kg/m2. We defined obesity according to the age- and gender-specific cutoffs by the BMI percentile curves for Chinese children aged 6-18 years. We used multivariable Cox proportional hazard models to examine the association between parental healthy lifestyle score (both as continuous and categorical variables) and risk of offspring obesity.

Results

Overall, 597 (10.2%) offspring developed obesity during a median follow-up of 6 years. Compared to the lowest tertile of parental healthy lifestyle score, participants in the highest tertile had a 42% (hazard ratio (HR) = 0.58; 95% confidence interval (CI) = 0.45-0.74) lower risk of obesity. Both maternal (HR = 0.75; 95% CI = 0.61-0.92) and paternal (HR = 0.73; 95% CI = 0.60-0.89) healthy lifestyle scores were associated with lower risks of obesity in offspring. For specific lifestyle factors, we observed beneficial associations for paternal diverse diet (HR = 0.73; 95% CI = 0.60-0.88) and healthy BMI (HR = 0.65; 95% CI = 0.55-0.78).

Conclusions

Adherence to an overall parental healthier lifestyle was associated with a lower risk of obesity in childhood and adolescence. This finding highlights the potential benefits of promoting a healthy lifestyle among parents for the primary prevention of offspring obesity.

Maternal nutrition during mid-pregnancy and children's body composition at 7 years of age in the SELMA study

Optimal nutrition during pregnancy is vital for both maternal and child health. Our objective was to explore if prenatal diet is associated with children's height and body fat. Nutrient intake was assessed through a FFQ from 808 pregnant women and summarised to a nutrition index, 'My Nutrition Index' (MNI). The association with children's height and body fat (bioimpedance) was assessed with linear regression models. Secondary analysis was performed with BMI, trunk fat and skinfolds. Overall, higher MNI score was associated with greater height (β = 0·47; (95 % CI 0·00, 0·94), among both sexes. Among boys, higher MNI was associated with 0·15 higher BMI z-scores, 0·12 body fat z-scores, 0·11 trunk fat z-scores, and larger triceps, and triceps + subscapular skinfolds (β = 0·05 and β = 0·06; on the log2 scale) (P-value < 0·05). Among girls, the opposite associations were found with 0·12 lower trunk fat z-scores, and smaller subscapular and suprailiac skinfolds (β = -0·07 and β = -0·10; on the log2 scale) (P-value < 0·05). For skinfold measures, this would represent a ± 1·0 millimetres difference. Unexpectedly, a prenatal diet in line with recommended nutrient intake was associated with higher measures of body fat for boys and opposite to girls at a pre-pubertal stage of development.

Relationships of pregnancy and postpartum diet quality with offspring birth weight and weight status through 12 months

OBJECTIVE

This study examined relationships of maternal pregnancy and postpartum diet quality with infant birth size and weight status indicators through 12 months and tested whether breastfeeding duration modifies these associations.

METHODS

In the Pregnancy Eating Attributes Study (PEAS), dietary intake was assessed six times in 458 mothers who were followed from early pregnancy through 12 months postpartum (2014-2018). Logistic and linear mixed models estimated relationships of pregnancy and postpartum diet quality (Healthy Eating Index [HEI]) with offspring who were large-for-gestational-age (LGA) at birth, as well as BMI z score (BMIz) and weight-for-length z score (WFLz) at birth, 6 weeks, 6 months, and 12 months.

RESULTS

Pregnancy HEI was inversely related to LGA (odds ratio [OR] = 0.95, 95% CI: 0.92 to 0.98); HEI was also inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.002) and BMIz (β = -0.009, 95% CI: -0.02 to -0.0009) from birth through 12 months. Postpartum HEI was inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.0009) and BMIz (β = -0.008, 95% CI: -0.02 to 0.0007) in infants who were breastfed for at least 6 months, but not in those who were breastfed for a shorter duration.

CONCLUSIONS

Maternal diet quality during pregnancy (and during postpartum in mothers who breastfed for a longer duration) was inversely related to LGA and weight status indicators from birth through 12 months. Increasing maternal diet quality may have use for promoting healthy infant weight development.

The Assessment of Neonatal Anthropometric Indices Association with Umbilical Cord Blood Zinc and Magnesium Levels

Background

The present research aims to find the association between neonatal anthropometric parameters and zinc and magnesium concentration in cord blood.

Materials and Methods

The current cross-sectional report is a sub-study from the "PERSIAN Birth Cohort Study" conducted on 112 pairs of mother-neonate referring to the index hospitals for giving birth to their children during 2018-19. Umbilical cord blood was collected at delivery for the measurement of zinc and magnesium. Anthropometric indices were measured in standard protocols. Validated questionnaires were used for maternal diet in different trimesters. Dietary patterns were acquired based on exploratory factor analysis.

Results

The birth weight was reversely correlated with zinc concentration (r = -0.249, P-value = 0.008); however, the other anthropometric parameters did not show any association with zinc levels (P-value > 0.05). Similar evaluations for magnesium revealed no association between any of the anthropometric indices and this micronutrient agent (P-value > 0.05). Further evaluations represented insignificant differences in both zinc (P-value = 0.51) and magnesium levels (P-value = 0.49) between those with normal versus low birth weight. There was a negative association between the Western dietary pattern in the first trimester of pregnancy and cord blood zinc concentration (β (SE) = -0.21 (0.10); P = 0.026); while healthy and traditional dietary patterns in second and third trimesters were positively related to cord zinc concentration (all P < 0.05).

Conclusion

This research did not document a positive statistical association of cord blood zinc and magnesium with birth weight. The association of maternal Western dietary patterns with lower cord blood zinc levels highlights the importance of healthy nutritional habits in pregnancy.

The association of maternal sugary beverage consumption during pregnancy and the early years with childhood sugary beverage consumption

OBJECTIVES

A woman's food choices during pregnancy may be associated with her offspring's food choices. Several studies support an association between childhood sugary beverage (SB) consumption and poor cardiometabolic health. This study aimed to assess the association of maternal SB consumption during pregnancy and later, with her offspring's SB consumption in early infancy and childhood.

METHODS

A total of 1945 women and 1595 children participating in 3 Canadian studies reported SB consumption during pregnancy, at 2 years of age, and/or at school age (5 to 8 years old). Mother and offspring SB intakes were self-reported by mothers. Multivariable linear regression analyses were conducted within each cohort and cohort data were combined using fixed effect meta-analyses.

RESULTS

Maternal SB consumption during pregnancy was associated with higher offspring SB consumption at 2 years of age (standardized β = 0.19 predicted change in the number of standard deviations of offspring SB intake for an increase of 1 standard deviation in maternal serving [95% CI: 0.16 to 0.22]). Concurrent maternal SB consumption was associated with higher offspring SB intake when children were aged 5 to 8 years (standardized β= 0.25 [95% CI: 0.10 to 0.40]).

CONCLUSION

Maternal SB consumption during pregnancy is associated with a marginally higher SB intake among their offspring at age 2, and concurrent maternal consumption is associated with a higher SB intake among school-aged offspring (5 to 8 years old). Future interventions tailored for pregnancy and early childrearing years to reduce SB intakes of mothers may reduce young children's SB intake.

Associations of Maternal Consumption of Sugary Beverages in Pregnancy With Infant Weight Status

OBJECTIVES

To examine associations of maternal consumption of 100% juice and sugar-sweetened beverages (SSBs) in the third trimester of pregnancy with infant weight status at 6 and 12 months.

METHODS

We studied 379 mother-infant dyads from Rise & SHINE, a prospective cohort study. Exposures were maternal consumption of 100% juice and SSBs in the third trimester. Outcome measures were infant weight-for-length (WFL) z-scores at 6 and 12 months and rapid infant weight gain (RIWG; change in weight-for-age z-score ≥0.67) from birth to 6 and 12 months.

RESULTS

Mean (SD) maternal age was 32.8 (5.1) years; 71.7% reported household income ≥$50,000. In the third trimester, nearly daily or daily consumption of 100% juice and SSBs was 25.9% and 16.6%, respectively. Mean (SD) WFL z-scores at 6 and 12 months were 0.35 (0.96) and 0.50 (0.98). RIWG was present in 30.2% and 36.6% of infants from birth to 6 months and birth to 12 months, respectively. In multivariable models, 100% juice consumption was associated with higher WFL z-score at 6 months (β = 0.26; 95% confidence interval [CI]: 0.03, 0.49) and higher odds of RIWG from birth to 6 months (adjusted odds ratio [aOR] = 2.09; 95%CI: 1.23, 3.56) and birth to 12 months (aOR = 1.85; 95%CI: 1.04, 3.28). 100% juice consumption was not associated with WFL z-score at 12 months and SSB consumption was not associated with any of the outcomes.

CONCLUSIONS

Consumption of 100% juice, but not SSBs, in the third trimester of pregnancy is associated with infant weight status at 6 months and RIWG.

Association of Maternal Diet during Pregnancy and Metabolite Profile in Cord Blood

Cord blood metabolites can be predictive of long-term disease risk, but how levels of different metabolites might vary with respect to maternal diet is not well understood. The aim of this study was to evaluate the associations of different dietary patterns during pregnancy with cord blood metabolites (including glycerophospholipid fatty acids, polar lipids, non-esterified fatty acids, amino acids, and the sum of hexoses). Participants from the German LISA birth cohort study, with available data on targeted cord blood metabolomics and maternal diet, were included (n = 739). Maternal diet during the last 4 weeks of pregnancy was assessed by a non-quantitative food-frequency questionnaire. Using factor analysis, ten dietary patterns were identified, which were used in linear regression models exploring associations with cord blood metabolites. After correction for multiple hypothesis testing and adjustment for basic covariates, “fish and shellfish” was associated with higher glycerophospholipid fatty acid C20:5 n3 and lower C22:5 n6, whereas the “meat and potato” pattern was directly associated with propionylcarnitine (C3:0). The observed associations highlight potential metabolic pathways involved in the early programming of health and disease through maternal diet, as well as the potential for establishing quantitative biomarkers for dietary patterns of pregnant women.

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.

Longitudinal dietary trajectories from preconception to mid-childhood in women and children in the Southampton Women's Survey and their relation to offspring adiposity: a group-based trajectory modelling approach

BACKGROUND

Rates of childhood obesity are increasing globally, with poor dietary quality an important contributory factor. Evaluation of longitudinal diet quality across early life could identify timepoints and subgroups for nutritional interventions as part of effective public health strategies.

OBJECTIVE

This research aimed to: (1) define latent classes of mother-offspring diet quality trajectories from pre-pregnancy to child age 8-9 years, (2) identify early life factors associated with these trajectories, and (3) describe the association between the trajectories and childhood adiposity outcomes.

DESIGN

Dietary data from 2963 UK Southampton Women's Survey mother-offspring dyads were analysed using group-based trajectory modelling of a diet quality index (DQI). Maternal diet was assessed pre-pregnancy and at 11- and 34-weeks' gestation, and offspring diet at ages 6 and 12 months, 3, 6-7- and 8-9-years using interviewer-administered food frequency questionnaires. At each timepoint, a standardised DQI was derived using principal component analysis. Adiposity age 8-9 years was assessed using dual-energy X-ray absorptiometry (DXA) and BMI z-scores.

RESULTS

A five-trajectory group model was identified as optimal. The diet quality trajectories were characterised as stable, horizontal lines and were categorised as poor (n = 142), poor-medium (n = 667), medium (n = 1146), medium-better (n = 818) and best (n = 163). A poorer dietary trajectory was associated with higher maternal pre-pregnancy BMI, smoking, multiparity, lower maternal age and lower educational attainment. Using linear regression adjusted for confounders, a 1-category decrease in the dietary trajectory was associated with higher DXA percentage body fat (0.08 SD (95% confidence interval 0.01, 0.15) and BMI z-score (0.08 SD (0.00, 0.16) in the 1216 children followed up at age 8-9 years.

CONCLUSION

Mother-offspring dietary trajectories are stable across early life, with poorer diet quality associated with maternal socio-demographic and other factors and childhood adiposity. The preconception period may be an important window to promote positive maternal dietary changes in order to improve childhood outcomes.

Influence of antibiotics given during labour and birth on body mass index z scores in children in the All Our Families pregnancy cohort

BACKGROUND/OBJECTIVES

Little is known about obesity risk associated with intrapartum antibiotic prophylaxis (IAP). Our objective was to determine if maternal antibiotic exposure during birth is associated with child body mass index (BMI) z scores in the first 3 years of life.

METHODS

In 2008 to 2010, 3388 pregnant women were recruited to the All Our Families study. Here, we included women with available data from obstetrical records on antibiotic use during birth (n = 1303) and children with at least one valid BMI z score (final sample n = 1262). The primary outcome was infant BMI z score at 1, 2 and 3 years of age.

RESULTS

IAP occurred in 432 of 1262 women. Children exposed to IAP had significantly higher mean [standard error (SE)] BMI z scores (1.071 [0.087] unit) at 1 year of age compared to non-exposed infants (0.744 [0.064] unit). Although the association was no longer significant after adjustment for confounding factors in the growth trajectory model, IAP resulted in a 0.255 unit increase in BMI z score at 1 year of age. Differences in BMI z score between exposed and non-exposed at baseline (year 1) only remained significant in sensitivity analysis.

CONCLUSION

The potential association between maternal IAP and increased infant BMI z score at 1 year of age should be confirmed in other cohorts and warrants investigation of interventions to mitigate this possible risk.

Racial Disparities in Obesity Treatment Among Children and Adolescents

PURPOSE OF REVIEW

With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation.

RECENT FINDINGS

Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.

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.

Associations of prenatal metabolomics profiles with early childhood growth trajectories and obesity risk in African Americans: the CANDLE study

OBJECTIVE

Prenatal metabolomics profiles, providing measures of in utero nutritional and environmental exposures, may improve the prediction of childhood outcomes. We aimed to identify prenatal plasma metabolites associated with early childhood body mass index (BMI) trajectories and overweight/obesity risk in offspring.

METHODS

This study included 450 African American mother-child pairs from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood Study. An untargeted metabolomics analysis was performed on the mothers' plasma samples collected during the second trimester. The children's BMI-z-score trajectories from birth to age 4 [rising-high- (9.8%), moderate- (68.2%), and low-BMI (22.0%)] and overweight/obesity status at age 4 were the main outcomes. The least absolute shrinkage and selection operator (LASSO) was used to select the prenatal metabolites associated with childhood outcomes.

RESULTS

The mothers were 24.5 years old on average at recruitment, 76.4% having education less than 12 years and 80.0% with Medicaid or Medicare. In LASSO, seven and five prenatal metabolites were associated with the BMI-z-score trajectories and overweight/obese at age 4, respectively. These metabolites are mainly from/relevant to the pathways of steroid biosynthesis, amino acid metabolism, vitamin B complex, and xenobiotics metabolism (e.g., caffeine and nicotine). The odds ratios (95% CI) associated with a one SD increase in the prenatal metabolite risk scores (MRSs) constructed from the LASSO-selected metabolites were 2.97 (1.95-4.54) and 2.03 (1.54-2.67) for children being in the rising-high-BMI trajectory group and overweight/obesity at age 4, respectively. The MRSs significantly improved the risk prediction for childhood outcomes beyond traditional prenatal risk factors. The increase (95% CI) in the area under the receiver operating characteristic curves were 0.10 (0.03-0.18) and 0.07 (0.02-0.12) for the rising-high-BMI trajectory (P = 0.005) and overweight/obesity at age 4 (P = 0.007), respectively.

CONCLUSIONS

Prenatal metabolomics profiles advanced prediction of early childhood growth trajectories and obesity risk in offspring.

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 Maternal Dietary Patterns during Pregnancy and Offspring Weight Status across Infancy: Results from a Prospective Birth Cohort in China

Literature on maternal dietary patterns during pregnancy and offspring weight status have been largely equivocal. We aimed to investigate the association of maternal dietary patterns with infant weight status among 937 mother–infant dyads in a Chinese birth cohort. We assessed maternal diet during pregnancy using food frequency questionnaires (FFQ) and three-day food diaries (TFD) and examined infants’ body weight and length at birth, 1, 3, 6, 8 and 12 months. Maternal adherence to the “protein-rich pattern (FFQ)” was associated with lower infant body mass index z-scores (BMIZ) at birth, 3 and 6 months and lower odds of overweight and obesity (OwOb) across infancy (quartile 3 (Q3) vs. quartile 1 (Q1): odds ratio (OR): 0.50, (95% confidence interval: 0.27, 0.93)). Maternal adherence to the “vegetable–fruit–rice pattern (FFQ)” was associated with higher BMIZ at birth, 3 and 6 months and higher odds of OwOb across infancy (Q3 vs. Q1: OR: 1.79, (1.03, 3.12)). Maternal adherence to the “fried food–bean–dairy pattern (TFD)” was associated with lower BMIZ at 3, 6, 8 and 12 months and lower odds of OwOb (Q3 vs. Q1: OR: 0.54, (0.31, 0.95)). The study results may help to develop interventions and to better define target populations for childhood obesity prevention.

Fish consumption during pregnancy and risk of allergic diseases in the offspring: A systematic review and meta-analysis

Although several studies have reported the beneficial effects of maternal fish consumption on allergy diseases in the offspring, the findings are conflicting. We summarized earlier data on the association between maternal fish intake and risk of allergy diseases in the offspring through a meta-analysis. A systematic literature search of relevant reports published in Medline/PubMed, ISI web of Science, EMBASE, SCOPUS and Google Scholar prior to February 2020 was conducted. All observational studies (cross-sectional, case-control or cohort) that examined the relationship between intake of maternal fish and risk of allergy diseases in the offspring were considered. Duplicate and non-related studies were excluded. In total, 31 studies on maternal fish consumption and risk of allergic diseases in the offspring were included. Greater maternal fish intake was associated with a reduced risk of wheeze (Pooled effect size: 0.97; 95% CI: 0.96-0.99) and food allergy (0.75; 95% CI: 0.64-0.88). Maternal fish consumption was not associated with risk of asthma (pooled effect size: 0.99; 95% CI: 0.89, 1.11), eczema (pooled effect size: 0.93; 95% CI: 0.84, 1.03), allergic rhinitis (pooled effect size: 0.91; 95% CI: 0.75, 1.09), and inhalant allergy (pooled effect size: 0.86; 95% CI: 0.66, 1.13). In non-linear dose-response meta-analysis, increased intake of fish during pregnancy (at the level of 50 to 200 grams per week) was associated with a reduced risk of eczema (P non-linearity = 0.042). Meta-regression of included studies revealed an inverse linear association between maternal fish intake and risk of eczema; such that every additional 30-gram per week consumption of fish during pregnancy was associated with a 4% reduced risk of eczema. We found that fish intake during pregnancy was associated with a lower risk of wheeze, eczema and food allergy in children. No significant association was seen between maternal fish consumption and risk of offspring's asthma, allergic rhinitis, and inhalant allergy.

Maternal Vegetable and Fruit Consumption during Pregnancy and Its Effects on Infant Gut Microbiome

Maternal nutrition intake during pregnancy may affect the mother-to-child transmission of bacteria, resulting in gut microflora changes in the offspring, with long-term health consequences in later life. Longitudinal human studies are lacking, as only a small amount of studies showing the effect of nutrition intake during pregnancy on the gut microbiome of infants have been performed, and these studies have been mainly conducted on animals. This pilot study explores the effects of high or low fruit and vegetable gestational intake on the infant microbiome. We enrolled pregnant women with a complete 3-day dietary record and received postpartum follow-up. The 16S rRNA gene sequence was used to characterize the infant gut microbiome at 2 months (n = 39). Principal coordinate analysis ordination revealed that the infant gut microbiome clustered differently for high and low maternal fruit and vegetable consumption (p < 0.001). The linear discriminant analysis effect size and feature selection identified 6 and 17 taxa from both the high and low fruit and vegetable consumption groups. Among the 23 abundant taxa, we observed that six maternal intake nutrients were associated with nine taxa (e.g., Erysipelatoclostridium, Isobaculum, Lachnospiraceae, Betaproteobacteria, Burkholderiaceae, Sutterella, Clostridia, Clostridiales, and Lachnoclostridium). The amount of gestational fruit and vegetable consumption is associated with distinct changes in the infant gut microbiome at 2 months of age. Therefore, strategies involving increased fruit and vegetable consumption during pregnancy should be employed for modifying the gut microbiome early in life.

Pre-Pregnancy Diet Quality Is Associated with Lowering the Risk of Offspring Obesity and Underweight: Finding from a Prospective Cohort Study

Maternal diet plays a critical role in epigenetic changes and the establishment of the gut microbiome in the fetus, which has been associated with weight outcomes in offspring. This study examined the association between maternal diet quality before pregnancy and childhood body mass index (BMI) in offspring. There were 1936 mothers with 3391 children included from the Australian Longitudinal Study on Women’s Health (ALSWH) and the Mothers and their Children’s Health (MatCH) study. Maternal dietary intakes were assessed using a semi-quantitative and validated 101-item food-frequency questionnaire (FFQ). The healthy eating index (HEI-2015) score was used to explore preconception diet quality. Childhood BMI was categorized as underweight, normal, overweight, and obese based on sex and age-specific BMI classifications for children. Multinomial logistic regression with cluster-robust standard errors was used for analyses. Greater adherence to maternal diet quality before pregnancy was associated with a lower risk of offspring being underweight after adjustment for potential confounders, highest vs. lowest quartile (relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.49, 0.96). Higher adherence to preconception diet quality was also inversely linked with the risk of childhood obesity (RRR = 0.49, 95% CI: 0.24, 0.98). This association was, however, no longer significant after adjusting for pre-pregnancy BMI. Sodium intake was significantly associated with decreased risk of childhood overweight and obesity (RRR = 0.18, 95% CI: 0.14, 0.23) and (RRR = 0.21, 95% CI: 0.17, 0.26), respectively. No significant association was detected between preconception diet quality and offspring being overweight. This study suggests that better adherence to maternal diet quality before pregnancy is associated with a reduced risk of childhood underweight and obesity.

Maternal diet in pregnancy is associated with differences in child body mass index trajectories from birth to adolescence

BACKGROUND

Nutrition in pregnancy and accelerated childhood growth are important predictors of obesity risk. Yet, it is unknown which dietary patterns in pregnancy are associated with accelerated growth and whether there are specific periods from birth to adolescence that are most sensitive to these associations.

OBJECTIVES

To examine the extent to which 3 dietary indices in pregnancy [Dietary Inflammatory Index (DII), Alternate Healthy Eating Index for Pregnancy (AHEI-P), and Mediterranean Diet Score (MDS)] are associated with child BMI z-score (BMI-z) trajectories from birth to adolescence.

METHODS

We examined 1459 mother-child dyads from Project Viva that had FFQ data in pregnancy and ≥3 child BMI-z measurements between birth and adolescence. We used linear spline mixed-effects models to examine whether BMI-z growth rates and BMI z-scores differed by quartile of each dietary index from birth to 1 mo, 1-6 mo, 6 mo to 3 y, 3-10 y, and >10 y.

RESULTS

The means ± SDs for DII (range, -9 to +8 units), AHEI-P (range, 0-90 points), and MDS (range, 0-9 points) were -2.6 ± 1.4 units, 61 ± 10 points, and 4.6 ± 2.0 points, respectively. In adjusted models, children of women in the highest (vs. lowest) DII quartile had higher BMI-z growth rates between 3-10 y (β, 0.03 SD units/y; 95% CI: 0.00-0.06) and higher BMI z-scores from 7 y through 10 y. Children of women with low adherence to a Mediterranean diet had higher BMI z-scores from 3 y through 15 y. Associations of AHEI-P with growth rates and BMI z-scores from birth through adolescence were null.

CONCLUSIONS

A higher DII and a lower MDS in pregnancy, but not AHEI-P results, are associated with higher BMI-z trajectories during distinct growth periods from birth through adolescence. Identifying the specific dietary patterns in pregnancy associated with rapid weight gain in children could inform strategies to reduce child obesity.

Influence of ultra-processed foods consumption during pregnancy on baby's anthropometric measurements, from birth to the first year of life: a systematic review

Abstract Objectives: to perform a systematic review of studies that investigated the influence of ultra-processed foods (UPF) consumption during pregnancy on child’s anthropometric parameters up to one year of life. Methods: cohort and cross-sectional studies were researched in BVS, Cinahl, Cochrane, Embase, Pubmed, Scopus and Web of Science databases until March 2020, and the main descriptors were: “Pregnant Women”, “Ultra-processed foods”, “Birth Weight”, “Smallfor Gestational Age”, “Infant”, “Newborn”. Results: seventeen articles were considered eligible and evaluated the associations between the exposures: ultra-processed dietary patterns; soft drinks, sugar-sweetened beverages, artificially sweetened beverages; fast food, junk food, sweets, snacks and the outcomes: birth weight and its classifications; length and head circumference at birth; birth weight adjustments according to gestational age; weight/age, length/age, body mass index/age and weight/length indices. The results showed: 36 non-significant associations between the exposures and the outcomes; 13 direct associations (outcomes versus ultraprocessed dietary patterns, soft drinks, artificially sweetened beverages, sweets, junk food) and 5 inverse associations (outcomes versus ultra-processed dietary patterns, soft drinks). Conclusions: most of the evaluated literature did not demonstrate the influence of UPF consumption during pregnancy on the newborn’s anthropometric measurements up to one year of life and denoted a smaller number of direct and inverse associations between the exposures and the outcomes.

Impact of the factors shaping gut microbiota on obesity

Obesity is considered as a risk factor for chronic health diseases such as heart diseases, cancer and diabetes 2. Reduced physical activities, lifestyle, poor nutritional diet and genetics are among the risk factors associated with the development of obesity. In recent years, several studies have explored the link between the gut microbiome and the progression of diseases including obesity, with the shift in microbiome abundance and composition being the main focus. The alteration of gut microbiome composition affects both nutrients metabolism and specific gene expressions, thereby disturbing body physiology. Specifically, the abundance of fibre-metabolizing microbes is associated with weight loss and that of protein and fat-metabolizing bacteria with weight gain. Various internal and external factors such as genetics, maternal obesity, mode of delivery, breastfeeding, nutrition, antibiotic use and the chemical compounds present in the environment are known to interfere with the richness of the gut microbiota (GM), thus influencing weight gain/loss and ultimately the development of obesity. However, the effectiveness of each factor in potentiating the shift in microbes' abundance to result in significant changes that can lead to obesity is not yet clear. In this review, we will highlight the factors involved in shaping GM, their influence on obesity and possible interventions. Understanding the influence of these factors on the diversity of the GM and how to improve their effectiveness on disease conditions could be keys in the treatment of metabolic diseases.

Diet during Pregnancy and Gestational Weight Gain in a Michigan Pregnancy Cohort

BACKGROUND

Gestational weight gain (GWG) has important health implications for both the mother and offspring. Maternal diet during pregnancy may play an important role in achieving adequate GWG, although its precise role is unclear.

OBJECTIVES

Associations between maternal dietary components (fruits and vegetables, added sugar, percentage energy from fat, dairy) and GWG were examined in 327 pregnant women from the Archive for Research on Child Health cohort.

METHODS

Self-reported usual dietary intake was assessed with validated dietary screening tools at the first prenatal visit. GWG was obtained from the birth certificate and was categorized as inadequate, adequate, or excessive according to the Institute of Medicine recommendations. Associations between dietary components and GWG were assessed using multivariable regression models, stratified by maternal prepregnancy BMI category.

RESULTS

Only 31.5% of women had adequate GWG, with 24.8% gaining insufficient weight and 43.7% gaining excessively. Women who consumed more fruits and vegetables were suggestively less likely to have excessive GWG (OR: 0.86; 95% CI: 0.75, 1.00) in the minimally adjusted model, but the association became nonsignificant after adjusting for covariates (OR: 0.89; 95% CI: 0.77, 1.03). In stratified models, higher fruit and vegetable intake was linked to lower likelihood of excessive GWG among women with obesity (OR: 0.77; 95% CI: 0.60, 0.97), whereas higher added sugar intake was linked to a slight reduction in likelihood of excessive GWG (OR: 0.91; 95% CI: 0.84, 0.99) among women with a prepregnancy BMI in the normal range. Other dietary components were not significantly associated with GWG.

CONCLUSIONS

These results suggest that consuming fruits and vegetables during pregnancy may reduce risk of excessive GWG among women with obesity. With the rising prevalence of obesity among women of reproductive age, interventions to increase fruit and vegetable intake during pregnancy may have broad public health impact by improving maternal and child health outcomes.

Prenatal dietary exposures and offspring body size from 6 months to 18 years: A systematic review

BACKGROUND

In utero dietary exposures may influence childhood obesity.

OBJECTIVES

To evaluate the relationship between prenatal dietary exposures and offspring body size from 6 months to 18 years.

DATA SOURCES

Articles were identified in PubMed and Web of Science (January 2010-March 2018) using the PRISMA guidelines. Additional studies were identified through a reference review of articles that met the inclusion criteria and related reviews.

STUDY SELECTION

Prospective cohort studies that assessed dietary patterns, foods, macronutrients, or beverages during healthy pregnancy and offspring body size. The extraction of articles was done using predefined data fields.

SYNTHESIS

One author extracted all information and evaluated bias with the NHLBI's Quality Assessment Tool.

RESULTS

A total of 851 research articles were evaluated. Twenty-one studies assessing dietary patterns, macronutrients, foods, and beverages met inclusion criteria. Consumption of a Mediterranean dietary pattern during pregnancy was associated with reduced body size, while refined carbohydrates were associated with offspring obesity. No association was observed between data-driven dietary patterns and offspring body size, as well as a pro-inflammatory diet pattern and offspring body size. Mixed and null findings were observed for the relationship between total carbohydrates, n-3 polyunsaturated fatty acids, protein, sugar-sweetened beverages, and artificially sweetened beverages and offspring body size.

CONCLUSIONS

Adhering to a Mediterranean diet and limiting refined carbohydrates during pregnancy may influence offspring body size between 6 months and 18 years. The diverging results that exist between studies highlight the complexity of this topic.

Effects of Maternal Dietary Patterns during Pregnancy on Early Childhood Growth Trajectories and Obesity Risk: The CANDLE Study

We investigated the associations between maternal dietary patterns during pregnancy and early childhood growth trajectories and overweight/obesity risk in offspring. Maternal diet was assessed using a food frequency questionnaire during the second trimester, and dietary patterns were derived by reduced rank regression. The associations between maternal dietary pattern scores and body mass index (BMI) trajectories from birth to age four (rising-high, moderate, and low BMI trajectories) as well as overweight/obesity risk at age four were analyzed (n = 1257). Two maternal dietary patterns were identified. The fast food pattern included a higher intake of fried chicken and fish, fruit juices, mayonnaise, and sugar-sweetened beverages, while the processed food pattern included a higher intake of dairy, salad dressing, processed meat, and cold breakfast cereal. Women with greater adherence to the fast food pattern were more likely to have children in the rising-high BMI trajectory group [OR (95% CI) = 1.32 (1.07-1.62); p = 0.008] or having overweight/obesity at age four [OR (95% CI) = 1.31 (1.11-1.54); p = 0.001]. The processed food pattern was not associated with these outcomes. The maternal dietary pattern during pregnancy represented by fried foods and sugar-sweetened beverages may contribute to rapid early childhood growth and increased risk for obesity in offspring.

Resting Energy Expenditure Relationship with Macronutrients and Gestational Weight Gain: A Pilot Study

Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG) or maternal diet. The objective of this study was to examine the impact of metabolic tracking on GWG and the association with maternal macronutrients. Pregnant women aged 29.8 ± 4.9 years (78.6% non-Hispanic, White) with gestational age (GA) < 17 week were randomized to Breezing™ (n = 16) or control (n = 12) groups for 13 weeks. REE by Breezing™ indirect calorimetry, anthropometrics and dietary intake were collected every two weeks. Early (14–21 weeks), late (21–28 weeks), and overall (14–28 weeks) changes in macronutrients and GWG were calculated. The Breezing™ group had a significantly greater rate of GWG [F (1,23) = 6.8, p = 0.02] in the latter half of the second trimester. Late (−155.3 ± 309.2 vs. 207.1 ± 416.5 kcal, p = 0.01) and overall (−143.8 ± 339.2 vs. 191.8 ± 422.2 kcal, p = 0.03) changes in energy consumption were significantly different between Breezing™ and control groups, respectively. Early changes in REE were positively correlated with overall changes in carbohydrates (r = 0.58, p = 0.02). Regular metabolism tracking alone did not have an impact on GWG. Early shifts in REE might impact GWG later in pregnancy. Investigation in a larger population from preconception through postpartum is needed.

Predictors of Developmental Patterns of Obesity in Young Children

Introduction: The current study characterizes longitudinal patterns in obesity in young children and their prediction from developmental programming and social determinant hypotheses. Materials and Methods: The data are based on the Family Life Project, a prospective longitudinal study of 1,292 families recruited from low-income, racially diverse, rural communities in Pennsylvania, and North Carolina. Pre-natal, peri-natal, and post-natal risks for childhood obesity were collected from 2 months of age; in-person assessments of child growth were used to identity obesity on multiple occasions from 24 to 90 months of age. Results: Two major novel findings emerged. First, longitudinal analyses identified four distinct obesity development profiles: stable obesity, later-onset obesity, moderate/declining obesity, and non-obese; these groups had distinct risk profiles. Second, prediction analyses favored developmental programming explanations for obesity, including evidence even in early childhood that both low- and high birth weight was associated with stable obesity. There was no indication that pre- and peri-natal and post-natal factors predicted obesity differently in non-minority and minority children. Discussion: Factors derived from the developmental programming model of obesity overlapped with, but predicted early onset obesity independently from, risks associated with social determinant models of obesity.

Effects of social exclusion and maternal rejection on Children's high-caloric food consumption

Research has shown that the quality of interpersonal relationships plays an important role in influencing childhood obesity-risk behavior. However, studies conducted so far have focused mostly on self-report data. But they rarely control for the effect of experimentally-induced social rejection or perceived maternal rejection. The aim of this study was to investigate the effects of the quality of the maternal relationships as well as experimentally-induced social rejection on children's motivation to consume high-caloric food. Eighty children (8-12 years of age) and their mothers participated in an experimental study. Participants were randomly assigned to a social inclusion (acceptance) or exclusion (rejection) condition in a computer-based ball-toss game (Cyberball). After completing the Cyberball game, children were presented with high-caloric food and were evaluated on the amount of the food they consumed. Participants also completed a self-report questionnaire assessing their perceptions of their mothers' acceptance-rejection. Further, mothers' Body Mass Index (BMI) was measured, and a semi-structured interview was conducted to assess the tendency of mothers to regulate their child's stress with food. Results showed that the consumption of high-caloric food was directly influenced by the children's perceptions of maternal acceptance-rejection, and by the experience of brief, experimentally-induced social exclusion (rejection). Additionally, children's consumption of high-caloric food was related to their mothers' use of food to help regulate children's distress, and by the children's own BMI. The results document the importance of affective-relational experiences in the development of childhood obesity. The results also highlight the apparent fact that regardless of individual and family characteristics, the experience of even short-term social rejection can activate obesity-risk behaviors which deplete children's self-regulatory mechanisms, thereby resulting in more consumption of high-caloric food.

Gestational weight gain trajectories over pregnancy and their association with maternal diet quality: Results from the PRINCESA cohort

OBJECTIVE

The aims of this study were to characterize, among pregnant Mexican women, gestational weight gain (GWG) trajectories; assess associations of maternal dietary quality score (MDQS) with GWG during early-mid pregnancy, middle pregnancy, late pregnancy, and prolonged pregnancy; and evaluate the association between MDQS and adequacy of GWG, throughout pregnancy. We hypothesized that higher MDQS adherence is protective against insufficient or excessive GWG across pregnancy and that the association between MDQS adherence and GWG would vary by prepregnancy body mass index (BMI) category.

METHODS

We analyzed data from 660 pregnant women participating in the PRINCESA (Pregnancy Research on Inflammation, Nutrition and City Environments: Systematic Analyses) cohort in Mexico City, 2009 to 2014. Repeated measures of dietary intake and mother's weight were obtained during pregnancy. Individual GWG trajectories were modeled in a multilevel regression framework. Associations between MDQS (low, medium, and high adherence) and GWG were investigated using mixed-effect regression models with linear splines.

RESULTS

Women with prepregnancy BMI of ≥30 kg/m2 had a slower rate of GWG (RGWG) compared with other categories. A higher adherence to MDQS was protective against an insufficient (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.42-0.95; P = 0.03) and an excessive RGWG (OR, 0.62; 95% CI, 0.41-0.94; P = 0.03) throughout pregnancy, adjusting for prepregnancy BMI, energy intake, maternal age, educational level, parity, fetal sex, marital status, and physical activity. Associations between diet and RGWG differed by gestational period.

CONCLUSION

A better quality diet, as measured by MDQS, was associated with appropriate GWG during pregnancy in the PRINCESA cohort.

Effects of consuming date fruits (Phoenix dactylifera Linn) on gestation, labor, and delivery: An updated systematic review and meta-analysis of clinical trials

BACKGROUND

Recent studies have shown that consumption of date fruits during pregnancy and also postpartum period might affect some pregnancy outcomes. We performed an updated systematic review and meta-analysis about the effects of consuming date fruits on gestation, labor, and delivery.

METHODS

Two researchers independently searched the online databases of PubMed, Scopus, Web of Science, Embase, Google Scholar, and EBSCO up to January 2019 for clinical trials examining the effects of date fruits consumption on any types of gestation, labor, and delivery outcomes. A fixed-effects model or random-effects models were applied to pool data, where appropriate. Quality assessment was done by Jadad scale.

RESULTS

In total, 11 and 8 studies were included in the systematic review and meta-analysis. Meta-analysis revealed that date fruit consumption significantly reduced gestation duration (pooled effect size: -0.30, 95% CI: -0.45, -0.15; P < 0.001), increased cervical dilation on admission (pooled effect size: 0.94, 95% CI: 0.88, 1.00; P < 0.001), and shorten duration of first stage of labor (pooled effect size: -50.09, 95% CI: -72.25, -27.93; P < 0.001). Also, it was revealed that date fruit consumption significantly reduced duration of second stage of labor in fixed-effects model (pooled effect size: -9.85, 95% CI: -14.00, -5.70; P < 0.001); however, this effect was not significant in random-effects analysis (pooled effect size: -11.27, 95% CI: -28.23, -5.68; P = 0.193).

CONCLUSIONS

Date fruits intake seems to reduce gestation duration and duration of the first stage of labor, and also increase cervical dilation on admission.

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.

Maternal lipid levels during pregnancy and child weight status at 3 years of age

BACKGROUND

The intrauterine environment is critical in the development of child obesity.

OBJECTIVE

To investigate the association between maternal lipid levels during pregnancy and child weight status.

METHODS

Maternal lipid levels (total cholesterol, high-density and low-density lipoprotein cholesterol, triglycerides) collected from fasting blood samples collected at less than 20 and 24-29 weeks' gestation and child weight status at age 3 were examined prospectively among 183 mother-child dyads enrolled in the Pregnancy, Infection, and Nutrition. Measured height and weight at 3 years were used to calculate age- and sex-specific body mass index z-scores. Child risk of overweight/obesity was defined as body mass index greater than or equal to 85th percentile for age and sex. Regression models estimated the association between maternal lipid levels and child body mass index z-score and risk of being affected by overweight/obesity, respectively.

RESULTS

Higher triglyceride levels at less than 20 and 24-29 weeks of pregnancy were associated with higher body mass index z-scores (β = 0.23; 95% CI: 0.07-0.38 and β = 0.15; 95% CI: 0.01-0.29; respectively) after adjusting for confounders. There was no evidence of an association between total or low-density lipoprotein cholesterol and child weight status at age 3.

CONCLUSIONS

Early childhood body mass index may be influenced by maternal triglyceride levels during pregnancy.

The effect of Ramadan fasting during pregnancy on perinatal outcomes: a systematic review and meta-analysis

Background

Although exempt, many pregnant Muslim women partake in the daily fast during daylight hours during the month of Ramadan. In other contexts an impoverished diet during pregnancy impacts on birth weight. The aim of this systematic review was to determine whether Ramadan fasting by pregnant women affects perinatal outcomes. Primary outcomes investigated were perinatal mortality, preterm birth and small for gestational age (SGA) infants. Secondary outcomes investigated were stillbirth, neonatal death, maternal death, hypertensive disorders of pregnancy, gestational diabetes, congenital abnormalities, serious neonatal morbidity, birth weight, preterm birth and placental weight.

Methods

Systematic review and meta-analysis of observational studies and randomised controlled trials was conducted in EMBASE, MEDLINE, CINAHL, Web of Science, Google Scholar, the Health Management Information Consortium and Applied Social Sciences Index and Abstracts. Studies from any year were eligible. Studies reporting predefined perinatal outcomes in pregnancies exposed to Ramadan fasting were included. Cohort studies with no comparator group or that considered fasting outside pregnancy were excluded, as were studies assuming fasting practice based solely upon family name. Quality of included studies was assessed using the ROBINS-I tool for assessing risk of bias in non-randomised studies. Analyses were performed in STATA.

Results

From 375 records, 22 studies of 31,374 pregnancies were included, of which 18,920 pregnancies were exposed to Ramadan fasting. Birth weight was reported in 21 studies and was not affected by maternal fasting (standardised mean difference [SMD] 0.03, 95% CI 0.00 to 0.05). Placental weight was significantly lower in fasting mothers (SMD -0.94, 95% CI -0.97 to  -0.90), although this observation was dominated by a single large study. No data were presented for perinatal mortality. Ramadan fasting had no effect on preterm delivery (odds ratio 0.99, 95% CI 0.72 to 1.37) based on 5600 pregnancies (1193 exposed to Ramadan fasting).

Conclusions

Ramadan fasting does not adversely affect birth weight although there is insufficient evidence regarding potential effects on other perinatal outcomes. Further studies are needed to accurately determine whether Ramadan fasting is associated with adverse maternal or neonatal outcome.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2048-y) contains supplementary material, which is available to authorized users.

Developmental Origins of Disease: Emerging Prenatal Risk Factors and Future Disease Risk

Purpose of review

Many of the diseases and dysfunctions described in the paradigm of the developmental origins of health and disease have been studied in relation to prenatal nutrition or environmental toxicant exposures. Here, we selectively review the current research on four exposures-two nutritional and two environmental-that have recently emerged as prenatal risk factors for long-term health outcomes.

Recent findings

Recent studies have provided strong evidence that prenatal exposure to (1) excessive intake of sugar-sweetened beverages, (2) unhealthy dietary patterns, (3) perfluoroalkyl substances, and (4) fine particulate matter, may increase risk of adverse health outcomes, such as obesity, cardiometabolic dysfunction, and allergy/asthma.

Summary

Emerging prenatal nutritional factors and environmental toxicants influence offspring long-term health. More work is needed to identify the role of paternal exposures and maternal exposures during the preconception period and to further elucidate causality through intervention studies. The ubiquity of these emerging nutritional and environmental exposures makes this area of inquiry of considerable public health importance.

Omega-6/omega-3 fatty acid intake of children and older adults in the U.S.: dietary intake in comparison to current dietary recommendations and the Healthy Eating Index

BACKGROUND

Omega-6 and omega-3 fatty acids (FAs) and their ratio have been shown to affect cognitive function in children and older adults. With these analyses, we aimed to describe omega-6 and omega-3 FA intake among children and older adults in light of FA intake recommendations and with consideration of overall diet.

METHODS

Data were merged from two cross-sectional studies with 219 children 7 to 12 years old and one longitudinal study with 133 adults 65 to 79 years old. Demographic data, anthropometric data, and Healthy Eating Index scores were used to study relations among the omega-6 to omega-3 FA ratio and age, education, body mass index, and diet quality. FA intake, demographic, and anthropometric data were examined using partial correlations, t-tests, and analysis of variance.

RESULTS

Most children and adults consumed at least the recommended amount of alpha-linolenic acid (LNA; omega-3) for their age and gender without consuming high amounts of linoleic acid (LA; omega-6), but did not consume sufficient eicosapentaenoic acid (EPA; omega-) and docosahexaenoic acid (DHA; omega-3). The average omega-6 to omega-3 ratios in both groups were lower than previously reported. Eating lower ratios was associated with healthier diets and consuming adequate amounts of several other nutrients. No demographic or anthropometric variables were related to FA intake in children. Adults with a college degree had significantly lower ratios than those without a college degree.

CONCLUSIONS

American children and older adults are able to consume more balanced omega-6 to omega-3 ratios than has been indicated by commodity data. However, very few American children met even the lowest recommendations for EPA and DHA intake. Research is needed to clarify recommendations for the optimal ratio across development, which may aid in increasing EPA and DHA intake and improving health outcomes in the United States.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02199808 13 July 2014, NCT01823419 (retrospectively registered) 20 March 2013, and NCT01515098 18 January 2012.

Lifestyle of women before pregnancy and the risk of offspring obesity during childhood through early adulthood

BACKGROUND

In women, adhering to an overall healthy lifestyle is associated with a dramatically reduced risk of cardio-metabolic disorders. Whether such a healthy lifestyle exerts an intergenerational effects on child health deserves examination.

METHODS

We included 5701 children (9-14 years old at baseline) of the Growing Up Today Study 2, and their mothers, who are participants in the Nurses' Health Study II. Pre-pregnancy healthy lifestyle was defined as a normal body mass index, no smoking, physical activity ≥150 min/week, and diet in the top 40% of the Alternative Healthy Eating Index-2010. Obesity during childhood and adolescence was defined using the International Obesity Task Force age- and sex-specific cutoffs. Multivariable log-binominal regression models with generalized estimating equations were used to evaluate the association of pre-pregnancy healthy lifestyle and offspring obesity.

RESULTS

We identified 520 (9.1%) offspring who became obese during follow-up. A healthy body weight of mothers and no smoking before pregnancy was significantly associated with a lower risk of obesity among offspring: the relative risks [RRs; 95% confidence intervals (CIs)] were 0.37 (0.31-0.43) and 0.64 (0.49-0.84), respectively. Eating a healthy diet and regular moderate-to-vigorous physical activities were inversely related to offspring obesity risk, but these relations were not statistically significant. Compared to children of mothers who did not meet any low-risk lifestyle factors, offspring of women who adhered to all four healthy lifestyle factors had 75% lower risk of obesity (RR: 0.25, 95% CI: 0.14-0.43).

CONCLUSION

Adherence to an overall healthy lifestyle before pregnancy is strongly associated with a low risk of offspring obesity in childhood, adolescence, and early adulthood. These findings highlight the importance of an overall healthy lifestyle before pregnancy as a potential strategy to prevent obesity in future generations.

Nutrient Intake according to Weight Gain during Pregnancy, Job Status, and Household Income

The objective of this study was to investigate the association of nutrient intake and pregnancy outcome mediated by weight gain during pregnancy, job status, and household income. Maternal age, educational level, self-reported pre-pregnancy weights, educational level, and household income were collected from the women at 2 months postpartum. For each offspring, weight at birth, length at birth, and gestational age were collected. Participants were asked to report the frequency of consumption of foods between 28–42 weeks into the pregnancy. Diet was assessed by using a validated 106-item semi-quantitative food-frequency questionnaire (SQFFQ) and women were asked portions and quantities based on pictures, food models, and measuring tools such as cups or teaspoons. Results showed that women who gained below the recommended weight gain during pregnancy, within, and over were 25.3%, 38.7%, 36.0%, respectively. In comparison to weight gain and the offspring's length and weight at birth, the offspring of mothers with a lower weight gain had a higher length. Energy, protein, vitamin B₂, vitamin C, calcium, and potassium were significantly lower at employed group. We did not observe a significant difference between birth characteristics and maternal nutrient intake by income. Infants with a higher ponderal index at birth were born to women with a higher pre-pregnancy body mass index (BMI).